[Grace]

Reflection activity: Thinking of your current or a past workplace provide specific examples of each hierarchy of control – see Appendix B.

[Sara]

remove the hazard: the regulation, control, and removal of by-products and wastes in the body
replace the hazard
Engineering controls, when feasible, are considered the first line of defence for avoiding exposure to bloodborne pathogens. Examples of engineering controls are safe needle devices or lab equipment like sealed centrifuge rotors. Isolate people from the hazard
Administrative controls – Change the way people work
Personal protective equipment– Protect the worker with PPE, this the last line of protection

[Brianne]

Elimination- Removing the hazard, so removing broken equipment
Substitution- when doing blood draws, having the needle retract
Engineering Controls- Sharps containers
Administrative Controls- policies, training, active screening
PPE- Gloves, gown, goggles

[Sarah]

As we all have similar responses to the hierarchy, and hope to have all the required materials and education to do our job. And also be able to reinforce the rules and regulations to follow the hierarchy.

[Rahmatu]

Hi Brianne,

Yes, I agree that sharp containers are very good engineering controls for infection control. Although, I find that in some facilities, staff use it as a container for disposing medications, and this is usually listed by pharmacy as one of the options in which narcotics can be wasted.

[Sherri]

Elimination – This involves removing the hazard altogether-this is difficult but there was tons of equipment and furniture removed from healthcare settings if they were not able to be completely disinfected
Substitution – Replacing the hazard could be disposable equipment such as disposable stethoscopes and thermometers
Engineering – reduces the hazard from reaching people -using blunt end needles, plexiglass barriers, retractable needles,
Administrative – policies and procedures – educating everyone on the IPAC rules, screening,
PPE – ensuring supplies are always available of gloves, gowns, googles, masks

[Pallavi]

Hi Sherri,

You have provided some good examples on the hierarchy of control. I agree that even though elimination is the most effective one however, it might not be always feasible to adopt this hierarchy especially in health care settings. Substituting traditional equipment with disposable ones is a great method and many care settings have implemented this control method to reduce the chain of transmission. Further to your engineering control examples, installing HEPA filtration system is also one of the great methods to remove airborne particles and reduce risk of airborne transmission such as COVID 19.
Hence, utilization of various hierarchy of control to mitigate the risk of infection transmission and hence promote the safety and wellbeing of staff/ patients should be a utmost priority in the organization.

[Sarah]

Elimination- removing hazards that are broken, like furniture and equipment used to support our patients.
Substitution- replace furniture that is old or broken and have the upholstery washable to prevent breakdown. Update and replace broken equipment with more durable pieces. Talk to staff about efficiency and economical supplies.
Engineering- have biohazard bins in every room and in nursing stations to reduce the risk of needle exposure and human error. Have retractable needs and gloves on at all times when handling biohazard material.
Administrative- have yearly education that is mandatory for all staff to ensure IPAC practices are being met and ensure staff understand the purpose behind infection control.
PPE- keep a stock pile of PPE available for staff at all times and make sure staff are aware of the location of supplies. Provide accommodation to supplies that may cause allergy reactions to gloves or masks.

[Robin]

Very good examples. I see a lot of this in the hospital I work for.

[Lourdine]

Administrative Controls
  Inforce a mandatory training program for all employees on proper lifting techniques. **Personal Protective Equipment (PPE)
Example: providing workers on a construction site with personal protective equipment such as hard hats, safety goggles, and hearing protection to mitigate risks associated with falling objects, dust, and noise.

[Pallavi]

Here are some examples on hierarchy of control pertaining to health care facilities:

Elimination: eliminating broken/old equipment, eliminating non-urgent procedure such as elective surgery during the outbreak period
Substitution: Substituting traditional gown with disposable gown, substituting harsh chemical agents with environment friendly cleaning agents, substituting needles with retractable/ safety glide ones
Engineering Controls: installing hands free automatic hand sanitizer, sharp containers, HEPA filtration system
Administrative Controls: establishing policies/ procedures on IPAC measures, regular audits, staff education and training
PPE: Masks, gowns, eye goggles

[Author]

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