[Grace]

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

[Bunmi]

At my current workplace, the following examples illustrate the application of the Hierarchy of Controls in infection prevention and control:
1. Elimination which the most effective
During the COVID-19 outbreak, non-essential visitors were restricted from entering the facility. This measure effectively removed a potential source of infection, helping to safeguard residents and staff.
2. Substitution
To enhance hand hygiene compliance, alcohol-based hand rub (ABHR) was used instead of soap and water when hands were not visibly soiled. This substitution helped minimize the transmission of pathogens by making hand hygiene quicker and more accessible.
3. Engineering Controls
Physical barriers, such as plexiglass, were installed at nursing stations and between residents in shared rooms. These modifications helped reduce the risk of droplet transmission during outbreaks.
4. Administrative Controls
Administrative strategies included staff training on proper PPE use, regular hand hygiene audits, clear signage for isolation precautions, and the development of resident cohorting plans to manage infectious cases effectively.
5. Personal Protective Equipment (PPE) (Least Effective – but Essential)
Staff used appropriate PPE—including gloves, gowns, masks, and face shields—when caring for residents on isolation or during outbreaks. Proper training on how to don and doff PPE was emphasized to reduce the risk of cross-contamination.

[Shanna]

Hello Bunmi,
Thank you for sharing these clear examples from your workplace. It shows how important each step in the Hierarchy of Controls is to prevent infection. Restricting visitors during COVID-19 was a smart way to remove risk. Using alcohol-based hand rub made hand hygiene easier and faster. Installing barriers helped protect both staff and residents. Training staff and having clear signs made sure everyone followed safety rules. And using PPE correctly kept staff safe when caring for sick residents. Great summary!

[Samoya]

Hierarchy of Controls- Workplace Application in the Hospital

To reduce the transmission of bloodborne pathogens, the hospital initiated interventions on each level of the hierarchy of control:

Elimination: The hospital eliminated the need for recapping needles by implementing retractable syringes, which automatically withdraw the needle into the barrel after use. This removed one of the most dangerous steps in sharps handling and significantly reduced the risk of accidental injuries.

Substitution: For blood draws, the hospital substituted standard leur-lock blood collection needles with butterfly needles that feature an automatic retraction mechanism, activated by pressing a small lever on top. This substitution reduced the risk of needlestick injuries by using a safer, more controlled device during venipuncture.

Engineering Controls: Sharps containers were installed at every point of care to allow for immediate, safe disposal of used needles.

Administrative Controls: All healthcare staff completed mandatory annual training on sharps safety, which included a strict “no recapping” policy. Staff were also required to report any needle-stick injuries immediately. The hospital tracked incidents to identify patterns and implement targeted interventions. In addition, all staff complete mandatory pre-placement health assessments where vaccines such as Hepatitis B are recommended to reduce the risk of occupational exposure to infectious diseases.

Personal Protective Equipment (PPE): Gloves were worn during all procedures involving sharps. While they don’t prevent puncture wounds, they provide a layer of protection against blood exposure in the event of a needle-stick injury.

[Gemma]

Samoya,
I appreciated your explanations of the hierarchy of controls, specifically addressing retractable needles as both an elimination and substitution tactic. Needle-stick injuries are often avoidable when utilizing these safer alternatives. Your point highlights how important it is for facilities to invest in safety-engineered devices and ensure proper staff training. When combined with administrative controls and consistent use of personal protective equipment, the risk of injury can be significantly reduced.

[Shanna]

Hierarchy of Controls Examples in a Retirement Home During COVID-19

1.Elimination
-Cancel group activities and social gatherings to stop the virus from spreading.
-Screen everyone (staff, visitors, residents) for symptoms before entering the building.

2.Substitution
-Replace in-person visits with video calls or phone calls to keep residents connected but safe.
-Use cleaning products that kill the coronavirus but are safe for frequent use.

3.Engineering Controls
-Improve air flow by opening windows or using air purifiers with HEPA filters.
-Install clear plastic barriers at reception desks and dining tables to reduce close contact.
-Create isolation rooms for residents who test positive to stop spreading the virus.

4.Administrative Controls
-Train staff on proper hand hygiene, mask-wearing, and how to use PPE correctly.
-Limit the number of visitors and schedule visiting hours to avoid crowding.
-Implement daily symptom checks and COVID testing for staff and residents.
-Use signage and reminders to encourage physical distancing and hygiene.

5.Personal Protective Equipment (PPE)
-Staff must wear masks, gloves, gowns, and eye protection when caring for residents, especially if they are suspected or confirmed COVID cases.
-Provide residents with masks when they leave their rooms or interact with others.

[Ivy]

Thank you for sharing. During the COVID-19 pandemic, I believe every healthcare worker learned and understood the importance of the hierarchy of controls to slow and stop the spread of illnesses. I did not pay too much attention until COVID about little things that can make a difference in ensuring the safety of self and others. Understanding this hierarchy of controls, especially for nurses, is essential in promoting the safety of everyone.

[Priscilla]

Hierarchy of Controls in CTO LTC where I did my clinical placement. Whenever there is an outbreak, the facility:

Elimination: Exclude symptomatic staff from entering the facility. Cohorting residents to prevent cross-infection and limiting non-essential visitors during outbreaks.

Substitution: Switching to less harmful disinfectants for staff or residents sensitivities.

Engineering Controls: Ventilation systems such as using HEPA filters to improve airflow. Hand hygiene stations placed at entrances, hallways and isolation rooms. In addition, apply negative pressure rooms, if available for isolation.

Administrative Controls: Infection prevention training for staff such us donning/doffing PPE & hand hygiene. Routine testing during outbreaks. Clear signage for precautions such as contact/droplet/airborne signage on doors. Visitor education and control during outbreaks.

PPE: use of appropriate PPE for various job tasks and hazards. PPE is important but relies on correct and consistent use.

[Mebo]

The hierachy of control I have experience working in LTC facilitty
Elimination- physically removing the hazard- Resident positive with TB isolated to privated room

Substitution-replacing harzard with a safer alternative- I have seen replacement of manual lifting of residents with the use of ceiling lifts devices during transfers to resduce musculoskeletal injuries.

Engineering Control-isolating residents from hazards the hazards for example having rooms with negative pressure available for residents during airborne infections outbreak.

Administration Control- Implementing a staff vaccination policy- At work we have annual flu shot for staff and residents

PPE- Using N95 respirators when caring for patients with TB

[Gurdeep]

Hierarchy of control at my long term care facility to prevent covid spread.

Elimination- Prohibited staff crossing on different floors to prevent cross contamination.
substitution- released staff for 5 day off the facility with symptom of covid.
Engineering control- Assigned patient to contact and droplet precaution to prevent spread of infection.
Administration control- screened staff and available of self examination kits.
PPE- PPE kits hanged on the door of active resident.

[Diana Ampate]

Reflection on the Hierarchy of Controls in the Workplace

The hierarchy of controls provides a structured approach to minimizing or eliminating hazards in the workplace, especially relevant in health care settings to prevent infection transmission. Reflecting on my current/past workplace, I can identify specific examples for each level of the hierarchy:
Elimination:
Although completely removing a hazard in health care can be challenging, an example would be implementing telehealth appointments when possible to eliminate face-to-face exposure to contagious patients.
Substitution:
Replacing multi-use equipment with single-use disposable items, such as single-use blood glucose meters or disposable patient care supplies, helps reduce cross-contamination risks.
Engineering Controls:
Physical barriers like plexiglass shields at reception desks, negative pressure isolation rooms, and hands-free sinks are engineering controls that help reduce pathogen transmission without relying on staff behaviour.
Administrative Controls:
Clear policies such as visitor restrictions during outbreaks, mandatory IPAC training for staff, and scheduled cleaning protocols are administrative controls that guide behaviour to reduce risk.
Personal Protective Equipment (PPE):
Use of gloves, gowns, masks, and eye protection during patient care, especially when contact or droplet precautions are required, is the last line of defence to protect healthcare workers.
Integrating all these levels of controls, my workplace creates multiple layers of protection, recognizing that no single intervention is completely effective alone. Understanding and applying the hierarchy of controls promotes a safer environment for both patients and healthcare providers.

[Anthonia]

In the hospital where I worked, elimination was practiced by screening patients and visitors for symptoms at the entrance and restricting access to those with infectious symptoms. Substitution was seen when the hospital switched from a harsh chemical disinfectant to a safer, hospital-grade cleaning product to protect both staff and patients. Engineering controls included using negative pressure rooms for patients with airborne infections and installing plexiglass barriers at nursing stations. Administrative controls were applied through regular staff training on infection prevention, clear signage on isolation protocols, and policies promoting vaccination. Finally, PPE was a key frontline measure, with staff wearing gloves, gowns, masks, and face shields when providing care to protect themselves and prevent the spread of infection.

[Gemma]

Hierarchy of controls in long-term care

Elimination:
Mandating all sick employees stay home from work

Substitution:
During an outbreak, switch from normal cutely and serve ware to single use paper plates, cups, utensils and dispose of after use.

Engineering Controls:
Isolate sick residents to their room, at the direction of public health isolate their roommate as well if needed.

Administrative Controls:
Infection control signage placed outside of rooms, limiting to essential caregivers only, mandating staff and visitors wear masks at all times. Housekeeping to clean rooms more thoroughly with appropriate cleaning products to kill the infective agent.

Personal Protective Equipment (PPE):
Staff and visitors to wear appropriate PPE when entering rooms of sick residents. Providing PPE right outside rooms

[Carolina]

Hi Gemma,
Thank you for sharing. Implementing of Hierarchy of Controls in a LTC must be difficult;especially, when it is about to isolate residents, but it is imperative to give them an adequate care.

[Shiyu]

Hi Gemma,

Thank you very much for your post. A small change, such as using disposable utensils, can really make a big difference. Infection prevention and control is not only about PPE, it also involves polices and practical changes.

[Bolatito Esther]

Hierarchy of controls in a long-term care facility on recent Respiratory syncytial virus RSV)

Elimination: Effected resident rooms thoroughly deep-cleaned by housekeeping. Alcohol base sanitizer used.

Substitution: Food room services provided with disposable utensils, a personal sling for transfer, and a vitals machine kept in residents’ rooms.

Engineering Controls: Affected resident isolated in their rooms

Administrative Controls: Cohort staff provided to care for residents. Active screening for staff and visitors.

Personal Protective Equipment (PPE): Contact precautions signs are placed on each resident’s door
Family members and staff were advised to wear masks.

[Bolatito Esther]

Hi Shana,
COVID-19 is one of the traumatic experiences in the long-term care facilities in the past years , and hierarchy of control is the key of survival.

[Carolina]

Home-Visit : Examples of Hierarchy of Controls: influenza A infection
1. Elimination
Example: Switching routine, provide telehealth instead of in-person visits to stable clients. Eliminating exposure risk. It removes the hazard (no face-to-face contact, no transmission).
2. Substitution
Example: using metered-dose inhalers (MDIs) with spacers instead of nebulizers for respiratory patients. Reducing aerosol generation and lowers infection risk.
3. Engineering Controls
Examples: Limiting exposure, encouraging opening a window or door to improve ventilation and dilute virus particles in the air.
4. Administrative Controls
Examples: Conducting pre-visit symptom screening: nurse calls in advance to check for fever, cough, or recent exposure. Performing a Point-of-Care Risk Assessment (PCRA) upon arrival to decide what precautions to take. Scheduling visits to influenza-positive patients at the end of the day to reduce cross-contamination risk. Providing patient and caregiver education on respiratory hygiene, cough etiquette, and the importance of isolation. Ensuring nurses have influenza vaccination, training in PPE use, reporting sick policies, and adherence to workplace illness protocols.
5. Personal Protective Equipment (PPE)
Examples: Nurse wears surgical mask (for droplet protection), eye protection, gown, and gloves when within 2 meters of the patient. Nurse uses a fit-tested N95 respirator. Following strict donning/doffing protocols, dispose or sanitize PPE between visits, and perform hand hygiene.

[Fatma]

Hi Carolina,
Thank you for sharing these practical examples of the Hierarchy of Controls for Influenza A during Home Visits. This is an excellent reminder of how layered infection prevention strategies work together to reduce risk. Your points on administrative controls and PPE highlight the critical role of thorough planning, screening, and correct protective equipment use. It’s important that we all continue to apply these measures consistently, especially when caring for high-risk populations in the community setting.

[Juana]

Minimize risks of falls for patients and musculoskeletal injuries for staff during patient transfers.
Elimination: Physically remove the hazard. Removing clutter or unused equipment from hallways or patient rooms to prevent falls and improve mobility safety during ambulation or therapy.
Discontinuing unsafe or outdated mobility devices such as old wheelchairs with faulty brakes.

Substitution: Replace the hazard with a safer alternative.|
Instead of staff manually lifting or transferring patients such as high risk of staff back injury and patient falls, consistently use ceiling-mounted track lifts or mobile floor lifts for all high-dependency patient transfers. This substitutes a high-risk manual task with a lower-risk mechanical one.

Engineering Controls: Isolate people from the hazard or use physical changes to the workplace.
Installing bed alarms or chair alarms to alert staff when a high-fall-risk patient attempts to get up unassisted. Using grab bars and non-slip flooring in bathrooms and patient areas to prevent falls.

Administrative Controls: Change the way staff work (procedures, training, signage).
Providing ongoing training for safe transfers and stroke-specific care techniques such as managing hemiparesis, dysphagia. Regular and mandatory training for all staff (nurses, therapists) on proper body mechanics, use of lifting equipment, transfer techniques. Implementing a system of regular, scheduled patient rounds to proactively address patient needs (toileting, pain, repositioning) before they attempt to mobilize independently.

Personal Protective Equipment (PPE): Protect the individual with equipment.
Providing specific non-slip socks or shoes for patients, particularly during therapy sessions and when ambulating independently. Standard use of medical gloves by staff during direct patient contact (e.g., assisting with toileting, wound care) to protect against exposure to bodily fluids. (This is not directly related to falls or musculoskeletal injuries but it’s a common PPE in any health care setting).

[Juana]

This is an excellent application of the Hierarchy of Controls to home visits for influenza A. Your examples clearly illustrate each level, especially how elimination through telehealth directly removes the hazard. The idea of substitution with MDIs and spacers is also very insightful, showing procedural risk reduction. You’ve provided practical engineering controls like ventilation and a comprehensive list of administrative controls that are vital for proactive risk management. Your emphasis on proper PPE use as an essential last line of defense ties it all together perfectly. Overall, it’s a great demonstration of how these controls aren’t static but require continuous assessment and adaptation, especially in dynamic environments like home healthcare.

[Fatma]

In the oncology unit, where patients are highly vulnerable to infections, it is essential to understand and apply the Hierarchy of Control Measures to reduce the risk of infectious agent exposure. The most effective control is Elimination, such as excluding sick staff from patient care, followed by Substitution, like choosing less invasive procedures when possible. Engineering Controls come next, using negative-pressure rooms, ventilation systems, or safety-engineered devices to isolate hazards. Administrative Controls include enforcing hand hygiene, infection control training, staff vaccination, and patient screening protocols. The last line of defense is Personal Protective Equipment (PPE)—such as gloves, gowns, and masks—which is critical but less reliable due to dependence on consistent and correct usage. Focusing on higher-level controls whenever possible provides stronger protection for both staff and patients, reinforcing our shared responsibility for infection prevention in oncology care.

[Aleksandra]

Thank you for your post—it clearly explains how the Hierarchy of Control Measures helps protect patients and staff in an oncology unit. I agree that using higher-level controls, like elimination and engineering controls, is the most effective way to reduce infection risk, especially for patients with weak immune systems.

Excluding sick staff from work is a great example of elimination. It’s a simple but powerful step that can stop infections before they enter the unit. Substituting with less invasive procedures when possible also helps lower the risk of infection for patients who may not recover easily from complications.

I also liked your point about engineering controls, like proper ventilation and safety devices. These changes to the environment help control infection without relying on human behavior, which makes them very effective.

Administrative controls like hand hygiene, training, and screening are key to keeping everyone alert and prepared. They help build a strong IPAC culture. And while PPE is important, it should always be used along with the other controls, not as the only protection.

Overall, your post is a strong reminder that in high-risk areas like oncology, every layer of the hierarchy matters. We all have a part in preventing infections, and using these controls the right way helps keep both patients and staff safe. Great job!

[Nel]

A sharps injury prevention program should apply the hierarchy of
Controls.,
1. Elimination – Can be challenging to completely eliminate needles as these are necessary in certain procedures (surgery, medication preparation, medication administration).
2. Engineering Controls – Implement safety-engineered sharps disposal containers
and devices with built-in injury prevention features. Tools such as forceps can be used
to handle needles and scalpels, minimizing direct contact. Careful selection is
necessary since no single device or strategy is universally effective.
3. Substitution – Use safety-engineered devices, such as retractable needles or blunt
suture needles, to replace traditional ones.
4. Administrative Controls – Establish safe work practices through education,
training, policies, and signage. Examples include avoiding hand-to-hand passing of
sharps, segregating sharps from other waste, and handling garbage or linen bags away
from the body.
5. Personal Protective Equipment (PPE) – PPE should be a last resort where other
controls are impractical. Examples include puncture- and cut-resistant gloves,
particularly for waste disposal tasks.

[Juana]

Minimize risks of falls for patients and musculoskeletal injuries for staff during patient transfers.
Elimination: Physically remove the hazard. Removing clutter or unused equipment from hallways or patient rooms to prevent falls and improve mobility safety during ambulation or therapy.
Discontinuing unsafe or outdated mobility devices such as old wheelchairs with faulty brakes.

Substitution: Replace the hazard with a safer alternative.|
Instead of staff manually lifting or transferring patients such as high risk of staff back injury and patient falls, consistently use ceiling-mounted track lifts or mobile floor lifts for all high-dependency patient transfers. This substitutes a high-risk manual task with a lower-risk mechanical one.

Engineering Controls: Isolate people from the hazard or use physical changes to the workplace.
Installing bed alarms or chair alarms to alert staff when a high-fall-risk patient attempts to get up unassisted. Using grab bars and non-slip flooring in bathrooms and patient areas to prevent falls.

Administrative Controls: Change the way staff work (procedures, training, signage).
Providing ongoing training for safe transfers and stroke-specific care techniques such as managing hemiparesis, dysphagia. Regular and mandatory training for all staff (nurses, therapists) on proper body mechanics, use of lifting equipment, transfer techniques. Implementing a system of regular, scheduled patient rounds to proactively address patient needs (toileting, pain, repositioning) before they attempt to mobilize independently.

Personal Protective Equipment (PPE): Protect the individual with equipment.
Providing specific non-slip socks or shoes for patients, particularly during therapy sessions and when ambulating independently. Standard use of medical gloves by staff during direct patient contact (e.g., assisting with toileting, wound care) to protect against exposure to bodily fluids. (This is not directly related to falls or musculoskeletal injuries but it’s a common PPE in any health care setting).

[Mae Anne Zyrene]

Thank you for sharing your experience! This is an excellent example of applying the Hierarchy of Controls to reduce patient falls and musculoskeletal injuries among healthcare staff. It begins with Elimination, removing hazards like clutter or outdated equipment that pose tripping or mobility risks. Substitution is effectively used by replacing manual patient lifts—a high-risk activity—with ceiling-mounted or mobile floor lifts, significantly lowering injury risk. Engineering controls such as grab bars, non-slip flooring, and bed or chair alarms help isolate people from hazards by modifying the environment. Administrative controls reinforce these measures through consistent staff training, proper transfer techniques, and proactive rounding to address patient needs before they attempt unsafe movement. Although PPE is the least effective control, the use of non-slip footwear for patients and gloves for staff adds another layer of safety and hygiene. Overall, this example demonstrates a comprehensive and layered approach that prioritizes both patient and staff safety by systematically addressing risk at every level. This is such a great insight!

[Mae Anne Zyrene]

My experience of Hierarchy of controls at the LTC I worked at as a PSW before and as a nurse now regarding COVID-19:
Elimination: Reducing or limiting the amount of visitor allowed to visit per resident during an outbreak, reducing the time spent in common places to lessen the possibility of transmission, and providing meals in the rooms instead of going into the dining room.
This reduces the amount of people that could possibly get transmitted to and lessens the impact of COVID-19 at the time.

Substitution: We switched from regular cutlery to disposable ones to eliminate the possibility of contamination, instead of the normal routine for PSWs, we had one person assigned for the positive cases and the rest cares for the non-positive cases to reduce the possibility of transmission.
This easily reduces the possibility of transmission as there are less contact with bodily fluids from the cutlery and dishes as meals are a big part of LTC routines. Having one person in charge, reduces the risk of transmission to multiple people at once and ensures proper knowledge and continuity with the care provided and safety.

Engineering Controls: Air purifiers that have HEPA filters are placed throughout the facility to promote and effectively clean the air and have ventilation, and we put up more alcohol-based hand sanitizers outside each room and inside the rooms to encourage and have an easy access for staff to do their hand-hygiene in between residents. The facility put up a station before coming into the facility where you have to test yourself with the RAT test for proof of a negative COVID-19 test.

Administrative controls: Posted signs regarding the status of the resident are put up on their doors as well as the proper PPE to be worn are indicated as well. Before being allowed in the facility, proof of a negative RAT test is needed before being allowed into the facility. Frequent rounds of the IPAC manager on the floor to guide the staff about the PPE use and to make sure everyone follows the guidelines indicated.

PPE: Use of PPE is strictly followed and initiated by the registered nursing staff as well as the IPAC manager. Posted signage instructing staff how to don and doff the PPE needed for each room.

[Aleksandra]

Working in long-term care, I’ve seen firsthand how each level of the Hierarchy of Controls plays a part in preventing infections and protecting both residents and staff.

Elimination was applied during influenza season when a symptomatic volunteer was asked to stay home until they were cleared by Public Health. Removing the source of infection is the most effective control.

Substitution occurred when we replaced reusable cloth curtains with disposable privacy curtains in isolation rooms. This reduced the chance of fabric holding onto germs and spreading them between residents.

Engineering controls included setting up touchless hand sanitizer stations throughout the home, especially at entrances, dining rooms, and nursing stations. These changes made it easier for staff and visitors to perform hand hygiene without touching a dispenser.

Administrative controls are heavily used in our home. For example, staff are assigned to work on specific units during outbreaks (cohorting) to limit movement and reduce the chance of spreading infections between floors. We also perform regular IPAC audits and provide refresher training during staff meetings.

Personal Protective Equipment (PPE) is always used when caring for residents on precautions. During a recent outbreak, staff wore masks and face shields at all times, with gowns and gloves when entering isolation rooms.

This layered approach works best when all parts of the hierarchy are used together. While PPE is necessary, relying on it alone is not enough. Strong prevention starts higher up the chain.

[Mintesinot]

Reflection Activity: Hierarchy of Control in the Workplace
In my previous job at a long-term care facility, I learned how to apply the Hierarchy of Control to prevent infections and maintain the safety of both residents and staff. Here are some easy examples for each level:
Elimination
To reduce the risk of cross-contamination, shared equipment such as thermometers and blood pressure cuffs have been eliminated from common areas. Whenever possible, each resident is provided with dedicated equipment, effectively minimizing the potential transmission of pathogens.
Substitution
The facility changed from using regular cleaners to using strong disinfectants that work well against many types of germs. This change greatly reduced the chance of infections by making sure that surfaces were cleaned very well.
Engineering Controls
To combat the spread of respiratory droplets, transparent plexiglass barriers were strategically installed at nursing stations and throughout dining areas, creating a protective shield that offered both safety and reassurance. These gleaming panels served as a reminder of the commitment to health, allowing interaction while minimizing risk. Furthermore, each room was fitted with advanced HEPA filters, meticulously designed to purify the air, ensuring that the atmosphere remained crisp and clean, promoting a sense of well-being and tranquility within the space.
Administrative Controls
To keep everyone safe, they put in place strict rules to prevent infections. This included checking daily for any symptoms, limiting visitors, regularly training our staff, and having plans ready for any outbreaks. These steps made sure everyone knew about and followed the safety procedures.
Personal Protective Equipment (PPE)
Staff were mandated to wear gloves, gowns, surgical masks, and face shields while caring for residents, especially those with known infections or during outbreak situations. By employing these layered control measures, the facility effectively reduced the risk of infection and improved safety for both residents and healthcare workers. This experience highlighted the importance of utilizing a full range of infection control strategies, rather than depending solely on personal protective equipment (PPE), to achieve thorough infection prevention.

[Najmo]

Examples of the Hierarchy of Elimination in community work.
Elimination: By identifying that carrying large sharps disposal bins into clients’ homes increased manual handling risks and potential exposure to sharps injuries. The service modified its policy to provide clients with smaller personal sharps containers, thereby eliminating the need for nurses to transport them.
Substitution: Nurses previously used a skin disinfectant that caused skin irritation for some clients and staff. The product was substituted with a gentler, hypoallergenic antiseptic that was equally effective, reducing adverse reactions.
Engineering: To prevent needlestick injuries, the nursing service introduced safety-engineered devices, such as retractable needles and needleless IV systems. This created a physical barrier between the nurse and the hazard, reducing injury risk.
Administrative Control: The service introduced a lone worker protocol, including check-in/check-out procedures, scheduled welfare calls, and risk assessments before home visits. This changed how nurses planned and conducted visits, improving safety when working alone.
Personal Protective Equipment (PPE); Nurses are required to wear gloves, masks, and sometimes gowns when performing wound care or when visiting patients with infectious diseases. This protects both the nurse and the patient from cross-contamination.

[Earlnie]

Hi Najmo,

I really like how you tied each level of the hierarchy to practical changes in community care. The switch to smaller sharps containers under Elimination is a smart, proactive step that not only improves safety but also reduces manual handling strain. Your Substitution and Engineering examples clearly show how small product changes can make a big difference in reducing harm. Great examples!

[Earlnie]

Examples of each hierarchy of control in home care

Elimination: switching to telehealth visits for clients with contagious infections (i.e., flu, COVID-19), removing tripping hazards in the home

Substitution: substituting latex gloves for nitrile to prevent allergic reactions, substituting glass ampules with prefilled, plastic syringes to prevent breakage, cuts and incorrect medication dose

Engineering: using sharps disposal bins at the point of use to reduce needle-stick injuries, opening windows for ventilation

Administrative control: training caregivers on infection control, detailed care plans, regular risk assessments, self- and client screenings

PPE: non-slip shoes to prevent falls, wearing gloves, gowns, masks, face shields when caring for clients with infections or when dealing with bodily fluids

[Shiyu]

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

1. Elimination: From my previous clinical placement, I have seen that reusable bedpans have been replaced by disposable bedpans.

2. Substitution: By using the needles with built-in retractable mechanisms, the staff can greatly reduce the needlestick injuries.

3.Engineering Controls: At my previous placement, I have seen a patient with tuberculosis who was isolated and placed in the negative pressure room to protect other patients and staff.

4.Administrative Controls: All employees and nursing students are required to complete the mandatory training modules for infection prevention and control.

5.PPE: When caring for patients with known or suspected COVID-19, staff have to wear N95 masks.

[Kaitlynn]

Examples of the hierarchy of control during Covid-19 in LTC facility include:
Elimination: excluding sick visitors and staff from entering the facility – removes potential sources of infection.
Substitution: Switching oral thermometer to laser/scanner thermometer. Switching hand sanitizer to one with aloe/moisturiser in it to prevent skin breakdown in staff.
Engineering controls: Installing plexiglass barriers at reception and between waiting room chairs.
Administrative controls: Active screening, staff education and training on PPE use, visitor policies, electronic alert system/contact tracing.
PPE: Gloves, gowns, N95 masks, eye protection

[Ivy]

During the recent parainfluenza outbreak in my workplace, here is the hierarchy of control that was implemented and followed, from most to least effective.
1. Elimination
a. Transfer/remove an infected individual from shared space.
b. Cancel non-essential visits or appointments for infected individuals until they are no longer contagious.

2. Substitution – in parainfluenza, substitution is not applicable.

3. Engineering controls
a. Isolation of symptomatic residents
b. Adequate ventilation and air filtration

4. Administrative controls
a. Screening protocols for staff and visitors
b. Hand hygiene audits and signage
c. Infection prevention education for staff, residents, and families

5. Personal Protective Equipment
a. Gloves, surgical masks, gowns, and eye protection for staff interacting with infected individuals.
b. Face masks for symptomatic residents, if tolerated.
c. Hand sanitizer and gloves readily available throughout the facility.

[Yiqun]

Hi, Ping

Thank you for your sharing.

I agree with you that hierarchy of Control measures you mentioned when we working in the LTC settings. The most effective way of control would be elimination and substitution and least effective way would be PPE. I do believe when we facing residents who exhibit new onset of symptoms, we have to implement all methods to ensure infection agent were determined and care quality was not compromised.

[Samoya]

Hello Nwuli.
Thank you for sharing your post. Your explanation of the hierarchy of controls for a long-term care respiratory outbreak was informative. I have witnessed similar tactics employed to safeguard residents while attempting to meet their social and emotional needs, so I found your example of replacing group activities with in-room alternatives to be especially relatable. I appreciate how you highlighted the administrative controls used during the outbreak as administrative controls, are often overlooked but essential in stopping the spread of infection. Examples of these controls include staggered staff breaks and symptom screening. I was particularly impressed by the careful application of engineering controls, such as the isolation room’s distinct airflow and plexiglass barriers. All things considered, these environmental changes significantly improve safety as any of us have witnessed especially during the recent COVID-19 pandemic. Many supermarkets, restaurants and other businesses have adopted engineering controls such as plexiglass barriers since the COVID-19 pandemic. I’m interested to know if the limitations and heightened security caused any problems with resident or staff morale at your institution. If so, what tools or plans were implemented to help deal with that?

[Natieja]

These are amazing suggestion as my Home uses similar strategies in order to create a safe environment for residents staff and visitors . I especially like the part that you discussed staffing as I fine sometimes the building has a lot of people moving through it especially during outbreaks I also believe that limiting how many people are in the building at once can reduce the spread of infection.

[Mebo]

Thank you for sharing your contributions provided
Clear alignment with each level of control.
emphasizing the layered approach to infection prevention.
Appropriate use of healthcare-relevant examples (for example shared equipment, isolation protocols). Long term care experience infection outbreaks frequently and having a good understanding of the hierachy of controls is very crutial.

[Mintesinot]

Hi Helen,
Thank you for explaining how your long-term care facility prevents infections using different safety methods. Your examples help me understand how each step, from removing hazards to using personal protective gear, helps reduce the risk of germs.

I really like your focus on engineering controls, like clear barriers. These are often missed but work well to stop germs from spreading, especially in shared areas. Also, your idea of using stronger disinfectants is great. This keeps the place cleaner without needing to clean as often, which is important in busy places.

You’ve shown that no single method is enough by itself; instead, it’s the combination of all these steps that makes everyone safer. It’s great to see that your facility is using these measures in a practical way to protect both residents and staff.
Thank you for sharing these insights!

[Denise]

Thank you for your thoughtful post. I really appreciate how clearly you outlined each level of the hierarchy of control and applied it specifically to infection prevention in your long-term care facility. Your point about eliminating shared equipment like stethoscopes and thermometers really stood out to me. That is such a practical and impactful way to reduce cross-contamination, sometimes we overlook how the simplest changes, like removing shared tools, can make a big difference.
I also agree with your example of using transparent barriers as an engineering control. We implemented similar measures during COVID-19 in our facility, and it helped reduce the spread of respiratory droplets in common areas without isolating residents entirely. It is also great to see you emphasize administrative controls like symptom screening and hand hygiene; these are so crucial in environments where residents are particularly vulnerable.
Overall, your examples highlight how important it is to use a combination of controls rather than relying solely on PPE. When all five levels work together, the result is a much safer environment for everyone.

[Diana Ampate]

Thank you for sharing these clear and practical examples from your acute medicine unit! I especially appreciate how you highlighted sterilizing vital machines as an elimination strategy. It’s a great reminder that even routine cleaning can effectively remove hazards. Your example of using safety needles for substitution shows how small changes can prevent serious injuries. The engineering control with negative pressure rooms is a perfect way to protect patients and staff from airborne infections. I agree that administrative controls like ongoing hand hygiene training are essential to sustain good practices. And of course, your point about PPE being unavoidable but only compelling when used correctly really ties it all together. Your approach reflects a solid understanding of layering controls to create a safer environment.

[Anthonia]

I really love how you’ve captured practical, real-life examples for each level of the hierarchy of controls—it shows a deep understanding of how safety works on the floor, not just on paper. The idea of using censored lights and reducing room clutter to prevent falls is such a smart approach to elimination that directly impacts patient safety. Substituting latex gloves for non-latex and using disposables during outbreaks shows how small changes can make a big difference in reducing harm. The use of bed and chair alarms as engineering controls is a great reminder of how technology can support staff in keeping patients safe. I also appreciate your mention of team huddles—they’re often underestimated but play such a powerful role in keeping everyone on the same page. And of course, proper PPE signage and having enough supplies on hand is the final but crucial layer that helps protect everyone in the care environment. You’ve really painted a vivid picture of how all these pieces work together to create a safer hospital space!

[Kaitlynn]

Thanks for sharing! I really like how your care home used all levels of controls—from eliminating group activities to isolating residents and creating a dedicated care team. Switching to disposable wipes is a smart substitution to reduce cross-contamination. Having PPE stations right outside rooms is also a great way to ensure staff follow safety protocols. Your post shows how combining these controls helps keep everyone safer.

[Nel]

Hi Janecia,
Your post effectively outlines how the Hierarchy of Controls is applied in your facility to manage the spread of the influenza virus. It’s great to see a multi-layered approach that includes proactive environmental cleaning, thoughtful substitution during mealtimes, and strong administrative measures like clear signage to communicate outbreak protocols. The use of engineering controls, such as isolating symptomatic residents, is a critical step in minimizing transmission. Additionally, providing PPE caddies and instructional signage ensures staff are well-equipped and reminded to protect themselves and others. Overall, your facility demonstrates a comprehensive and practical infection control strategy.

[Author]

Posts