Busting the myths in infection control

BUSTING THE MYTHS
IN INFECTION
CONTROL
Manolito L. Chua, MD, FPCP, FPSMID
21st Annual Convention Philippine Hospital Infection Control Society, Inc.
May 29, 2015
by Dr. ML Chua presented during the 21st PHICS Annual
Convention, 27-28 May 2015

Objective
• To enumerate common misconceptions and
wrong practices in infection control and
discuss the evidence that support / debunk
these practices

MYTHS
William Schaffner 1980....
• A belief given uncritical acceptance by a group,
especially in support of traditional practices
• A notion held to be true but without factual basis
• Dirty hospitals have high rates of infection. This
sounds so obvious that it must be true
• Alcohol hand gel kills all dangerous microbes
• Giving too many antibiotics is bad because
people become immune to them

References:
1. Healthcare Personnel Attire in Non-Operating-Room
Settings. Gonzalo Bearman, MD, MPH; Kristina Bryant, MD; Surbhi Leekha, MBBS,
MPH; Jeanmarie Mayer, MD; L. Silvia Munoz-Price, MD; Rekha Murthy, MD; Tara Palmore, MD;
Mark E. Rupp, MD; Joshua White, MD. Infect Control Hosp Epidemiol 2014;35(2):107-121
2. Infection prevention myths demystified Laura Hinz (Meds 201
1) and Jennifer N. Bondy (Meds 2012) UWO Medical Journal, Vol 78, Issue 2
3. Infection Control Guidelines for Personal
Appearance Services 2012. Queensland Government
4. Double Gloving: Myth versus Fact . Linda McNeilly
5. Infection Control and Occupational Health. Jacqui
Richmond. B Positive – all you wanted to know about hepatitis B : A guide for primary
care provider p.82-89

1. Do long sleeve
shirts and medical
gowns facilitate
transmission of
hospital acquired
pathogens and
subsequent
infections?

2. What accessories, jewelries, garment
are not allowed when making rounds?
• e.g. artificial nails, neck ties etc.

Three Components
•a review and interpretation of the medical literature
regarding
• (a) perceptions of HCP attire (from both HCP and patients)
• (b) evidence for contamination of attire and its potential contribution
to cross-transmission
•a review of hospital policies related to HCP attire, as
submitted by members of the Society for Healthcare
Epidemiology of America (SHEA) Guidelines Committee
•a survey of SHEA and SHEA Research Network members
that assessed both institutional HCP attire policies and
perceptions of HCP attire in the cross transmission of
pathogens.

• Specific approaches to practice related to
HCP attire may be considered by individual
facilities;
• however, in institutions that wish to pursue
these practices, measures should be
voluntary and accompanied by a well-
organized communication and education
effort directed at both HCP and patients.

A. "Bare below the elbows" (BBE)
• HCP's wearing of short sleeves, no
wristwatch, no jewelry, and no ties during
clinical practice.
• Facilities may consider adoption of a BBE
approach to inpatient care as an infection
prevention adjunct, although the optimal choice of
alternate attire, such as scrub uniforms or other
short-sleeved personal attire, remains undefined.

A. "Bare below the elbows" (BBE)
• Rationale:
• While the incremental infection prevention impact
of a BBE approach to inpatient care is unknown,
this practice is supported by biological plausibility
and studies in laboratory and clinical settings and
is unlikely to cause harm.

B. White Coats
• Functions of the white
coat
1. Storage
2. Protects clothing
3. Identification
4. Warmth
5. Symbolism

B. White coats
• Facilities that mandate or strongly recommend use of a
white coat for professional appearance should institute
one or more of the following measures:
• 1. HCP engaged in direct patient care (including house
staff and students) should possess 2 or more white coats
and have access to a convenient and economical means
to launder white coats (eg, institution-provided on-site
laundering at no cost or low cost).
• Rationale: These practical considerations may help achieve the desired professional
appearance yet allow for HCP to maintain a higher frequency of laundering of white
coats.

B. White coats
• Facilities that mandate or strongly recommend use of a white
coat for professional appearance should institute one or more
of the following measures:
• 1. HCP engaged in direct patient care (including house staff
and students) should possess 2 or more white coats and have
access to a convenient and economical means to launder
white coats (eg, institution-provided on-site laundering at no
cost or low cost).
• Rationale: These practical
considerations may help achieve
the desired professional
appearance yet allow for HCP to
maintain a higher frequency of
laundering of white coats.

White coats
• 2. Institutions should provide coat hooks that would
allow HCP to remove their white coat (or other
longsleeved outerwear) prior to contact with patients
or the patient's immediate environment.
• Rationale: This practical consideration may help achieve the desired professional appearance yet limit
patients' direct contact with potentially contaminated attire and avoid potential contamination of white
coats that may otherwise be hung on inappropriate objects in the hospital environment.

White coats
• 2. Institutions should provide coat hooks that would allow HCP to
remove their white coat (or other longsleeved outerwear) prior to
contact with patients or the patient's immediate environment.
• Rationale: This practical consideration may help
achieve the desired professional appearance yet
limit patients' direct contact with potentially
contaminated attire and avoid potential
contamination of white coats that may otherwise be
hung on inappropriate objects in the hospital
environment.

C. Other HCP apparel
• On the basis of the current evidence, we cannot
recommend limiting the use of other specific items of HCP
apparel (such as neckties).
• Rationale: The role played by neckties and other specific
items of HCP apparel in the horizontal transmission of
pathogens remains undetermined.
• If neckties are worn, they should be secured by a white
coat or other means to prevent them from coming into
direct contact with the patient or near-patient
environment.

D. Laundering - Frequency
• Optimally, any apparel worn at the bedside that
comes into contact with the patient or patient
environment should be laundered after daily use.
• In our opinion, white coats worn during patient
care should be laundered no less frequently than
once a week and when visibly soiled,
• .

D. Laundering - Frequency
• Optimally, any apparel worn at the bedside that comes into contact with the
patient or patient environment should be laundered after daily use.
• In our opinion, white coats worn during patient care should be laundered no
less frequently than once a week and when visibly soiled,
• Rationale: White coats worn by HCP who care for very
few patients or by HCP who are infrequently involved in
direct patient care activities may need to be laundered
less frequently than white coats worn by HCP involved
with more frequent patient care. At least weekly
laundering may help achieve a balance between
microbial burden, visible cleanliness, professional
appearance, and resource utilization.

D. Laundering - Home laundering
• Whether HCP attire for nonsurgical settings
should be laundered at home or professionally
remains unclear. If laundered at home, a hot-
water wash cycle (ideally with bleach) followed by
a cycle in the dryer is preferable,
• Rationale: A combination of washing at higher
temperatures and tumble drying or ironing has
been associated with elimination of both
pathogenic gram-positive and gram-negative
bacteria.

E. HCP footwear
• All footwear should have closed toes, low
heels, and nonskid soles.

E. HCP footwear
• All footwear should have closed toes, low heels, and
nonskid soles.
• Rationale: The choice of HCP footwear
should be driven by a concern for HCP
safety and should decrease the risk of
exposure to blood or other potentially
infectious material, sharps injuries, and
slipping

F. Identification
• Name tags or identification badges should be
clearly visible on all HCP attire for identification
purposes.
• Rationale: Name tags have consistently been
identified as a preferred component of HCP attire
by patients in several studies, are associated with
professional appearance, and are an important
component of a hospital's security system.

• Shared equipment, including stethoscopes,
should be cleaned between patients.
• No guidance can be offered in general regarding
prohibiting items like lanyards, identification tags
and sleeves, cell phones, pagers, and jewelry, but
those items that come into direct contact with the
patient or environment should be disinfected,
replaced, or eliminated

3. Are Hand dryers more hygienic
than paper towels ?

Hand towels vs. air dryers
The Myth
• Are paper towels or air dryers more effective?
• Proponents of towels argue that you may as
well not wash your hands if you insist on using air
dryers as they just blow the germs back on.
• Proponents of air dryers lament the
environmental impact of towels.
• Unfortunately, the literature is similarly divided on
the issue.

The Evidence
• Uncertainty began to mount in 1991 when a study in
the American Journal of Infection Control reported
that air dryers were more effective in reducing the
numbers of Escherichia coli and rotavirus from
hands.
• The argument was levelled when a randomized
control trial conducted in 2000 failed to find a
significant difference in bacterial numbers when the
use of rotary dispenser towels, stacked paper towels,
air dryers, and spontaneous evaporation were
compared.

The Evidence
• It is interesting to note that in a separate study, it was
found that hands that were held stationary under the dryer
retained fewer bacteria than rubbed hands.
• This difference was explained by the fact that rubbing
allows bacteria to migrate from the hair follicle to the skin
surface, thus the finding may simply be a measurement
bias.
• Nonetheless, they concluded that stationary hands under
an air dryer was the best method, followed by a tie
between paper towels and rubbed hands.

The Evidence
• Taylor et al concluded that in bathrooms equipped
with paper towels, the germs were transferred from
the hands to the towels, which were then disposed of
in open receptacles where they acted as reservoirs of
bacteria.
• In contrast, while the air dryers killed a sizable
proportion of microorganisms by virtue of the heater,
the splattering of water droplets onto the wall behind
the dryer made this one area of the bathroom to
avoid.

The Verdict
• Despite the controversy, all studies were in agreement
about the importance of hand washing.
• Proponents of towels can argue using evidence from early
literature, the finding that paper towels were more
effective in removing bacteria from the fingertips in
particular and the CDC recommendation that one use a
paper towel to turn off the tap.
• They may also argue that air dryers are not
recommended in critical care environments due to the
possibility of air dispersal of bacteria-laden droplets.
• Air dryer enthusiasts can cite findings from more recent
studies, environmental considerations, and the capacity to
remove bacteria from the air.

• The important takeaway points are to wash
your hands well;
• if you choose a towel, dispose of it in a
closed receptacle;
• if you choose an air dryer, try to use an
automatic model and don’t rub your hands.

Show Me the Science -
How to Wash Your Hands
• Dry your hands using a clean towel or air dry them.
•
Why? Germs can be transferred more easily to and from
wet hands; therefore, hands should be dried after
washing. 1,2 However, the best way to dry hands remains
unclear because few studies about hand drying exist, and
the results of these studies conflict. Additionally, most of
these studies compare overall concentrations of
microbes, not just disease-causing germs, on hands
following different hand-drying methods. It has not been
shown that removing microbes from hands is linked to
better health 3. Nonetheless, studies suggest that using a
clean towel or air drying hands are best 4-6.

References
1. Patrick DR, Findon G, Miller TE. Residual moisture determines the level of touch-
contact-associated bacterial transfer following hand washing. Epidemiol Infect. 1997
Dec;119(3):319-25.
2. Todd EC, Michaels BS, Smith D, Greig JD, Bartleson CA. Outbreaks where food
workers have been implicated in the spread of foodborne disease. Part 9. Washing
and drying of hands to reduce microbial contamination. J Food Prot. 2010
Oct;73(10):1937-55.
3. Luby SP, Agboatwalla M, Billhimer W, Hoekstra RM. Field trial of a low cost method to
evaluate hand cleanliness.Trop Med Int Health. 2007 Jun;12(6):765-71
4. Gustafson DR, Vetter EA, Larson DR, Ilstrup DM, Maker MD, Thompson RL,
Cockerill FR 3rd. Effects of 4 hand-drying methods for removing bacteria from
washed hands: a randomized trial. Mayo Clin Proc. 2000 Jul;75(7):705-8.
5. Huang C, Ma W, Stack S. The hygienic efficacy of different hand-drying methods: a
review of the evidence. Mayo Clin Proc. 2012 Aug;87(8):791-8.
6. Jensen D, Schaffner D, Danyluk M, Harris L. Efficacy of handwashing duration and
drying methods. Int Assn Food Prot Annual Meeting. 2012 July 22-25.

4. What is the role of hand
sanitizer in preventing
influenza?

• A randomized intervention trial involving 1437 young adults
living in university residence halls during the 2006–2007
influenza season was designed.
• Residence halls were randomly assigned to 1 of 3 groups—
1. face mask use
2. face masks with hand hygiene
3. control— for 6 weeks.
• Generalized models estimated rate ratios for clinically
diagnosed or survey-reported ILI weekly and cumulatively

Mask Use, Hand Hygiene, and Seasonal Influenza-
Like Illness among YoungAdults:A Randomized
Intervention Trial
• The study by Aiello et al did not
demonstrate that hand hygiene prevented
transmission of influenza.
• First of all, the authors make clear that
most of their influenza- like illness (ILI)
cases were likely not associated with
influenza infection.
• Second, their study showed no benefit for
hand hygiene.

Mask Use, Hand Hygiene, and Seasonal Influenza-
Like Illness among YoungAdults:A Randomized
Intervention Trial
• Aiello et al conclude,
• “ILI incidence between the face mask and hand hygiene
group and the face mask-only group were not
substantially different, suggesting that the addition of a
hand sanitizer component did not appreciably decrease
the rate of ILI in this study population.”
• They further state, “It is important to note that
handwashing habits were the same in both the face
mask—only and control groups at baseline and over the
study period, which suggests that mask use alone may
provide a reduction in respiratory illness regardless of
handwashing practices.”

What is the role of hand sanitizer in
preventing influenza?
• The efficacy of hand hygiene in reducing
transmission of influenza likely hinges on a
fundamental, unresolved issue:
• Is influenza virus spread primarily by large
droplets or by small-particle aerosols?
• The greater the importance of large droplets, the
more likely that hand hygiene will reduce
transmission.
• If small-particle aerosols predominate, hand
hygiene may provide little benefit.

• Evidence exists that 100-fold greater quantities of
virus are required for infection by intranasal drops
than with aerosols
• illness after intranasal inoculation is milder than
naturally acquired disease, has shorter duration
of cough
• lacks the abnormalities in small airway function
and transient increase in airway reactivity that
characterize naturally acquired disease.

• One study showed no detectable influenza
virus on hands 5 minutes after transfer from
environmental surfaces .
• Another study showed no detectable virus on
the hands of 6 of 20 volunteers 2 minutes after
inoculation with a high concentration of H1N1
virus .
• Volunteers with detectable virus at 2 minutes
showed a 3–4 log reduction compared with the
initial inoculum.

•In the absence of data demonstrating
that hand hygiene reduces
transmission of influenza, it has been
argued that recommending it is
prudent.

• However, the incremental cost of following this
recommendation — certainly if alcohol based
hand sanitizer is widely employed — would be
considerable when extended to the large at-risk
population around the world.
• Also, if hand hygiene is ineffective and individuals
behave inadvisably, increased cases of influenza
would result.

When to Use Hand Sanitizer
• Washing hands with soap and water is the best way to reduce
the number of microbes on them in most situations. If soap and
water are not available, use an alcohol-based hand sanitizer that
contains at least 60% alcohol.
•
Why? Many studies have found that sanitizers with an alcohol
concentration between 60–95% are more effective at killing
germs than those with a lower alcohol concentration or non-
alcohol-based hand sanitizers . Non-alcohol-based hand sanitizers
may 1) not work equally well for all classes of germs (for example,
Gram-positive vs. Gram-negative bacteria, Cryptosporidium,
Norovirus); 2) cause germs to develop resistance to the sanitizing
agent; 3) merely reduce the growth of germs rather than kill them
outright, or 4) be more likely to irritate skin than alcohol-based hand
sanitizers .

• Alcohol-based hand sanitizers can quickly reduce the number of
microbes on hands in some situations, but sanitizers
do not eliminate all types of germs.
•
Why? Although alcohol-based hand sanitizers can inactivate many
types of microbes very effectively when used correctly, people may
not use a large enough volume of the sanitizers or may wipe it off
before it has dried . Furthermore, soap and water are more
effective than hand sanitizers at removing or inactivating certain
kinds of germs, like Cryptosporidium , Norovirus ,
and Clostridium difficile

• Hand sanitizers may not be as effective when hands are visibly
dirty or greasy.
•
Why? Many studies show that hand sanitizers work well in clinical
settings like hospitals, where hands come into contact with germs but
generally are not heavily soiled or greasy . Some data also show that
hand sanitizers may work well against certain types of germs on
slightly soiled hands. However, hands may become very greasy or
soiled in community settings, such as after people handle food, play
sports, work in the garden, or go camping or fishing. When hands are
heavily soiled or greasy, hand sanitizers may not work
well Handwashing with soap and water is recommended in such
circumstances.

5. Does Reverse Isolation Work ?

REVERSE ISOLATION

REVERSE ISOLATION
• Reverse isolation is when there is positive
pressure in the room. Filtered, clean air is
brought into the room and allowed to vent out of
the room to the surrounding corridors. Usually
visitors must wear protective garb to protect the
patient from the visitors (masks, etc), if visitors
are allowed at all.
Isolation is when the patient can infect others.
Reverse isolation is when others can infect the
patient (if the patient is immuno-compromised,
like with leukemia, etc).

Does Reverse Isolation Work ?
• Evidence does not support the use of reverse
isolation in hospitals…the use of reverse isolation
procedures should be discouraged as they are
unlikely to be of benefit, and commonly cause anxiety
and confusion for patients, families, and healthcare
workers”
Sheshadri, S. and Baumann, M.Reverse isolation for Neutropenic
Patients. Comunity Oncology. November 2008

• Reverse isolation was eliminated as an isolation
category by the Centers for Disease Control (CDC) in
the mid 1980’s.
• There are three types of isolation: Transmission-
Based (Contact), Airborne, and Droplet.
• Reverse Isolation was eliminated as it was not found
to improve outcomes for neutropenic patients, and
isolation is a negative experience for the patient.
• Debunking Reverse Isolation. Beth Hawkes. December 7, 2014
• http://nursecode.com/2014/12/debunking-reverse-isolation

6. The hotter the water you use
for handwashing, the better

How hot does water need to be when
you wash your hands?
• In a 2005 study documented in the Journal of Occupational and
Environmental Medicine, participants were instructed to wash
their hands in water ranging from 40 degrees all the way up to
120 degrees. What the study found is that the temperature of
the water doesn’t really matter when it comes to getting your
hands truly clean.
•
• The FDA recommends washing dishes at an uncomfortable
110 degrees as one of the steps to get rid of harmful bacteria.
Interestingly, even though the FDA recommends washing your
dishes at 110 degrees as one of its bacteria-killing steps,
studies have shown that washing dishes in colder water can
kill bacteria too. The difference may be in how quickly the
grease comes off.

The Claim: Always Wash Your Hands With
Hot Water, Not Cold Anahad O ‘Connor
• Scientists with the Joint Bank Group/Fund Health Services
Department pointed out that in studies in which subjects
had their hands contaminated, and then were instructed to
wash and rinse with soap for 25 seconds using water with
temperatures ranging from 40 degrees Fahrenheit to 120
degrees, the various temperatures had “no effect on
transient or resident bacterial reduction.”
• no evidence that hot water had any benefit, and noted that
it might increase the “irritant capacity” of some soaps,
causing contact dermatitis
• Hot water for hand washing has not been proved to
remove germs better than cold water

The Truth Behind the Myths: Hot Water Hand Washing and
The Five Second Rule (Infographic) by Unity Point Clinic -
December 18, 2014
• Myth One: Using hot water to wash your hands kills
more germs.
• The researchers discovered that the average water
temperature people used while washing their hands was
between 104° and 131°. While this amount of heat has
the possibility of killing germs, the amount of time required
in constant contact with the hot water would damage the
first layer of the skin. The damage, in turn, would make us
more susceptible to bacteria as we would have decreased
our defense system.
• The group says that water as cold as 40° still reduces the
amount of bacteria on the skin when hands are washed
properly.

• Wet your hands with clean, running water (warm or cold), turn off
the tap, and apply soap.
•
Why? Because hands could become recontaminated if placed in a
basin of standing water that has been contaminated through previous
use, clean running water should be used . However, washing with
non-potable water when necessary may still improve health . The
temperature of the water does not appear to affect microbe removal;
however, warmer water may cause more skin irritation and is more
environmentally costly .
• Turning off the faucet after wetting hands saves water, and there are
few data to prove whether significant numbers of germs are
transferred between hands and the faucet.

December 18, 2014
• Myth Two: As long as you pick up food that
was dropped on the floor in 5 seconds or less,
there won’t be any germs on it.
• National Public Radio reported on a study done
by biology students at Aston University in
Birmingham, UK.
• The students completed an experiment on how
much bacteria was found on food dropped on
tiles, linoleum and carpet for various amounts of
time.

December 18, 2014
• They found that …
• sticky foods picked up bacteria faster than dry
foods
• food dropped on the carpet was contaminated
with the least amount of germs
• The team also surveyed 500 people and discovered that
87% of them ate food off of the floor. Of that 87%, three-
quarters used the five second rule.

December 18, 2014
• Microbiologist Eric Schulze expressed a warning about
the five second rule.
• He stated that it could take less than five seconds for
hundreds of bacteria to attach themselves to food on
the floor.
• After one minute, that number increases to ten times
more bacteria.
• His advice is simple: People track things like fecal
matter on the bottoms of their shoes.

December 18, 2014
• While not all of the bacteria on the floor is
harmful to people, it’s an issue of risk each
time you decide to eat it.
• Eating food off of the floor means that you
are taking the chance that your food did not
fall in the area of harmful bacteria.

7. Does wearing a mask by
patients decrease the risk of
transmitting airborne / droplet
infection?

Does Wearing a Mask Prevent the Flu?
Kristeen Cherney , May 7, 2015
• When the Unites States experienced an outbreak of the swine flu in
2009, everyone was talking about how to reduce the spread of the
infection.
• Health organizations reminded people of the importance of regular
handwashing with warm water and soap.
• People who developed the flu were advised to stay home to recover
and avoid spreading the virus to others.
• Then, some people started doing something most of us hadn't seen
before: wearing surgical masks.

• First, a 2008 study published in the international Journal
of Infectious Diseases concluded that when used
correctly, (The First Randomized, Controlled Clinical Trial of Mask Use in
Households to Prevent Respiratory Virus Transmission C.R. MacIntyre 13th
International Congress on Infectious Diseases Abstracts)
• masks are highly effective in preventing the spread of
viral infections.
• Family members of children with flu-like illnesses who
used the masks properly were 80 percent less likely to
be diagnosed with the illness.
• Surprisingly, the difference between types of masks
used was insignificant.

• Another study published in the Annals of Internal
Medicine reported similar results.
• (Facemasks and Hand Hygiene to Prevent Influenza Transmission in
Households: A Cluster Randomized Trial . Benjamin J. Cowling, Ann Intern
Med. 2009;151(7):437-446)
• 407 people who had the flu
• They found that family members reduced their risk of getting the flu by
70 percent when they washed their hands often and wore surgical
masks.
• In 154 households in which interventions were implemented within 36
hours of symptom onset in the index patient, transmission of RT-PCR
confirmed infection seemed reduced, an effect attributable to fewer
infections among participants using facemasks plus hand hygiene
(adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87])

• Other studies found promising results
outside of the household. Facemasks, Hand Hygiene,
and Influenza among Young Adults: A Randomized Intervention Trial.
Allison E. Aiello. January 25, 2012
• Researchers from University of Michigan conducted on
more than 1,000 students living in residence halls.
• They assigned the student to groups: those who wore
masks, those who wore masks and practiced hand
hygiene, and those who did neither.
• The results showed that those who wore masks in
residence halls and practiced good handwashing
reduced their risk of flu-like illness by an astonishing 75
percent.

• Still, the study found no reduction in
symptoms for mask use alone.
• This finding suggests that the use of masks
should always be paired with regular
handwashing.

• Different Types of Masks
• Facemasks
• Facemasks are fairly loosely fitting, disposable masks approved by
the U.S. Food and Drug Administration for use as medical devices.
• These masks prevent large droplets of bodily fluids that may
contain viruses from escaping via the nose and mouth.
• Facemasks also protect against splashes and sprays from others,
such as those from sneezes and coughs.
• The downside is that these masks don’t prevent the inhalation of
small, airborne contaminants.

• Different Types of Masks
• Respirators
• Respirators, also called N95 respirator masks, are designed to
protect the wearer from small particles in the air that may contain
viruses.
• They are certified by the CDC and the National Institute for
Occupational Safety and Health.
• The name comes from the fact that they can filter 95 percent of
airborne particles, according to the CDC.
• N95 masks are also often used when painting or handling
potentially toxic materials.

• Respirators are selected to fit your face. They must form a
perfect seal so that no gaps allow airborne viruses in.
Healthcare workers use them to protect against airborne
infectious diseases such as tuberculosis and anthrax.
Unlike regular facemasks, respirators protect against both
large and small particles.
• Overall, respirators are considered much more effective at
preventing the flu virus than regular facemasks. Still,
studies have found benefits to both types of masks.

CAN “FACEMASKS” PREVENT
DISEASE?
• Infectious diseases such as influenza (the “flu”) can be
• spread by several methods, including:
• Airborne droplets or sprays,
• Hand to mouth/nose/eye contact,
• Direct surface contact, or
• Combinations of these methods.
• Because recent evidence suggests that inhalation of
microscopic airborne particles may also transmit some
diseases, it has been suggested that “masks” might
reduce disease transmission.

Surgical Masks (SM)
• A surgical mask can:
• Protect patients from bacteria
and other particles exhaled by
health care workers.
• Protect health care workers
from contact with sprays or
splashes that may contain
infectious organisms.
• SM ARE NOT designed to reduce the
inhalation of small airborne particles that
may contain infectious organisms.
• DO NOT expect a SM to protect you
from inhaling
• infectious organisms.

N95 Filtering Facepiece Respirators FFR
CAN ONLY PROTECT WHEN WORN
• The benefit of using any respirator, including a properly
fitting N95 FFR, is quickly lost if it is not worn at ALL
times the hazard is present.
• Most of the benefit of wearing a respirator is lost unless it
is worn at least 90% of the time.
• Infectious aerosols are invisible, so there is no indication
when they are present. Also, some sick people may
produce particles that can infect others before they show
any symptoms themselves. Therefore, it is very easy to
receive a significant exposure without knowing.
• Even taking the respirator off to talk or eat in an area
where infectious particles are present might allow enough
exposure to cause infection.

N95 Filtering Facepiece Respirators FFR
CAN ONLY PROTECT WHEN WORN
• Unfortunately, there may be little benefit from wearing an
N95 FFR that has not been fit‐tested on the wearer.
• Effective fit‐tests may be difficult to obtain for members of
the general public. Contact the organizations listed at the
end of this fact sheet for more information about fittesting
and infectious aerosols.
RESPIRATORS ALONE
WILL NOT PREVENT
DISEASE
TRANSMISSION

• While wearing a properly fit N95 FFR can
reduce inhalation exposures, frequent hand
washing with soap and water can help
minimize transmission through other
exposure routes.
• An annual seasonal flu vaccination is
the best way to reduce the chances that
you will get seasonal flu

•OTHER MYTHS

• MYTH – Wearing gloves means you do
not need to wash your hands.
• FACT – Gloves are not a substitute for
effective hand-washing..

• MYTH – Health care workers should use
additional precautions when caring for a
patient with HBV to prevent
transmission.
• FACT – The implementation of standard
precautions ensures a high level of
protection against the transmission of HBV
in the health care setting.

• MYTH – Health care workers need to have
booster doses of hepatitis B vaccine every
five years.
• FACT – Booster doses are no longer
recommended in immunocompetent individuals
after a primary course of HBV vaccine, as
evidence suggests that a completed course of
HBV vaccination provides long-lasting protection.

• MYTH – Health care workers with HBV
must not have contact with patients
because of the risk of transmission.
• FACT – Health care workers with HBV are
generally advised to avoid performing
exposure prone procedures, however, they
can still have non-invasive contact with
patients.

BUSTING THE MYTHS
IN INFECTION
CONTROL

Busting the myths in infection control

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