2. • Infection prevention means decontamination and clean technique which
includes the procedures used to reduce the numbers of micro-organisms and
prevent their spread from one place or person to another.
• Patients entering the health care setting are at risk of acquiring infections
because of their low immunity, presence of microorganisms in the environment
and invasive procedures carried out during treatment.
• Since health workers work in the environment where pathogens are always
present, they must take a precaution to protect themselves and their patients and
visitors and all the health workers should remember how to vent infection.
• Nurses are responsible for providing quality care that incorporates infection
control practices.
Introduction
3. Terminology of infection prevention
• Infection:
• An infection is the result of an interaction between a susceptible hose and
an infectious agent (bacteria, viruses, fungi, parasites) a clinical syndrome
caused by the invasion and multiplication of a pathogen in the body.
• It is the invasion of the body by pathogens e.g. micro-organisms that
reproduce multiple and cause diseases.
• Local infection:
• It is limited to the specific part of the body where the micro-organisms
remain.
• Systemic infection:
• If the microorganism spread and damage different parts of the body.
4. Terminology of infection prevention
• Host:
• It is living organism harboring another organism as a parasite, typically
providing nourishment and shelter in which an organism reaches maturity and
reproduces.
• Host is an organism that can be affected by an agent.
• Agent:
• It is biological pathogen that causes diseases, such as virus, parasite, fungus or
bacterium and a toxin or toxic chemical that can cause illness.
• Aseptic technique:
• Asepsis or aseptic techniques are general terms used in health care settings to
describe the combination of efforts made to prevent the entry of microorganisms
into any area of the body where they are likely to cause infection.
5. • Sepsis:
• A combination form meaning pertaining “to decay” or infection.
• Antisepsis:
• Antisepsis is the prevention of infection by killing or inhibiting microorganism
on skin and other body tissue, by using a chemical agent.
• Antiseptic:
• It is a substance that tends to inhibit the growth and reproduction of the
microorganism.
• Cleaning:
• Cleaning is the process that physically removes all visible blood, body fluid, other
foreign materials, such as duster dirt from skin or inanimate objects.
Terminology of infection prevention
6. • Disinfection:
• Disinfection is the process that eliminates most but not all diseases causing
microorganisms.
• High Level Disinfection (HLD) by boiling or the use of chemicals eliminates all
microorganisms except bacterial endospores.
• Decontamination:
• Decontamination is the process that makes objects safer to be handled by the staff,
especially cleaning personnel, before cleaning.
• Such objects include large surface eg (operation table) surgical instrument and
gloves contaminated with blood or body fluids during or following surgical
procedure.
Terminology of infection prevention
7. • Disinfectant:
• It is a germicidal chemical substance used on inanimate objects to kal pathogenic
microorganisms but not necessarily all others.
• Sterilization:
• Sterilization is the process that eliminates all microorganisms, including bacterial
endospores.
• Bacteremia:
• Where a culture of the person's blood reveals micro-organism the condition is
called bacteremia.
• Septicemia:
• When bacteremia results in systemic infection it refers to septicemia.
Terminology of infection prevention
8. • Acute infection:
• Generally, appears suddenly or lasts for a short time.
• Chronic infection:
• May occur slowly over a very long period and may last for months or year.
• Nosocomial infection:
• Nosocomial infections are infections that are associated with the delivery of
the health care services in health care facility.
• Nosocomial organisms may also be acquired by health personnel working in
the facility e.g. hepatitis B infection, HIV infection, etc.
Terminology of infection prevention
9. • Inflammation:
• It is a local and non-specific defensive response of the tissues to injury or infection; it is
characterized by five signs.
• Bactericidal:
• A chemical is bactericidal, it kills micro-organisms.
• Bacteriostatic :
• It is an agent that prevents bacterial multiplication but does not kill any forms of the
organism.
Terminology of infection prevention
10. Infection
• Infection is the invasion of the body by pathogenic or micro-organisms. Infectious
disease results from the interaction of an agent, a host, and an environment.
• Most of diseases follow a typical chain of infection that ends with an infected host.
• Understanding the chain of infection can help with both the prevention and treatment
of infectious diseases.
• There are 6 components in this cycle which are also known as the chain of infection.
• Infectious Agent
• Reservoir
• Portal of exit from reservoir
• Mode of transmission
• Portal of entry
• Susceptible host
11. • Infectious agent:
• The first link in the chain of infection is a microbial agent, which may be a
bacterium, virus, fungus or parasite.
• The ability of the infectious agent to cause disease depends on its pathogenicity,
virulence, invasiveness and specificity.
• Pathogenicity is the organism's ability to harm and to cause disease, virulence
relates to the vigor with which the organism can grow and multiply.
• Invasiveness describes the organism's ability to enter tissues; specificity refers
to the organism's attraction to a specific host, which may include humans.
• The more pathogenic virulent and invasive the organism, the more likely that it
can overcome normal body defense causing an infection.
Chain of Infection
12. • Reservoir (source):
• A reservoir is a place where a pathogen can survive but may or may not
multiply.
• Inanimate objects, human beings and animals are sources.
• Inanimate objects include medications, air, food, water or any other material
on which the organism can find nourishment or lie dormant and survive.
• Human sources include other clients, health care personnel, family
members, visitors and clients themselves e.g. humans are the reservoir of
tubercle bacilli and syphilis spirochete.
• Soil is the reservoir of organisms causing gas gangrene and tetanus.
Chain of Infection
13. • Portal of exit from reservoir:
• Before an infection can establish itself in a host, the microorganism must
leave the reservoir.
• Common human reservoirs and their associated portal of exit are nose,
mouth, urethra, vagina, wound, etc.
• Mode of transmission:
• After a micro-organism leaves its source of the reservoir, it requires a means
of transmission to reach another person or host through a portal of entry.
• Direct transmission: The organisms can be transmitted directly from person to person
through droplet infection, infected hands, sexual contact, etc.
• Indirect transmission: Contact with the secretions and excretions of the infected
person through fomites (instruments and utensils), through contaminated food and
water, through insects, through dust and through carriers.
Chain of Infection
14. • Portal of entry:
• From the vehicle of transmission, the micro-organisms reach the human
body through the portal of entry, which may be the mouth, nose or through
the cracked skin.
• Susceptible host:
• Any person can be at risk for infection. Compromised hosts are the persons
at increased risk.
• Body's defense and other factors can affect susceptibility to infection.
• There are many factors which influence the host's susceptibility e.g. body's
resistance to diseases, age, sex, race, climate, general health status or any
medication, etc.
Chain of Infection
15. • Infections that occur as a result of health care delivery is called nosocomial
infection.
• Prevalence of Health care associated infection (HAI) in developed countries
varies between 3.5% and 12%.
• Exogenous Nosocomial Infection: Pathogen acquired from health-care
environment
• Endogenous Nosocomial Infection: Normal flora multiply and cause infection
as a result of treatment
• Iatrogenic: Infection from a procedure eg UTI from Foley insertion
Nosocomial Infection
17. Heath impact of Nosocomial Infection
• Increased length of hospital stay : 2.8 times increased cost
• Create long-term disability
• Increase resistance to antimicrobials.
• Represent a massive additional financial burden for health system
• Extended day of stay in hospital.
• Multiple care givers.
• Leading cause of death
18. Causes of Nosocomial Infection
• Improper medical or surgical asepsis
• Urinary tract infection- Insertion, contamination of drainage system.
• Surgical site- Improper technique for hand washing or dressing change.
• Upper respiratory infection - Improper hand washing or suctioning technique.
• Intra venous - Improper hand washing or site care.
• Antibiotic choices and overuse.
• Improper medical or surgical asepsis.
19. Risk for Nosocomial Infection
• Age: Very young and very old
• Poor nutritional status
• Smoker
• Existing co-morbid conditions
• Prolonged ICU stay
• Compromised immune system
• Chronic illnesses, chemo, radiation
• Clients with invasive procedures
• Clients with prolonged stress
20. Preventing Nosocomial Infections
• The responsibility of HAI prevention is with the healthcare facility.
• Hospitals and healthcare staff should follow the recommended guidelines for
sterilization and disinfection.
• Taking steps to prevent HAls can decrease your risk of contracting them by
70 percent or more.
• However, due to the nature of healthcare facilities, it's impossible to eliminate
100 percent of nosocomial infections.
• Some general measures for infection control includes:
21. Preventing Nosocomial Infections
• Identifying the type of isolation needed, which can help to protect others
• Washing hands before and after procedure and touching patients in the hospital.
• Wearing appropriate personal protective equipment including gloves, gowns,
boot and faces protection.
• Cleaning surfaces properly, with recommended frequency.
• Maintaining aseptic technique while performing procedure.
• By doing decontamination of the infected equipment.
• Making sure rooms are well ventilated.
22. Asepsis
• It is the process by which the environment of the patient is protected from
contact with infective organisms.
• It is a series of tasks, each step of which is performed in a bacteria-free
environment, which serves to maintain the sterility of the entire process.
• The two types of aseptic techniques, the nurse usually practice are medical
and surgical asepsis.
23. Principles of Asepsis
• All personnel involved in an aseptic procedure are required to follow the principles
and practice of asepsis.
• Principles of sterile technique help control and prevent infectión, prevent the
transmission of all microorganisms in a given area, and include all techniques that
are practised to maintain sterility.
• It is the responsibility of all health care workers to speak up and protect all patients
from infection.
• Hand hygiene is a priority before any aseptic procedure.
• When performing a procedure, ensure the patient understands how to prevent
contamination of equipment and knows to refrain from sudden movements or
touching, laughing, sneezing, or talking over the sterile field.
24. Principles of Asepsis
• Choose appropriate PPE to decrease the transmission of microorganisms from
patients to health care worker.
• Review hospital procedures and requirements for sterile technique prior to initiating
any invasive procedure.
• Health care providers who are ill should avoid invasive procedures or, if they can't
avoid them, should double mask.
• Check packages for sterility by assessing intactness, dryness, and expiry date prior to
use.
• Any torn, previously opened, or wet packaging, or packaging that has been dropped
on the floor, is considered non-sterile and may not be used in the sterile field.
25. • Sterile objects must only be touched by sterile equipment or sterile gloves.
• Fluid flows in the direction of gravity.
• Keep the tips of forceps down during a sterile procedure to prevent fluid
travelling over entire forceps and potentially contaminating the sterile field.
• Keep all sterile equipment and sterile gloves above waist level.
• Set up sterile trays as close to the time of use as possible. Sterile objects can
become non-sterile by prolonged exposure to airborne microorganisms.
• Any puncture, moisture, or tear that passes through a sterile barrier must be
considered contaminated.
Principles of Asepsis
26. • Keep sterile surface dry and replace if wet or torn.
• Non-sterile items should not cross over the sterile field. For example, a non-
sterile person should not reach over a sterile field.
• When opening sterile equipment, follow best practice for adding supplies to a
stents field to avoid contamination.
• Do not sneeze, cough, laugh, or talk over the sterile field.
• Maintain a safe space or margin of safety between sterile and non-sterile
objects
• Keep operating room (OR) traffic to a minimum, and keep doors closed.
Principles of Asepsis
27. Medical Asepsis
• Medical asepsis or clean technique, refers to practices designed to reduce the numbers
of pathogenic microorganisms and limit their growth and transmission in the patient's
environment.
• It is "A state of cleanliness that decreases the potential for the spread of infections.“
• Medical Asepsis Includes
• Clean technique
• Maintaining a clean environment
• Maintaining clean hands
• Changing a clients linen daily
• Cleaning equipments
• Isolation precaution:
• Transmission based precautions, Barriers technique(e.g PPE)
28. Purposes of Medical Asepsis
• To help the patient fight a current infection and prevent its spread.
• To prevent the patient from being re-infected by the same pathogen.
• To prevent the patient from being infected with a new pathogen.
• To prevent health care professionals and visitors who come in contact with
the patient from being infected.
• To help decrease the chance of the patient acquiring a nosocomial infection
and dying because of a hospital-acquired infection.
29. Hand Hygiene
• Hand cleaning involves both mechanical and chemical action.
• Although the most effective preventive method of decreasing hospital acquired
infections is hand hygiene, it is used inconsistently and sometimes is done
inadequately.
• We can maintain hand hygiene by hand washing and using hand sanitizer
(Alcohol based hand rub 60% to 90% isopropanol or ethanol or combination).
30. Hand Washing
• Hand Careful washing of the hands reduces the number of bacteria.
• Hand-washing is simple and the most important procedure for the prevention
of hospital acquired infections.
• Use of soap in hand washing helps to remove dirt and micro-organisms from
the hands and keeps them clean.
• There are three methods of hand washing.
• 80% of pathogens are removed by hand washing with detergent and running
water.
31. • To remove dirt and transient micro-organisms from hands.
• To reduce the risk of transmission of micro-organism to patients.
• To reduce the risk of cross infection among patients.
• To prevent iatrogenic infections.
Purposes of Hand Washing
• Soap/antiseptic detergent
• Running warm water
• Nail brush in antiseptic lotion
• Towels (sterile)/drier
Articles of Hand Washing
32. • Before starting work on arrival at the hospital and completion of duty shifts.
• Before, between and after all physical contacts with the patients, and when
they are visibly dirty.
• Before performing any invasive and non-invasive procedure.
• Before preparing or serving food or administrating medications.
• After handling dirty and contaminated equipment (urinals, bed pans) or
dressings and linen.
• Before and after collecting specimens.
Indications of Hand Washing
33. • After taking care of such patients suffering from typhoid, hepatitis, AIDS or
the patient who is isolated and/or after handling items from such a room.
• After going to the toilet.
• After blowing the nose.
• After handling garbage.
• After finishing work.
• After dealing with situations when microbial contamination is likely even if
gloves are used.
Indications of Hand Washing
34. • Wash for at least 15 seconds in nonsurgical setting; 2-6 minutes in surgical
setting.
• Jewelry makes it difficult to adequately cleanse the hands. It is best to not
wear any jewelry in the clinical setting.
• Use warm water.
• Apply shop.
• Friction, running water, and a cleansing agent are necessary to remove
microorganisms.
• Clean beneath fingernails.
Guideline for Hand Washing
35. Precautions taken during hand washing
• Nails should be short to avoid the dirt and micro-organism.
• Remove artificial nails, watch and jewellery from hands and wrists.
• Folds back sleeves above elbow.
• Stand away from wash basin.
• Avoid splashing water against uniform clothes.
• Remove nail police especially in surgical hand washing.
