Infection Control

• Every year, an estimated 722,000 health care-associated infections (HAIs) occur resulting in 75,000 deaths
• HAIs originate in healthcare facilities
• An effective infection control program must be established in a healthcare setting to recognize and prevent HAIs
• Infectious diseases are caused by microscopic organisms that penetrate the body's natural barriers and multiply to create symptoms ranging from mild to deadly
• Examples of infections include:

  • Measles
  • Yellow fever
  • Common cold
  • Tuberculosis
  • Mumps
  • Hepatitis
  • Influenza
• Infectious agents transmitted during healthcare primarily derive from human sources, but inanimate environmental sources are also implicated in transmission
• Human reservoirs include:

  • Patients
  • Healthcare personnel
  • Household members
  • Visitors
• Inanimate environmental sources include:

  • Dry surfaces in patient care areas
  • Wet surfaces, moist environments, and biofilms
  • Indwelling medical devices
  • Dust or decaying debris
• A susceptible person is someone who is not vaccinated or otherwise immune, or a person with a weakened immune system who has a way for germs to enter the body
• Modes of transmission of pathogens include:

  • Direct or indirect contact
  • Droplet
  • Airborne routes
  • Bloodborne viruses
• Contact transmission is divided into two subgroups: direct contact and indirect contact
• Direct transmission occurs when microorganisms are transferred from one infected person to another person without a contaminated intermediate object or person
• Indirect transmission involves the transfer of an infectious agent through a contaminated intermediate object or person
• Droplet transmission involves respiratory droplets carrying infectious pathogens transmitting infection when they travel directly from the respiratory tract of the infectious individual to susceptible mucosal surfaces of the recipient
• Airborne transmission occurs by dissemination of airborne droplet nuclei or small particles containing infectious agents that remain infective over time and distance
• Microorganisms are spread in healthcare facilities through several modes including direct contact, indirect contact, droplet contact, airborne contact, and vector-borne contact
• Standard Precautions are intended to be applied to the care of all patients in all healthcare settings, regardless of the suspected or confirmed presence of an infectious agent
• Standard Precautions combine the major features of Universal Precautions (UP) and Body Substance Isolation (BSI) and are based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact skin, and mucous membranes may contain transmissible infectious agents
• Standard Precautions include a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered
• Standard Precautions are also intended to protect patients by ensuring that healthcare personnel do not carry infectious agents to patients on their hands or via equipment used during patient care
• Standard Precautions include:

  • Hand Hygiene
  • Personal Protective Equipment
  • Follow respiratory hygiene/cough etiquette
  • Ensure appropriate patient placement
  • Clean and disinfect the environment appropriately
  • Handle textiles and laundry carefully
  • Follow safe injection practices
  • Ensure health worker safety including proper handling of needles and other sharps
• Hand hygiene methods include handwashing and hand rubbing with alcohol
• Personal protective equipment includes lab coat or apron, surgical masks and respirators, eye or face protection, and safety gloves
• Respiratory hygiene/cough etiquette includes education, source control measures, hand hygiene, and spatial separation of persons with respiratory infections
• Patient placement options in hospitals and long-term care settings include single patient rooms, two patient rooms, and multi-bed wards
• Single patient rooms are preferred when there is a concern about transmission of an infectious agent
• Hospitals and long-term care facilities must consider many competing priorities when determining the appropriate room placement for patients
• Factors to consider when determining appropriate room placement for patients in hospitals and long-term care facilities:

  • Reason for admission
  • Patient characteristics (age, gender, mental status)
  • Staffing needs
  • Family requests
  • Psychosocial factors
  • Reimbursement concerns
• Cohorting:

  • Grouping together patients who are colonized or infected with the same organism to confine their care to one area and prevent contact with other patients
• Ambulatory Settings where patients infected with transmissible infectious diseases are seen:

  • Outpatient clinics
  • Physicians’ offices
  • Emergency departments
• Home Care considerations:

  • Focus on protecting others in the home from exposure to an infectious household member
  • Beneficial to remove or segregate vulnerable individuals within the home
  • Prohibition of non-household visitors during the period of infectivity
• Safe Injection Practices:

  • Importance of defining and reinforcing safe injection practices
  • Primary breaches in infection control practice that contributed to outbreaks
• Contact Precaution:

  • Use for patients with known or suspected infections that represent an increased risk for contact transmission
  • Intended to prevent transmission of infectious agents spread by direct or indirect contact with the patient or the patient’s environment
  • Recommendations for patient room placement and healthcare personnel precautions
• Droplet Precaution:

  • Intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions
  • Recommendations for patient room placement, healthcare personnel precautions, and patient transportation
• Airborne Precaution:

  • Prevent transmission of infectious agents that remain infectious over long distances when suspended in the air
  • Recommendations for patient room placement, requirements for airborne infection isolation rooms, and respiratory protection program
• Sterilization vs. Disinfection:

  • Historical background and importance in infection control
  • Definitions of sterilization and disinfection
  • Use of antiseptics
• Factors that affect the degree of killing:

  • Type of organisms
  • Number of organisms
  • Concentration of disinfecting agent
  • Presence of organic material
  • Nature of surface to be disinfected
  • Contact time
  • Temperature
  • pH
  • Biofilms
  • Compatibility of disinfectants and sterilants
• Glutaraldehyde can be used as a disinfectant or a sterilant
• Difference in contact time:

  • Used as a sterilant, the contact time is much longer than when used as a disinfectant
• Alcohol and iodine preparations must be in contact with an object for at least 1 to 2 minutes to kill microorganisms