[Sharon]

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

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[Marilyn]

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[Jelyn]

At my work, if there is an outbreak, either respiratory, or gastro , staffs are only allowed to work in the same floor until the outbreak is over, separate elevator and entrance is provided. There’s certain time of picking up laundries and garbage. 1 to2 symptoms will requires nasal swab/PCR. 3people that are symptomatic the floor will declare as outbreak floor.

[Catherine]

Sounds like your work has good policies in place to prevent the spread of infection. Glad to see this.

[Catherine]

Elimination: if there is broken/malfunctioning equipment it is put on lock out until replaced or repaired thus taking away the possibility of injury.

Substitutions: dietary substitutions are used in our LTC Home to prevent possible gastric issues/allergic reactions For example, we offer gluten free options and lactose free options to residents who have food allergies.

Engineering controls: residents are isolated from other residents (in their rooms) when they are ill with a contagious agent. They have separate PPE at their room, with separate laundry collection and garbage containers.

Administrative controls: We have huddled meetings almost daily at work. During these meetings we are educated and informed of any new policies and procedures as well as any infectious residents/outbreaks.

PPE: At our home, there is gloves, gowns, masks, and other required PPE available at all times if needed. Hand sanitizer is available in the halls outside resident rooms, as well at the entry/exit point of each room. Gloves are at regular points in the halls, as well in each resident washroom.

[Catherine]

Sounds like your work has very good policies in place to minimize the spread of infection. Glad to see they take these precautions.

[Josephine]

The examples you provide are well thought through. Working in a facility that implements these measures follows the hierarchy of controls, which leads to implementing a safer workplace.

[Patrice]

Elimination: In the Long-term Care setting, to eliminate the fall risk of residents, the facility removed bed rails which are considered safety hazards; beds are kept in the lowest position, which makes it difficult for residents to climb out of their beds.

Substitution: Healthcare workers are required to use mechanical lifts instead of manually lifting residents who are dependent to prevent the risk of musculoskeletal injuries.

Engineering Controls: Hand sanitizer dispensers are installed at the entrance of the facility, in the hallways, and in various locations throughout the facility to encourage regular hand hygiene among residents, staff, and visitors.

Administrative Controls: Proper shift scheduling was implemented to limit the number of repeated hours a healthcare worker can work to reduce the risk of exhaustion, burnout, and injuries.

Personal Protective Equipment: It is a requirement for healthcare workers to wear gloves, masks, gowns, or any other personal protective equipment based on the need, to prevent the spread of infections.

[Carmen]

Your facility’s approach to risk management prioritizes resident and staff safety. They take a comprehensive approach to maintain their commitment to health and safety. I appreciate how they take the time to prioritize staff well-being because being overworked can lead to stress and burnout, making individuals more susceptible to infections.

[Brittany]

I really enjoyed your description of fall prevention. Falls in long term care often lead to a decline. Your elimination and engineering solutions sound very effective.

[Carmen]

Elimination: To reduce infection transmission, the clinic eliminates the use of shared therapy tools. Instead, they assign dedicated equipment to each patient.

Substitution: Substitute in-person group therapy with virtual sessions especially during the pandemic. This reduces the need for patients to gather in one physical location, minimizing the risk of infection spread.

Engineering Controls: Having transparent barriers at the reception desk and using sharps containers in the aftercare injection rooms.

Administrative Controls: Having scheduled appointments to avoid overcrowding in waiting rooms, enforce mask wearing for patients and staff, and requiring staff to take annual refresher courses on PPE (doning/doffing) and infection control & prevention.

PPE: The organization ensures that staff have access to appropriate PPE depending on the nature of their interactions with patients and request that patients wear masks or face coverings during their entire visit.

[Antoinette]

Hi Carmen,

Thanks for your post. As I completed this post and I read through others, it made me think about the situations at the beginning of the pandemic. I feel like many aspects of the hierarchy of control was “forgotten” such as extreme rationing of N95 masks. Additionally, poor staffing resulted in nurses picking up extra work load, which meant either more shifts of more tasks within their shit resulting in decline in mental and increase in burnout. It is interesting to see how some of these controls are not prioritized based on what kinds of pressures are applied to the system.

[Babita]

Babita-member
In my previous roles in emergency and in family practice, it was the responsibility of all health care providers to monitor, initiate and implement action to eliminate, reduce the spread and Inform others of potential risk.
Although, there was IPAC in the hospital, front line workers can identify the risk sooner. Using the 5 hierarchy of controls can prevent outbreaks.

[Josephine]

ELIMINATION: In my Facility, a malfunctioning mechanical lift is being labeled and replaced for transferring residents who are total and require two-person assistance.

SUBSTITUTION: Residents at high risk for falls are given a floor mat to be placed in front of their bed; if the resident is independent or extensive, a bed alarm is added to prevent falls.

ENGINEERING CONTROLS: Staff are advised to use an electrical razor to shave residents instead of a manual razor to reduce irritation, close shave, and facial injuries and bruises.

ADMINISTRATIVE CONTROLS: Extra staff is placed on the unit to assist in reducing fatigue and injuries other staff may endure during the shift.

PPE: Staff must wear the proper PPE upon entering the resident’s room who is infected with a disease or for precautionary measures.

[Antoinette]

Elimination: All poorly functioning equipment such as hospital beds, sit to stand lifts and portable mechanical lifts need to be set-aside and labelled for biomed. So that they can be fixed or replaced.

Substitution: In my facility and many other hospitals, latex free gloves have replaced latex gloves to eliminate staff experiencing latex skin reactions.

Engineering Controls: When getting total patient’s out of bed, staff can use a ceiling lift that is electrically powered to help get the patient out of bed. This reduces the heavy lifting that nurses have to perform.

Administrative Controls: When patients have some sort of respiratory infection, such as covid-19, we are encouraged to “cluster care.” Clustering care limits the amount of face to face interaction between the nurse and the patient thus limiting the likelihood of the nurse becoming infected. This would mean clustering vital signs, medications and perhaps setting up for breakfast all at the same time. Rather than going in three separate times to complete each task.

PPE: Staff are encouraged to wear PPE if a patient begins to show any new infectious symptoms such as a new cough or PPE. It is no longer expected that you wait for a positive test such as a respiratory panel or c.diff swab.

[Patrice]

Hi Josephine,
Those are great approaches to prevent the spread of infection. Opting for electric ceiling lifts to assist with transfers is a decision as it helps alleviate the burden, on nurses. Additionally transitioning to latex gloves is an alternative to mitigate any potential skin reactions, among staff members.

[Brittany]

Brittany – infected pressure injuries
Elimination -prevent pressure injuries
Substitution- when repositioning is not guaranteed to prevent we will get an order for repositioning Q30m as a substitution for the hospital standard Q2H.
Engineering controls- using mech lifts and wheelchairs/Geri chairs, off loading wedges to help circulation.
Administrative-order a wound care consult at first site in order to get the proper medicated treatment as a standing order. (Inadine,betadine, hydrofera blue) perform head to toe assessments and keep injuries clean and dry with mepilex and regular brief checks.
Ppe-clean gloves. Mepilex

[Ashly]

Ashly
I work in the emergency department so we see everything and it the start of the process where it all begins

Eliminiation = We want to eliminate any air born respiratory viruses
Substitution : As soon as we suspect any patient that requires isolation we immediately put the order in meditect and we immediately begin to use PPE

Engineering controls: Isolate Patient that have any symptoms that could infect all other patients
Administrative control: We use alternative methods to keep us from going in and out of the room. We bring in everything that we need and we disinfected allot more when we use equipment in the isolation room
PPE : Gloves, eye protection, mark, gowns and face shields

[Nkechi]

Hello Brittany,

your hierarchy, Elimination -preventing pressure injuries -is essential especially with the older patients, palliative care, and people unable to move independently. this will help with repositioning to prevent pressure sores and promote blood circulation.

[Nkechi]

Nkechi

Elimination:
Example: In a hospital, the elimination of certain hazardous procedures that pose unnecessary risks to healthcare workers can be considered. For instance, transitioning to non-invasive diagnostic methods when possible to eliminate the need for invasive procedures.

Substitution:
Example: Substituting harsh chemical disinfectants with safer alternatives in patient care areas to reduce the risk of exposure and respiratory issues among healthcare staff.

Engineering Controls:
Example: Installing high-efficiency particulate air (HEPA) filtration systems in airborne infection isolation rooms (AIIRs) to control the spread of airborne pathogens and protect both patients and healthcare providers.

Administrative Controls:
Example: Implementing strict protocols for handling hazardous medications, including designated storage areas, specific handling procedures, and mandatory training sessions to minimize the risk of exposure to healthcare workers.

PPE (Personal Protective Equipment):
Example: Providing healthcare workers with appropriate PPE, such as gloves, masks, and gowns, when dealing with infectious patients to protect against the transmission of diseases through contact or airborne routes.

[Ayotunde]

Hi Nkechi,
You gave an explicit explanation of the above subject, this can be used to explain in detail to anyone who needs the subject broken down into bits and pieces.

[Ayotunde]

Elimination: Removing the hazard entirely is the most effective control measure because it eradicates the risk. For example, destroying infectious agents by breaking the chains of infection.

Substitution: Replacing the hazard with something less hazardous.
For example, using med patches to substitute for injections.

Engineering controls: These involve isolating people from hazards.
For example , placing barriers between healthcare workers and residents .

Administrative controls: These are procedures that change the way people work.
For example, Training and screening of staff.

Protective Personal Equipment; Providing protective wear to workers to reduce exposure and transmission to hazards.
For example, gowns, face and eye protection, gloves, masks and show covers can help protect workers even though it is the least effective because it rely on the individual to use them correctly.

[Olusola]

You are right Ayotunde, if pathogens can be eliminated and avoided in the first place, other steps will be much easier or completely unnecessary. I think authorities should do more on better providing elimination strategies.

[Olusola]

Elimination: There was a dedicated team whose main function is to make sure all regularly used equipment and frequently touched surfaces are sanitized/sterilized appropriately.

Substitution: An example of this used in my facility would be the infrared thermometer used in place of other types which allows measurements to be taken without touching the client directly and as such limiting pathogens that can be transmitted by the device.

Engineering controls: The management of the facility put in place processes to facilitate appropriate donning and doffing of PPE. This includes a temporary makeshift room at the entrance of any occupied isolation room alongside visual cues and directions.

Administrative controls: There is a dedicated team in the IPAC unit whose main duties include screening of visitors and staff while also monitoring and ensuring staff compliance to safe practices.

PPE: PPE like gloves, facial masks and shields, gowns etc. are made available and easily accessible at every focal point in the facility like room entrances, hallways, resident’s washroom and anywhere appropriate.

[Author]

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