Hierarchy for Infection Prevention and Exposure Control Measures
Protecting yourself and others by reducing the transmission of communicable diseases in health care settings is a critical component of health care. There are a wide variety of measures that can be taken. These measures vary in their effectiveness and ability to protect, and they can be ranked and organized into a hierarchy on these bases. Those at the top of the hierarchy are more effective and protective than those at the bottom. By implementing a combination of measures at each level, the risk of transmission is substantially reduced.1
Check out examples of measures at each control level by clicking the titles below:
Health Measures1
Health measures are society-wide actions to limit the spread of the infectious diseases and reduce severe complications, hospitalizations, and death from communicable disease. Examples include: public health orders from B.C.’s Office of the Provincial Health Officer, guidance emerging case finding and the impact on people of all ages and vulnerabilities, emphasizing the need for people to stay home when they are sick, and recommending immunizations. Information on current public health emergencies are posted on the Office of the Provincial Health Officer – Current Health Issues website2
Environmental Measures1
Environmental measures are physical changes in a setting that reduce the risk of exposure. Examples include: making use of outdoor spaces, having suitable indoor ventilation and air exchange, routine cleaning, and disinfection of work as well as living spaces.
Administrative Measures1
Administrative measures are policies, procedures, training, and care practices that prevent exposure to and/or transmission to others. Examples include: implementing facility or organizational infection prevention and control policies and procedures (e.g., screening for symptoms and risk factors, using appropriate signage, having a clear sick leave policy), providing regular training and education for health-care workers, isolation of people and their contacts who are infected, and limiting occupancy in an indoor location.
Personal Measures1
Personal measures are actions individuals can take to protect themselves and prevent spread to others. Examples include: washing hands frequently, staying home from work when sick, coughing into one’s elbow or tissue, and ensuring immunizations are up-to-date.
Personal Protective Equipment Measures1
Personal protective equipment measures refer to the use of specialized equipment that is designed to minimize exposure to a variety of health hazards when worn appropriately. PPE is considered a less protective infection prevention and exposure control measure because although the use of PPE is the most visible in the hierarchy of controls, it is effective only when used in conjunction with all the other control measures. PPE must be suited to the task and must be worn and disposed of properly. Examples include: wearing a mask in certain settings, and in health-care settings, using medical masks, eye protection, gowns, gloves, and N95 respirators when indicated.
At the locations of your clinical rotations, several levels of infection prevention and exposure controls will have been put into place to reduce the risk of person-to-person transmission of communicable diseases, including environmental, administrative, and PPE measures.
When possible, controls offering the highest level of protection will be used during your clinical rotations. If it is not possible to use the highest level of protection (e.g., during treatment of patient), lower levels of control will be used (e.g., PPE).
In the event of an outbreak, Medical Health Officers have the authorization to restrict student access to specific wards and locations at their discretion.3