Hierarchy of controls

The hierarchy of controls are applied to minimise risk in the workplace environment and are a wider part of IPC measures to control exposure to infections for healthcare workers.

Hierarchy of controls Effectiveness 1 to 5
(1 = most effective)




Physically remove the hazard – eliminate potential exposure risk

  • triage
  • source control
  • screening
  • risk assess.



Replace the hazard

  • find other ways to provide care that will reduce potential of transmission of diseases.

Engineering Controls



Isolate or reduce exposure of healthcare workers and people from the hazard

  • use of physical barriers and dedicated pathways
  • remote triage areas, 
  • airborne infection isolation rooms and single patient spaces 
  • engineering controls also focus on maintaining the quality of the indoor air.

Administrative Controls



Change the way people work

  • effective policies and protocols designed to prevent and reduce the risk of exposure and transmission of infections,
  • implementation of IPC measures – standard and transmission based precautions, hand hygiene, vaccination programmes for staff and vulnerable patients cleaning and disinfection
  • education and training.

Personal Protective Equipment




Protect the worker with personal protective equipment (PPE)

  • ensure that adequate supplies of PPE available for staff and that appropriate education and training provided including regular refresher training
  • availability of PPE at point of care
  • respiratory protection program
  • risk assess PPE recommendations for specific staff, activities and roles

Infection prevention and control measures

Standard Precautions

Standard Precautions are a set of routine infection prevention and control practices used to prevent transmission of diseases associated with healthcare.  

Standard Precautions should be used for all patient/client care activities, regardless of their diagnosis or suspected infectious status. This helps to protect health care workers from infection and prevents the spread of infection from patient to patient. 

Before any patient interaction, all health care workers should also assess the infectious risks posed to themselves, their colleagues, other patients and visitors. 

The key elements of Standard Precautions are as follows: 

  • Hand hygiene - hand hygiene must be performed before every episode of direct patient care and after any activity/task or contact that potentially results in hands becoming contaminated, including before and after putting on and removing personal protective equipment (PPE), and after equipment decontamination and waste handling.
  • Personal protective equipment (PPE) - Select PPE before any health care activity based on an assessment of the likely risk of exposure to body substances or contaminated surfaces. For example, wear gloves if your hands may be in contact with body fluids, wear an apron or gown to prevent soiling of clothing, and wear a face shield/mask/goggle if droplets or splashes are likely to be generated near your face (eg, when taking a nasopharyngeal swab). 
  • Respiratory hygiene and cough etiquette - sneezing or coughing into the crook of your elbow or covering coughs and sneezes with a tissue, then putting the tissue in a bin and cleaning your hands. 
  • Safe use and disposal of needles and other sharps  
  • Aseptic ‘non-touch’ technique - for all invasive procedures, including appropriate use of skin antisepsis.  
  • Patient care equipment – clean, disinfect and reprocess reusable equipment between patients.  
  • Appropriate cleaning and disinfection - of environmental and other frequently touched surfaces. 
  • Safe waste management  
  • Safe handling of linen 

Find out more about standard precautions in health care – World Health Organisation

Hand hygiene

Hand hygiene means washing your hands with soap and water for at least 20 seconds and drying them for 20 seconds. You can also use hand sanitiser (containing at least 60 percent alcohol) if soap, water and paper hand towels are not available, and if your hands are not visibly dirty. If you use hand sanitiser, cover all the surfaces of your hands and rub them together until they feel dry. 

Perform hand hygiene before and after touching a patient/client, before and after clean or aseptic procedures, after touching patient surroundings, as well as before and after putting on and taking off PPE. 

Remember to wash your hands before preparing and eating food, after using the toilet, and after sneezing and coughing. 

Respiratory hygiene and cough etiquette

People with respiratory symptoms should be encouraged to sneeze or cough into the crook of their elbow or cover their coughs and sneezes with a tissue, and to then put the tissue in a bin and clean their hands. 

Health care facilities should: 

  • Put signage at the entrance to health care facilities instructing people with acute respiratory symptoms to practice respiratory hygiene and cough etiquette, and alert staff to their symptoms. 
  • Make hand hygiene information, hand sanitiser, tissues and masks available in common areas and areas used for the evaluation of patients with respiratory illnesses. 
  • Place people with acute respiratory symptoms at least 1 metre away from others in common waiting areas or in a single room (if available). Ask the person to wear a mask until they can be moved to a single room. 

Transmission-Based Precautions

Transmission-Based Precautions are a secondary set of infection prevention and control practices. They are used in addition to Standard Precautions for patients who may be infected or colonised with infectious pathogens, specifically to prevent transmission of infections.

Transmission-Based Precautions are – contact, droplet and airborne.  
The Transmission-Based Precautions required to prevent each mode of transmission are set out in the following sections of this page. 

Contact Precautions

Contact Precautions are required when interacting with people known or suspected to have infections or diseases that can be transmitted through either direct or indirect contact with people, objects or environmental surfaces that have infectious matter on them. 

The following Contact Precautions apply for all interactions that involve contact with the patient or potentially contaminated objects and surfaces in the patient’s environment: 

  • Wear single-use, non-sterile gloves. 
  • Wear a disposable plastic apron or long sleeve gown. 

The patient should be placed in a single room, preferably with its own bathroom. Appropriate signage of PPE requirements should be displayed outside the room. 

Droplet Precautions

Droplet Precautions are required when interacting with people known or suspected to have infections or diseases that can be spread by droplets. 

The following Droplet Precautions apply for all interactions: 

  • Wear a medical mask upon room entry or when interactions mean that physical distancing of 1 metre cannot be maintained 
  • Wear eye protection (goggles or face shield) to reduce exposure to respiratory droplets by touching your eyes or patient coughing or sneezing 
  • Where possible, the patient should wear a medical mask whilst awaiting assessment, or for any movement outside of the single room, along with strict adherence to respiratory hygiene and cough etiquette. 

The patient should be placed in a single room, preferably with its own bathroom. Appropriate signage of PPE requirements should be displayed outside the room. 

Airborne Precautions

Airborne Precautions are required when interacting with people known or suspected to have diseases spread by very small particles that can suspend in the air and can be inhaled into the lungs.  

The following Airborne Precautions apply for all interactions: 

  • Wear a P2/N95 particulate respirator that you have fit checked before room entry. For guidance on donning, doffing and fit checking, see PPE information on masks, respirators, gloves, aprons and eye protection.
  • Where possible, the patient should wear a mask whilst awaiting assessment, or for any movement outside of a single room, along with strict adherence to respiratory hygiene and cough etiquette.

Patients in a hospital setting should be placed within an airborne infection isolation room (negative pressure room). In other settings, the patient should be placed in a single room, preferably with its own bathroom. Appropriate signage of PPE requirements should be displayed outside the room. 

Specific guidance for Mpox

Specific guidance for Candida auris

Candida auris (C. auris), is an emerging fungus (yeast) that can cause serious blood stream infections and other invasive infections in patients in hospitals and people in aged residential care facilities. C. auris can be difficult to contain in healthcare settings and it has become more widespread at a global level. 

Infection prevention and control guidance and resources for healthcare workers for managing C. auris has been developed to support healthcare facilities develop their own policies and procedures.

Candida auris infection prevention and control (Word, 58 KB)

Candida auris infection prevention and control (PDF, 118 KB)

Specific guidance for Vancomycin Resistant Enterococci (VRE)

Enterococci is a bacterium that most often lives harmlessly in the bowel as part of the normal human gastrointestinal flora and in the female genital tract. Some strains may acquire genes that cause resistance to vancomycin, an antibiotic used in serious infections due to Enterococci.  

VRE may be shed into the environment from the gastrointestinal tract and is able to survive for weeks or months in the environment.

While VRE is not currently endemic in New Zealand in comparison to some other countries, there has been an increase in hospital patients colonised with VRE in some regions of New Zealand. Update on the national situation with VRE.

National guidance and resources have been developed to support healthcare facilities respond to cases of VRE, to minimise further transmission of MDROs and to provide information to patients and their whānau.

Multi-drug resistant organism (MDRO) resources

MDROs are microorganisms that have become resistant to a range of antibiotics. Methicillin resistant Staphylococcus aureus (MRSA) is a notable example of an MDRO.

The patient information resources below have been kindly developed and provided by the IPC team at Te Whatu Ora Waitaha Canterbury Hospital.

These resources assist healthcare workers in communicating with patients, their whānau and caregivers about MDROs and the preventative measures implemented within a hospital setting.

Specific guidance for Norovirus

The 2009 guidelines for the Management of Norovirus Outbreaks in Hospitals and Elderly Care Institutions were developed to standardise the approach of public health services, managers and health care workers of hospitals and elderly care facilities in New Zealand to both the investigation and control of institutional norovirus outbreaks.

See the guidelines here

New Resources are available to help healthcare professionals reduce the risk of healthcare associated infections by using the New Zealand Aseptic Technique (NZAT).


Health Quality & Safety Commission New Zealand

The Health Quality & Safety Commission’s national Infection prevention and control programme aims to improve patient outcomes by reducing the incidence and impact of healthcare associated infections within the New Zealand health and disability sector.

Infection, prevention and control – Health Quality & Safety Commission New Zealand



Ministry of Health in conjunction with Careerforce have developed an on-line learning module for healthcare staff working in a variety of healthcare settings such as aged residential care, medical centre or the community.

This resource is a self-contained module based on IPC practices and the correct use of PPE.


New Zealand Aseptic Technique

Free to access and developed in Aotearoa New Zealand, NZAT is a simple, consistent approach to aseptic technique. It is consistent with, and complementary to, other aseptic education that some healthcare organisations have invested in, such as the Aseptic Non-Touch Technique.

Developed by experts across the health sector with support from ACC and Te Whatu Ora Hutt Valley, Capital and Coast and Counties Manukau, NZAT is designed for all health professionals who undertake procedures that may introduce infection, in any clinical setting.

These resources are available at LearnOnline.health.nz to support you and your organisation to use the NZAT. They are free to access and use, and it takes less than two minutes to create a log in. You will have access to:   

  • an in-person training package – this is a PowerPoint presentation to deliver in-person training to staff along with a supporting educational handout. 
  • an audit package including an audit tool and auditor’s user guide. These can be used to determine current practice and knowledge of aseptic technique principles, assess ongoing competency and further learning opportunities.    
  • an online e-learning module for healthcare workers. This takes about 30 minutes to complete, and learners will receive a printable certificate which can contribute to their professional development. This module can be added to your own e-learning platform, please contact us for more information.   
  • an Aseptic Technique policy template – developed by Te Whatu Ora Hutt Valley. This template is modifiable and can be used by organisations to support their compliance with the Ngā Parewa Health and Disability Sector Standard.

Please share this email with your teams/networks as you see fit.

Visit LearnOnline.health.nz for more information and to access the resources. Contact infection_prevention@acc.co.nz if you have any questions. 

Strategy and governance

National Infection Prevention and Control Strategy

A draft National IPC Strategy and draft IPC Action Plan have been distributed for consultation across the health sector until 17 June 2022. 

The purpose of the strategy is to enable those in leadership, planning, and co-ordination roles, to make and influence decisions, that will support the reformed health system to reduce healthcare-associated infections (HIAs) and the spread of antimicrobial resistance (AMR) in Aotearoa New Zealand.

A key purpose of the strategy is to enable a reduction in incidence of HAIs through effective IPC measures for Māori and other groups who are overrepresented with poorer health outcomes as an achievable goal for improvement. Through the five key priority areas, specific focus on equity for Māori will aim to reduce the impact that HAIs and AMR have on Māori consumers, whānau and staff.

National Infection Prevention and Control Leadership Group

The Ministry of Health established the National Infection Prevention and Control Leadership Group to support infection prevention and control (IPC) best practice in the health sector and provide leadership and governance to enable the development of a national IPC strategy.