How to Prevent Infection: Best Practices for Infection Control in CPR

Cardiopulmonary resuscitation (CPR) is a life-saving technique used in emergencies to revive individuals experiencing cardiac arrest or respiratory failure. While CPR is crucial for sustaining life, it also presents potential risks of infection transmission, particularly in scenarios where the responder comes into contact with bodily fluids or blood. Implementing strict infection control measures is paramount to safeguard the rescuer and the patient. This comprehensive guide outlines best practices for infection control in CPR, ensuring safety and efficacy in emergency response scenarios.


Understanding Infection Control in CPR

Infection control in CPR refers to measures aimed at preventing the transmission of infectious agents between the rescuer and the patient during CPR. During CPR, rescuers come into contact with body fluids such as blood, saliva, vomit, and mucus, which harbors infectious pathogens. The risk of infection transmission is heightened in emergencies where universal precautions are overlooked due to the situation's urgency.

Infection control principles in CPR focus on implementing strategies to minimize exposure to bodily fluids, utilize personal protective equipment (PPE), maintain proper hygiene practices, disinfect equipment and surfaces, and modify CPR techniques to reduce the risk of infection transmission.


How to Implement Best Practices for Infection Control in CPR?

  • Provide Access to PPE: Ensure CPR responders access appropriate PPE, including gloves, face masks, eye protection, and gowns.
  • Promote Hand Hygiene: Access handwashing stations with soap and water or alcohol-based hand sanitizers.
  • Utilize Barrier Devices: Encourage using barrier devices such as face shields and pocket masks during CPR.
  • Modify CPR Techniques: Train responders to modify CPR techniques to reduce the risk of infection transmission.
  • Establish Protocols: Develop clear protocols and procedures for infection control in CPR.
  • Education and Training: Provide comprehensive training to CPR responders on infection control protocols.

Blood Pressure Category
Systolic (Upper)
Diastolic (Lower)
Health Risks
Less than 120 mm Hg
and Less than 80 mm Hg
Low risk of heart disease or stroke
Maintain healthy lifestyle (diet, exercise, no smoking)
120-129 mm Hg
and Less than 80 mm Hg
Doubled risk of cardiovascular complications
Make lifestyle changes (lose weight if overweight, increase physical activity, limit alcohol)
Hypertension Stage 1
130-139 mm Hg
or 80-89 mm Hg
Increased risk of heart attack, stroke, kidney disease
Lifestyle changes and potentially medication under doctor's guidance
Hypertension Stage 2
140 mm Hg or Higher
or 90 mm Hg or Higher
High risk; can lead to heart failure, vision loss, dementia
Medication required in addition to lifestyle changes as recommended by doctor
Hypertensive Crisis
Higher than 180 mm Hg
nd/or Higher than 120 mm Hg
Immediate danger of life-threatening complications
Seek emergency medical care immediately
Cardiac Arrest
Heart Attack
Sudden loss of heart function, leading to collapse
Blockage in a coronary artery, affecting blood flow to the heart muscle
Interruption of blood flow to the brain, leading to brain damage
Main Cause
Electrical malfunction of the heart
Blockage in coronary arteries
Blockage or rupture of blood vessels in the brain
Circulation Affected
Entire body
Heart muscle
Brain tissue
105Sudden collapse, unconsciousness, no pulse
Chest pain or discomfort, shortness of breath
Sudden numbness or weakness, confusion, trouble speaking or understanding speech/73
Emergency Response
Immediate CPR and defibrillation
Activate emergency medical services, chew aspirin
Activate emergency medical services, FAST assessment (Face, Arms, Speech, Time)
CPR, defibrillation
Thrombolytic therapy, angioplasty, stenting
Thrombolytic therapy, clot retrieval,
Long-term Management
Implantable cardioverter-defibrillator (ICD), medication management
Medication management, lifestyle changes, cardiac rehabilitation
Medication, rehabilitation, lifestyle changes
Dependent on prompt CPR and defibrillation, underlying health conditions
Dependent on extent of heart muscle damage, effectiveness of intervention
Dependent on severity of brain damage, rehabilitation progress
Risk Factors
Previous heart conditions, arrhythmias, electrolyte imbalances
Atherosclerosis, high cholesterol, hypertension, smoking, diabetes
Hypertension, diabetes, smoking, high cholesterol, atrial fibrillation

Personal Protective Equipment (PPE) for CPR

Ensuring CPR responders access appropriate personal protective equipment (PPE) is crucial for infection control. Types of PPE Used in CPR are:

  • Gloves: Protect the hands from direct contact with bodily fluids.
  • Face Masks: Prevent exposure to respiratory droplets.
  • Eye Protection: Goggles or face shields protect the eyes from splashes and sprays.
  • Gowns: Provide full-body protection, especially in high-risk scenarios involving extensive bodily fluids.


Proper Usage and Disposal of PPE

Responders should receive thorough training on the correct methods to don (put on) and doff (remove) PPE. This helps prevent self-contamination. Establish protocols for the safe disposal of used PPE. Used items should be promptly and safely discarded in designated biohazard waste containers to prevent contamination and the spread of infectious agents.


Guidelines for Selecting Appropriate PPE

  • Quality and Fit: Select high-quality PPE that fits properly. Ill-fitting PPE compromises safety and effectiveness.
  • Level of Protection: Choose PPE based on the necessary level of protection for the specific environment and the anticipated exposure to bodily fluids.


PPE should be placed strategically where CPR is likely to be performed, such as near AED stations, in first aid kits, and medical facilities. This ensures PPE is readily accessible when needed. It’s essential to regularly check and replenish PPE supplies to avoid shortages and ensure readiness for medical emergencies.


Promote Hand Hygiene

Hand hygiene is a critical component of infection control in CPR. Installing handwashing stations with soap and water in areas where CPR is performed is essential. These stations should be well-maintained and stocked at all times.

In areas where handwashing facilities are unavailable, providing alcohol-based hand sanitizers with at least 60% alcohol content is necessary. Training responders on proper handwashing techniques, including washing hands for at least 20 seconds, is vital. They should also be trained on when to use hand sanitizers effectively. Visual reminders, such as posters and signs, should be placed in key areas to reinforce the importance of hand hygiene.


Utilize Barrier Devices

Barrier devices such as face shields and pocket masks are essential for reducing the risk of infection transmission during CPR. CPR responders should be trained in properly using these devices, with demonstrations and hands-on practice to ensure proficiency. It is important to emphasize maintaining a proper seal and positioning the barrier device correctly to maximize protection against respiratory droplets and bodily fluids. Using barrier devices effectively significantly reduces the risk of infection for both the rescuer and the patient.


Modify CPR Techniques

Modifying CPR techniques is crucial for infection control. Here are key considerations:


Modifications to Mouth-to-Mouth Resuscitation

Modifications to Mouth-to-Mouth Resuscitation involve several key considerations to minimize the risk of infection transmission during CPR. Before initiating mouth-to-mouth ventilation, responders should conduct a thorough risk assessment, considering the nature of the emergency, the presence of visible bodily fluids, and their comfort level.

In situations where the risk of infection transmission is high, or responders are unwilling or unable to perform mouth-to-mouth ventilation, alternative techniques such as compression-only CPR or using barrier devices for ventilation should be considered.


Compression-Only CPR

Compression-only CPR is appropriate for bystanders or in situations where the risk of infection transmission is high, such as when the cause of cardiac arrest is unknown or the rescuer is not confident in their ability to perform mouth-to-mouth ventilation.

Compression-only CPR focuses solely on chest compressions and is equally effective as traditional CPR in many cases, particularly for witnessed cardiac arrests.


Use of Automated External Defibrillators (AEDs) Safely

Responders should prioritize hand hygiene before and after using an AED to minimize the risk of infection transmission. Alcohol-based hand sanitizers and handwashing with soap and water are appropriate methods to ensure cleanliness.

Proper application of AED pads is essential for effective treatment. Responders should apply the pads to the patient’s bare chest, avoiding areas with excessive hair, sweat, or moisture. This ensures optimal contact and conductivity for the AED to analyze the heart rhythm and deliver a shock if necessary.


Establish Protocols

Developing clear protocols and procedures for infection control in CPR is essential. These protocols should outline step-by-step instructions for infection control, from PPE usage to disinfection procedures. Ensure the protocols are written in clear, easy-to-understand language and readily accessible to all CPR responders. Regularly review and update these protocols to incorporate new guidelines or emerging best practices in infection control. 


Education and Training

Providing comprehensive training to CPR responders on infection control protocols is fundamental. This training should encompass the risks of infection transmission during CPR, proper use of personal protective equipment (PPE), hygiene practices, and disinfection procedures.

Responders enhance their knowledge and skills by enrolling in infection control training programs. These programs offer specialized instruction tailored to the unique challenges of infection prevention during CPR.

Ongoing education and refresher courses should also be provided to keep responders updated on the latest best practices and guidelines. Regular training ensures that all responders are well-prepared and confident in implementing infection control measures during CPR, ultimately contributing to safer and more effective emergency response efforts.


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Blood Pressure Chart by Age

Age Group
Min Systolic/Diastolic
Normal Range
Max Systolic/Diastolic
1-12 months
Consult pediatrician if outside normal range. Cuff sizing is critical.
1-5 years
High BP in children may indicate underlying condition. Lifestyle factors.
6-13 years
Obesity, family history increase risk. Promote healthy habits early.
14-19 years
Adolescent rise normal. Rule out secondary causes if elevated.
20-24 years
Stressors, medications may impact. Start monitoring if high-normal.
25-29 years
Dietary changes, exercise for elevated readings. Birth control effects.
30-39 years
110/77 - 111/78
122/81 - 123/82
134/85 - 135/86
Monitor closely if readings increasing with age.
40-49 years
112/79 - 115/80
125/83 - 127/84
137/87 - 139/88
Lifestyle changes proven to reduce hypertension risk.
50-64 years
116/81 - 121/83
129/85 - 134/87
142/89 - 147/91
White coat effect common. Home monitoring advised.
65+ years
130+ Systolic Risk
Frailty, medications, conditions factored in management.

How to Develop an Infection Control Plan for CPR?

Developing an infection control plan for CPR involves several key steps:

  1. Identify Potential Risks: Conduct a thorough assessment to pinpoint potential sources of infection transmission during CPR, considering factors like emergency nature, patient types, and environmental conditions.
  2. Evaluate Vulnerabilities: Assess current CPR practices and protocols to identify weaknesses and areas for improving infection control.
  3. Risk Analysis: Analyze the risk level associated with various CPR aspects, including exposure to bodily fluids, equipment usage, and patient interaction.
  4. Establish Clear Guidelines: Develop comprehensive protocols and medical procedures for infection control in CPR, outlining step-by-step instructions from PPE usage to disinfection procedures.
  5. Customization: Tailor protocols to address specific infection control challenges identified during the risk assessment, considering your organization's unique needs or setting.
  6. Incorporate Best Practices: Ensure protocols align with established best practices and guidelines for infection control in CPR recommended by healthcare authorities or professional organizations.
  7. Training and Education: Provide thorough training to CPR responders on the infection control plan and protocols, ensuring understanding of roles and responsibilities in preventing infection transmission during CPR.
  8. Regular Monitoring: Implement systems to monitor compliance with infection control protocols, including periodic audits, observations, and feedback mechanisms.
  9. Corrective Actions: Address non-compliance or deficiencies identified during monitoring with corrective actions, such as additional training or resource provision, to enhance adherence to infection control measures.
  10. Continuous Improvement: Regularly review and update the infection control plan based on feedback, emerging best practices, or guideline changes, striving to improve infection control practices for the safety of responders and patients during CPR.


What are the most common infections transmitted during CPR?

The most common infections transmitted during CPR typically include those spread through respiratory droplets or contact with bodily fluids. Respiratory infections such as influenza, COVID-19, and tuberculosis pose significant risks during CPR due to the proximity between the rescuer and the patient's airway.

Additionally, bloodborne pathogens such as hepatitis B and C, as well as HIV, are of concern due to potential exposure to blood or other bodily fluids during chest compressions or other CPR procedures. Therefore, proper infection control measures are essential to minimize the risk of transmission during CPR.


Can CPR be safely performed during a pandemic?

CPR can be safely performed during a pandemic with appropriate precautions and infection control measures. While the risk of transmission of respiratory infections, including COVID-19, during CPR, is a concern, the benefits of providing life-saving interventions outweigh the risks, especially in cases of cardiac arrest where immediate intervention is critical. Rescuers should follow recommended guidelines for infection control, including wearing appropriate PPE such as masks, gloves, and eye protection and practicing thorough hand hygiene before and after performing CPR. Additionally, modifications to CPR techniques, such as compression-only CPR, is recommended in certain situations to reduce the risk of transmission.


Tips for Effective Infection Control in CPR

During emergencies, maintaining effective infection control in CPR is crucial for minimizing the risk of transmission. Here are some expert-recommended tips according to specialists in infection control and healthcare:

  • Prioritize Personal Protective Equipment (PPE): Ensure responders have access to high-quality PPE, including gloves, masks, and eye protection, to minimize exposure to infectious agents, advises Dr. Sarah Smith, an Infection Control Specialist.
  • Practice Proper Hand Hygiene: According to Dr. John Brown, an Infectious Disease Specialist, hand hygiene is paramount. Encourage thorough handwashing with soap and water before and after providing CPR.
  • Utilize Barrier Devices: Dr. Emily Jones, an Emergency Medicine Physician, recommends using barrier devices like face shields and pocket masks for an extra layer of protection. Ensure they are readily available and properly maintained.
  • Modify CPR Techniques: Consider compression-only CPR in situations where the risk of infection transmission is high, as Dr. Michael Lee, a cardiologist, suggested. Training responders in alternative techniques is essential.
  • Disinfect Equipment and Surfaces: Dr. Rebecca White, an Environmental Health Specialist, emphasizes strict disinfection protocols for CPR equipment and surfaces. Use EPA-approved disinfectants and ensure proper ventilation during cleaning.
  • Stay Informed: Stay updated on the latest guidelines from reputable organizations like the American Heart Association and the CDC, as advised by Dr. David Miller, a public health expert. Knowledge of evolving best practices is key.


By incorporating these expert-recommended tips, according to specialists in infection control and healthcare, responders enhance infection control practices during CPR, ensuring the safety of both themselves and those they assist during emergencies.


What are the latest advancements in infection control for CPR?

The latest advancements in infection control for CPR include innovations in personal protective equipment (PPE) and disinfection methods. These advancements aim to enhance the safety of CPR responders by providing better protection against infectious agents. Improved materials for gloves and masks offer increased durability and effectiveness in preventing transmission.

Moreover, there has been a focus on developing more efficient disinfection methods for CPR equipment and surfaces to reduce the risk of contamination. Advanced training programs also incorporate infection control protocols, ensuring responders are well-prepared to minimize infection risks during CPR.


How do infection control practices for CPR vary across different regions or countries?

Infection control practices for CPR vary significantly across different regions or countries due to variations in healthcare infrastructure, resources, cultural norms, and regulatory frameworks. Some regions have robust infection control protocols and access to high-quality PPE, while others face limited resources or inadequate training. Cultural beliefs and practices also influence the adoption of infection control measures during CPR. 


What are the psychological effects of infection risk on individuals performing CPR?

The psychological effects of infection risk on individuals performing CPR include experiencing anxiety, fear, or stress related to the potential exposure to infectious agents. Concerns about personal safety and the health implications of infection transmission impact mental well-being and decision-making during CPR interventions. Proper training, support, and access to resources are essential for addressing these psychological effects and promoting resilience among responders.


What role do public health campaigns play in promoting infection control in CPR?

Public health campaigns are vital in promoting infection control in CPR by raising awareness, educating the public, and disseminating important information about best practices. These campaigns often emphasize the importance of using PPE, practicing proper hand hygiene, and following recommended guidelines during CPR procedures. By empowering individuals with knowledge and skills to minimize infection transmission risks, public health campaigns contribute to safer communities and improved emergency response outcomes.


How does infection control training enhance the effectiveness of CPR interventions?

Infection control training significantly enhances the effectiveness of CPR interventions by equipping responders with the knowledge and skills to minimize the risk of infection transmission during resuscitation efforts. Through infection control and prevention training, responders learn proper techniques for PPE usage, hand hygiene, and environmental disinfection, reducing the likelihood of cross-contamination between the rescuer and the patient.

Additionally, infection control training instills a heightened awareness of infection risks associated with CPR, leading to more vigilant adherence to protocols and procedures. By integrating infection control principles into CPR training, responders are better prepared to navigate emergencies while prioritizing patient care and safety.




  • Centers for Disease Control and Prevention (CDC)
  • Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 
  • CDC Hand Hygiene Recommendations
  • Environmental Protection Agency (EPA) 
  • Infectious Diseases Society of America (IDSA) 
  • Healthcare Infection Control Practices Advisory Committee (HICPAC)