Infection prevention and Control

1. 1
Infection Prevention and Control
By: Dechasa Adare (MSc.)
Haramaya University
dechasaadare@gmail.com

2. Learning outcome/ objectives
• Define infection prevention and control
• Describe how IPC practices in
healthcare settings
• Identify risk factors within the patient
care environment
• Identify how the IPC core components,
provide a blueprint for successful
implementation of IPC programs
• Identify appropriate application of
standard precautions
2
• The engineering, work practice, and
environmental controls that protect
against HAI.
• Primary principles of public health
emergency management
• Identify barriers and personal PPE for
protection from exposure to potentially
infectious material.
• Use PPE properly as per the WHO
standard

3. Learning outcome/ objectives
• How sanitation and environmental hygiene
contribute to reducing risk of infection
transmission
• Hand and respiratory hygiene.
• Monitor cleaning, disinfection and
sterilization
• Explain food and water safety measures
• Housing standards of health facilities for
IPC.
• Health impacts, mitigations and adequate
responses to health care associated
infections (HAI).
3
• Recommendations and best practices for IPC.
• Principles for conducting HAI surveillances
• Design an approach and implement and interpret
surveillances findings.
• Describe and promote appropriate strategies for
outbreaks investigation.
• Policies and guidelines in relation to IPC
• Identify and promote non pharmaceutical
interventions to be applied at community level
• Adherence to IPC protocol

4. What is infection prevention and control?
• Infection prevention and
control (IPC) is:
– A scientific approach with a
practical solutions designed
to prevent harm
• Caused by infections
–To patients and health
care workers
• Grounded in principles of :-
– Infectious disease
– Epidemiology
– Social science and
– Health system strengthening
• Rooted in patient safety and
health service quality
4
Infection Prevention and Control

5. •It’s everyone’s business/responsibility
Break the Chain of Infection & Keep Yourself and Others Safe!
 There is a need for better collaboration and coordination
among clinical and non-clinical teams.
Cont..

6. 6
The Principles of a Safe Environment (Source: Horton and Parker, 2002)
Cont..

7. 7
HAI is everybody’s business
Clinical
Clinical
Doctors
Nurses
Microbiologists, etc.
Construction
Construction
Engineers
Architects, etc.
Facility and IPC Mngt
Cleaning
Catering
Waste Mgt
Maintenance
Estate engineering
Strategic management
Strategic management
Healthcare managers
Policy makers, etc.
Different
User Roles

8. Purpose of the infection prevention and control
• Improve patient safety
(prevention, identification, and
control of infections &
communicable diseases)
• Prevent HAI
• Minimize occupational health
risk to healthcare workers
8
Yourself
Family, community
& environment
The patients

9. IPC contributes to achieving the global health priorities
Cont..
9

10. IPC goals in outbreak preparedness​
1. To reduce transmission of health care associated infections
2. To enhance the safety of staff, patients and visitors
3. To enhance the ability of the organization/health facility
to respond to an outbreak
4. To lower or reduce the risk of the hospital (health care facility)
itself amplifying the outbreak
IPC goals
10

11. 6 links in a chain must be present for an infection to occur:
Pathogen A place where pathogens can
live. On humans or insects or
fomites, non-living object
A means of escape, such
as the respiratory tract,
skin, blood, gastro-
intestinal tract, and
mucous membranes.
The way a pathogen travels…
either by direct contact or
airborne droplet.
A place of entry, the same as
the means of escape PLUS
damaged or injured skin.
A host that does not
resist the infection or
may have an
immunity to it.
11

12. Who is at risk of
infection?
Everyone
Who is at risk of infection?
12

13. • Knowledge: have an understanding of the IPC strategies
needed for outbreaks/epidemics, etc
• Assessment, preparedness and readiness
• Policy and SOPs development
• Participate in response and recovery
• Participate in surveillance & monitoring
• Patient management
• Infrastructure for patient management
• Education
Role of the IPC focal point, team or committee
13

14. • Effective IPC requires constant action at all levels of the health
system, including:-
– Policymakers to facility managers
– Health workers
– Hygiene specialists and
– Those who access health services.
14
Cont..

15. Adapting IPC Core
Components
 Multimodal/multidisciplinary strategies
 Patient-centred
 Integrated within clinical procedures
 Innovative and locally adapted
 Tailored to specific cultures and resource level
Adapting IPC Core Components
15

16. IPC implementation approach
National
Health facility
IPC
Guidelines
Implementation
packages
IPCAT2
5-Step implementation
cycle
IPCAF
A WHO IPC implementationframework
16

17. • A multimodal strategy
comprises several elements or
components
– Three or more; usually five
– Implemented in an integrated
way with the aim of
improving an outcome and
changing behaviour.
17
• WHO core component 5 for effective IPC
Strong recommendation: multimodal strategies
• It includes tools, such as bundles
and checklists, developed by:-
• Multidisciplinary teams that
take into account local
conditions.

18. IPC multimodal improvement strategy
18

19. 19
• System change
• Availability of the appropriate infrastructure and supplies to
enable IPC recommendations implementation);
• Education and training
• For health care workers and key players
• Monitoring
• Infrastructures, practices, processes, outcomes and feedback;
• Communications
• Culture change
• Within the establishment or the strengthening of a safety climate.
The five most common components are:

20. 20
• It describe how a pathogenic MOs moves from an individual &/or
contaminated surface to another person or surface.
–From mother to child,
– Between individuals
o Direct mode of transmission e.g. a touching or coughing
o Indirect mode of transmission e.g. touching shared spaces (door
handles, curtains & benches) and patient/client without cleaning your
hands.
Transmission of Microorganisms

21. Multi-drug resistant organisms (MDROs)
• Organisms that have
developed resistance to
antimicrobial drugs
• Growing threat to public
health
Examples of MDRO
• Methicillin Resistant Staphylococcus Aureus
(MRSA)
• Vancomycin Resistant Enterococcus (VRE)
• Extended spectrum beta lactamase (ESBL)
i.e. Klebsiella, E. Coli
• Multi-drug resistant Acinetobacter
21

22. Transmission of Infectious Agents in Healthcare Settings
Transmission of infectious agents within a healthcare setting requires three
elements: a source of infectious agents, a susceptible host with a portal of
entry receptive to the agent, and a mode of transmission for the agent.
Sources
of
Infectiou
s Agents
Susceptibl
e hosts
Mode of
Transmiss
ion
22

23. Transmission: Direct Contact
• Gastrointestinal, respiratory, skin, and wound infections
• Most agents transmitted by droplets can also be transmitted by contact
• Transmission through the skin is the third most common mode of transmission of
infection.
• Penetration through intact skin is unlikely
• Fecal-Oral
– Excreted by the feces
– Transmitted to the oral portal of entry through contaminated food, contaminated
water, milk, drinks, hands, and flies
– Site of entry: oropharynx for some microorganisms; intestinal tract for most
viruses
23

24. Transmission: Droplet
Examples of organisms transmitted through Droplet Transmission:
• Hemophilus influenzae
• Meningococci
• Pneumococcal infections (invasive, resistant)
• Bacterial respiratory infections (Diptheria, Pertussis, pneumonic plague, pneumonia)
• Viral respiratory infections
– Adenovirus
– Influenza
– Mumps
– Parvovirus
• Any paroxysmal cough
24

25. Transmission: Airborne
• Droplet nuclei are droplets of less than 5 in diameter
• Transmission may occur over a long distance
• Transmitted by Droplet Nuclei
Tuberculosis (Infectious)
Suspects of TB: request sputum smear
Measles
Varicella
Smallpox (hemorrhagic)
25

26. Sources of Infectious Material
• Blood
• Internal body fluids
• Genital fluids
• Transplacental
• Secretions
• Excretions
• Mucosal membranes
• Skin
• Tissue
• Bites
Blood, internal
fluids and genital
fluids do contain
blood borne
pathogens (HIV,
HBV, HCV,
CMV)
26

27. Modes of transmission of MDROs
• Unwashed hands
• Gloves worn from patient to patient
• Contaminated environmental surfaces
• Inadequately cleaned and disinfected equipment
• Inadequate, inappropriate or prolonged use of antibiotic agents
27

28. Hospital-Acquired Infections
28

29. Tranquil Gardens
Nursing Home
Home
Care
Acute Care Facility
Outpatient/
Ambulatory
Facility
Long Term Care Facility
Healthcare Associated Infections
Source: CDC
29

30. Nosocomial Infections
 Infection acquired in the hospital:
• > 48 hours after admission
• $5 billion annually
• Increased hospital length of stay, antibiotics, morbidity and mortality
• Related to severity of underlying disease, immunosuppression, invasive
medical interventions
• Frequently caused by antibiotic-resistant organisms: MRSA, VRE, resistant
Gram- negative bacilli, Candida
30

31. • Death from HAI occurs in about 10% of affected patients
globally.
– About 7% of patients in developed and
– 10% in developing countries will acquire at least one HAI on
average
• WHO 2011
31

32. Nosocomial Infection
Types of Transmission
 airborne
– tuberculosis, varicella, Aspergillus
 contact
– S. aureus, enterococci, Gram-negative bacilli
 common vehicle
– food contamination
– Salmonella, hepatitisA
32

33. Hospital Acquired Infections/ Nosocomial Infections/Healthcare
Associated Infections
HAI as a localized or systemic condition resulting from an
adverse reaction to the presence of an infectious agent(s) or its
toxin(s) without any evidence of its being present or in
incubation at the time of admission.
An infection is attributed as HAI if date of event occurs on or
after 3rd calendar day (CL) of admission where day of
admission
33

34. HAI Risk Factors
• Transmission of communicable diseases
• Use of indwelling medical devices e.g. central line or urinary catheters
and endotracheal tubes
• Contamination of the healthcare environment
• Surgical Procedures
• Injections
• Overuse or improper use of antibiotics
34
34

35. 35
 Healthcare-associated infections include:
̶ Central line-associated bloodstream infections (CLABSI)
̶ Catheter-associated urinary tract infections (CAUTI)
̶ Surgical site infections (SSI)
̶ Clostridium difficile infections (CDI)
 Estimated more than 1 million HAI across healthcare settings each year.
 5 HAI cases per 100 hospital admissions or 1 in 20 patients acquires HAI
annually.

36. 36
HAIs in Healthcare Settings

37. Factors Affecting HAI
• Immune status
• Hospital environment
• Hospital organisms
• Diagnostic or therapeutic
interventions
• Transfusion
• Poor hospital administration
Sources of HAI
• Endogenous source- patient’s own
flora
• Exogenous source
o Environmental sources
o Health care workers
o Other patients
37

38. Microorganisms implicated in HAI
• The pathogens-
o Enterococcus faecium
o Staphylococcus aureus
o Klebsiella pneumoniae
o Acinetobacter baumannii
o Pseudomonas aeruginosa
o Enterobacter species and Escherichia coli
38

39. Major types of HAISs
• Catheter-associated urinary tract infection (CAUTI)
• Central line-associated blood stream infection (CLABSI)
• Ventilator-associated pneumonia (VAP)
• Surgical site infection (SSI).
39

40. Catheter-associated urinary tract infection (CAUTI)
Risk factors
• Age
• Gender
• Severe underlying disease
• Placement of a urinary catheter
for > 2 days.
Organisms
• Gram negative rods -majority cause
UTIs
• E.coli
• Gram-positive bacteria
• S.aureus, enterococci
40

41. 41
• How can you prevent CAUTI?
• Assess the need for Foley Catheters every shift
• Initiate the Nurse-Driven Foley Removal
Protocol when appropriate
• Keep Foley bags off the floor, below the
bladder and empty
• Secure tubing to the leg to prevent tension

42. Central line associated blood stream infection (CLABSI)
• Organisms
o S.aureus – Most common
o Followed by gram-negative
rods and Candida.
Risk factors
• Patient related:
o Age (<1 year and >60 years)
o Malnutrition
o Low immunity
o Severe underlying disease
o Loss of skin integrity i.e burn
o Prolonged stay in ICUs
• Device related
• HCW related: poor IPC practices.
42

43. 43
How can you prevent CLABSI?
• Assess the need for Central Lines every shift
• Assess the site every shift and change the
dressing if loose or soiled
• Scrub the hub before every access
– 15-30 seconds and allow air dry
• Change any line placed under adverse conditions
within 24 hrs

44. Ventilator associated pneumonia (VAP)
Risk factors for VAP
• Device related
• Patient related:
– Prolonged ICU stay leading to
colonization of hospital MDROs
• HCW related: poor IPC practices
Organisms:
• Gram-negative rods such as
Acinetobacter species and
Pseudomonas
• Gram positive bacteria
• How can you prevent VAP?
– Head of bead positioned at 30O
– Oral care every 4 hours and as
needed
44

45. Surgical site infections (SSI)
Definition:
• Develop at the surgical site within
30 days of surgery
• Within 90 days if prosthetic
material is implanted at surgery,
breast, cardiac etc.
• Under reported because 50% of
SSIs develop after the discharge.
45

46. 46
• Source of pathogens:
o Endogenous flora on the patient’s skin, mucous membranes
o Exogenous organisms by various pathogens
o (air in the operating room, surgical equipment, gloves
/hands, medications administered during operative
procedure)
• We can protect surgical patients from endogenous and exogenous
organisms.

47. Sources of SSI in the operating room environment specifically
1. Endogenous infections
• Patient’s own microflora
3. Environmental source
Contaminated air and dust due to inadequate
ventilation and cleaning
2. Staff in the operating room
• Staphylococci from nasal carriage, skin of hand
and forearm via contact through punctured gloves
or wet gown
47

48. Intact mucous membrane
Broken skin or mucous membrane
Foreign body implant (fully enclosed)
Foreign body from outside to inside body
Infection risk increases
Assessment of SSI risk
Intact skin
Low Risk Infection
48

49. • How can you prevent SSI?
• Pre-op. antibiotics
• Appropriate hair removal (no shaving)
• Glucose and temperature control
• Skin preparation, including
intraoperative temperature)
49
• Routes of entry
 Hands
 Equipment
 Intravenous
 Air
• Controlling the whole surgical
patient environment is very
important /experience

50. 50

51. WHO guidelines, 2016
Source: Global guidelines for the prevention of surgical site infection. Geneva: World Health Organization; 2016
(http://www.who.int/infection-prevention/publications/ssi-prevention-guidelines/en/). 51

52. Stepwise
approach
A WHO implementationframework
Sources: http://www.who.int/infection-prevention/tools/core-components/en
Preventing surgical site infections: implementation approaches for evidence-based recommendations. Geneva: World Health Organization; 2018 (http://www.who.int/infection-
prevention/tools/surgical/en/).
52

53. 53
HAI surveillance

54. HAI Surveillance
• HAI Surveillance - system that
monitors the HAIs in a hospital.
 Provides endemic rate/baseline HAI
 Comparing HAI rates within and
between hospitals.
 Identifies the problem area.
 Timely feedback to the clinicians.
 Input to take an actions
Surveillance is conducted to determine:-
• Catheter-associated urinary tract
infection
• Central line-associated blood stream
infection
• Ventilator-associated event
• Surgical site infection
54

55. Method of conducting HAI surveillance
Data
collection
Data
analysis
Data
interpretation
Dissemination
55

56. 56
Standard Precautions

57. Elements of Standard Precautions
• Hand hygiene
• Respiratory hygiene
• PPE
• Safe injection practices, sharps
management and injury prevention
• Safe handling, cleaning and
disinfection of patient care
equipment
• Environmental cleaning
• Safe handling and cleaning of
soiled linen
• Waste management
57

58. Chain of Transmission
• For an infection to spread, all links must be connected
• Breaking any one link, will stop disease transmission!
58

59. • Best way to prevent the spread of germs in the health care setting and
community
• Our hands are our main tool for work as health care workers- and they are
the key link in the chain of transmission
Hand Hygiene
Caregivers
Instruments
Cellphones
Medication
Door handles
59

60. • https://www.who.int/infection-prevention/tools/hand-hygiene/en/
Hand hygiene: WHO’s 5 moments
60

61. • Use appropriate product and
technique
• Soap, running water and single use
towel, when visibly dirty or
contaminated with proteinaceous
material
• An alcohol-based hand rub Rub
hands for 20–30 seconds!
– Wash hands for 40–60 seconds!
Hand hygiene: How?
https://www.who.int/infection-prevention/tools/hand-hygiene/en/
61

62. 62

63. Respiratory hygiene
Reduces the spread of microorganisms (germs) that cause
respiratory infections (colds, flu).
– Turn head away from others when coughing/sneezing
– Cover the nose and mouth with a tissue.
– If tissues are used, discard immediately into the trash
– Cough/sneeze into your sleeve if no tissue is available
– Clean your hands with soap and water or alcohol based
products
Do not spit here and there
63

64. • Promoting respiratory hygiene
• Encourage handwashing for patients with respiratory
symptoms
• Provide masks for patients with respiratory symptoms
• Patients with fever + cough or sneezing should be kept
at least 1m away from other patients
• Post visual aids reminding patients and visitors with
respiratory symptoms to cover their cough
64

65. • PPE for use in health care
Head cover
Head + hair
Goggle
Eyes
Nose + mouth
Face Mask Face shield
Eyes + nose + mouth
Gloves
Hands
Apron
Body
Gown
Body
N95 Mask
Nose + mouth
65

66. 66
Personal protective equipment
(PPE):
A. Gloves;
B. Plastic apron;
C. Gown;
D. Surgical mask;
E. N95 mask;
F. Cap;
G. Face shield;
H. Goggles;
I. Surgical shoes

67. • Always clean your hands before and after wearing PPE
• PPE should be available where and when it is indicated
– In the correct size
– Select according to risk or per transmission based precautions
• Always put on before contact with the patient
• Always remove immediately after completing the task and/or leaving the
patient care area
• Never reuse disposable PPE
• Clean and disinfect reusable PPE between each use.
Principles for using PPE
67

68. • Change PPE immediately if it becomes contaminated or damaged
• PPE should not be adjusted or touched during patient care; specifically
– Never touch your face while wearing PPE
– If there is concern and/or breach of these practices, leave the patient
care area when safe to do so and properly remove and change the PPE
– Always remove carefully to avoid self-contamination (from dirtiest to
cleanest areas)
Cont..
68

69. 69
Sequence for donning PPE
1. Perform hand hygiene
2. Put on gown/apron
3. Put on mask
4. Put on eye protection
5. Perform hand hygiene
6. Put on gloves
Sequence for donning and Doffing PPE

70. Put on Gown or Apron
1. Open the
gown without it
touching any
surfaces such as
floor or wall
2. Ties
secured at the
waist at the
back
3. Thumb
hooks (some
gowns) over
the thumb
1. Bare below elbows
2. Open the apron
without it touching any
surfaces such as floor or
wall
3. Ties
secured at the
waist at the
back
70

71. 71
1. Perform hand hygiene
2. Put on gown/apron
3. Put on mask
4. Put on eye protection
5. Perform hand hygiene
6. Put on gloves
1. Handle the mask by
the straps only
2. Secure loops
behind the ears
3. Mould the nose piece to
fit your face

72. 1. Put on a P2 or N95 mask to cover
your nose and mouth.
2. You should perform a fit check immediately
after donning the mask. Breathe in and out to
check that air is not escaping and the mask fits
you well.
72

73. 1. Perform hand hygiene
2. Put on gown/apron
3. Put on mask
4. Put on eye protection
5. Perform hand hygiene
6. Put on gloves
1. Perform hand hygiene
2. Put on gown/apron
3. Put on mask
4. Put on eye protection
5. Perform hand hygiene
6. Put on gloves
73

74. 1. Perform hand hygiene
2. Put on gown/apron
3. Put on mask
4. Put on eye protection
5. Perform hand hygiene
6. Put on gloves
• Do immediately before touching the
patient
• Note: When wearing a gown the
gloves should cover the cuffs of the
gown.
74

75. Doffing (Removing) PPE
 Remove and discard PPE:
o Away from the immediate patient environment
o Into general waste unless heavily contaminated by blood and or body
substances
 If the patient/client is in a single room:
o Remove gloves and gown – before leaving the patient’s room – hand
hygiene
o Eye protection and mask – is removed immediately outside patient’s
room/zone,
o For airborne precautions, remove mask after the door to patient’s room
has been closed (on exit)
75

76. Sequence for Removing PPE
• The sequence for removing PPE aims to limit opportunities for self contamination
and further environmental contamination.
• When using reusable eye protection perform hand hygiene after cleaning.
1. Remove gloves OR Remove gown and gloves in one step
2. Perform hand hygiene
3. Remove gown Perform hand hygiene
4. Perform hand hygiene Remove eye protection
5. Remove eye protection Remove mask
6. Remove mask Perform hand hygiene
7. Perform hand hygiene
76

77. Remove gloves
Care is taken to avoid contaminating the hands
1. Dirty to dirty
– pinch
outside of
glove
2. Peel first
glove off and
hold it with
your gloved
hand
3. Clean to
clean – slip
clean finger
UNDER the
remaining
glove
4. Peel glove
off, rolling it
over the top
of the held
glove
5. Dispose of
gloves in the
correct waste
bin
77

78. 1. Remove gloves OR Remove gown and gloves in one step
2. Perform hand hygiene
3. Remove gown Perform hand hygiene
4. Perform hand hygiene Remove eye protection
5. Remove eye protection Remove mask
6. Remove mask Perform hand hygiene
7. Perform hand hygiene
78
78

79. 1. Remove gloves OR Remove gown and gloves in one step
2. Perform hand hygiene
3. Remove gown Perform hand hygiene
4. Perform hand hygiene Remove eye protection
5. Remove eye protection Remove mask
6. Remove mask Perform hand hygiene
7. Perform hand hygiene
79

80. 4.Discard the
gown into
the general
waste bin
1.Untie the
gown
2.Pull the
gown away
from you
3.Roll it inwards and
downwards.
80

81. 81
1. Remove gloves OR Remove gown and gloves in one step
2. Perform hand hygiene
3. Remove gown Perform hand hygiene
4. Perform hand hygiene Remove eye protection
5. Remove eye protection Remove mask
6. Remove mask Perform hand hygiene
7. Perform hand hygiene

82. Safe injections
• Clean work space
• Hand hygiene
• Sterile safety-engineered syringe
• Sterile vial of medication and diluent
• Skin cleaning and antisepsis
• Appropriate collection of sharps
• Appropriate waste management
82

83. • It is important to ensure that environmental cleaning and disinfection
procedures
• Thorough cleaning environmental surfaces with
– Water and detergent or
– Sodium hypochlorite, 0.5%, or ethanol, 70% are effective and sufficient.
• Medical devices and equipment, laundry, food service utensils and
medical waste should be managed accordance with safe routine
procedures.
Environment cleaning, disinfection and BMWM
83

84. 84
Emergency Management

85. • Emergency: “An event affecting the overall target population and/or the
community at large,
 Which precipitates the declaration of a state of emergency at a local,
State, regional, or national level by:-
 an authorized public official such as government bodies.
85

86. 86
Emergency Management Program
Should consider the following key points:-
A. Emergency Management Planning
B. Linkages and Collaboration
C. Communications and Information Sharing
D. Maintaining Financial and Operational Stability

87. A. Emergency Management Planning – The Plan
– Based on Hazard Vulnerability Assessment (HVA)
– Hazards approach
– Board, Senior Mgt, and clinical staff should
have lead role in developing plan
– Include process for staff training
– Annual exercises, at a minimum

88. B. Linkages and Collaboration
• Health facility should integrate with emergency management
system:-
– State/local emergency management agencies
– State and local health departments
– Other health facility
– Mental health agencies
– National organizations
• Establish relationships with key decision makers before an
emergency
• Participate in community exercises

89. C. Communications and Information Sharing
– There should be communications plan as part of their
EMP
– There should be a policies and procedures for
communication
– Who is responsible for communicating important
information
• Which agencies/groups should receive this
information
• How will the information be communicated
• What types of information should be communicated
89

90. 90
• Health facility should have and test back-up, or redundant,
communication system
• Two-way radios
• Mobile/cell phones
• Wireless messaging
• Health facility should use an all-hazards command structure
• Health facility are encouraged to have systems in place to collect
and organize data for anticipated/required reporting

91. D. Maintaining Financial and Operational Stability
• Health facility should build, or develop a plan to build, cash reserves
• Insurance coverage should be reviewed and adjusted as needed
• Backup information technology systems are needed to ensure that
electronic financial and medical records
• Off-site or safe storage options for equipment and data
• Health facility should develop and implement strategies
• Grantees can use grant funds to provide services during an emergency as
long as they are within scope of project and the terms of grant award
91

92. Integrated Facilities Management
Core
Business
Accounts IT
Personnel
Purchasing
Distribution
Transport
Property &
Facilities
 Focus on Core Business
 Reduced Costs
 Increased Flexibility
 Improved Service Quality
 Introduce Best Practice
 Establish a Vehicle for Change
Drivers for
Change
92

93. Emergency Management Phases
Mitigation
Preparedness
Response
Recovery

94. Mitigation
It intended to lessen the impact of a potential disaster
–Long-term effort
–Risk identification – HVA
–Structural
»Reinforcing / strengthening
–Non-structural
»Light fixtures / HazMat Containers
94

95. Preparedness
Actions taken before an emergency to prepare for response
• Develop emergency management plan
• Develop Communication Plan
• Know emergency plans for community and partners
• Identify community planning efforts specific to those experiencing
homelessness – if none exist, educate partners on needs of your population
• Drills and Exercises to test plan and integration with partners
• Equip Emergency Operations Center (EOC)
• Obtain contact information
• Identify needs for response
95

96. Three Components to Preparedness
• Prepare your Program/Health Center
• Prepare your Staff
• Prepare Your Patients
96

97. Getting Started
• Obtain buy-in from senior leaders, Board
• Establish Emergency Management
Committee
• Appoint EM Coordinator
 Define Role of Coordinator
 Chair EM Committee
 Develop/revise EMP
 Attend local meetings
 Meet with key partners
 Coordinate staff training
 Facilitate/arrange exercises

98. Next Steps
• Familiarize yourself with local and state EM activities
• Get involved in local planning groups
• Evaluate availability of funds to support your EM efforts i.e CDC
• Determine to-date efforts and needs of community around planning for
your population
• Identify staff training needs and available resources to train them
98

99. Conduct a Hazard Vulnerability Analysis
• What are your risks?
• How likely are they to occur?
• How severely would they impact
– People – staff, patients, community?
– Property?
– Business?
• How prepared are you for these risks?
99

100. Planning Process
• Determine the role of your program – internal and external response
• Meet hospitals, community agencies to discuss role
• Train staff – Basic EM, NIMS, Basic IC, Donning/Doffing PPE, Gross
Decontamination, Risk Communication, personal and family
preparedness
• Educate patients – what to do in an emergency and where to go for
help
• Work with other agencies serving the same population to understand
their plans
100

101. Response
Activities to address immediate and short-term effects of a disaster
– Implement emergency management plan
– Adopt Incident Command System (ICS) structure
– Activate Emergency Operations Center (EOC)
• Save lives
• Protect property
• Meet basic human needs
101

102. Recovery
Restore essential functions and normal operation
 Starts with preparedness
• Adequate insurance coverage
• Back-up systems
• Cash reserve
 Assess damage / impact of disaster
 File insurance claims / assistance
 Address psychological needs of patients and staff
 Produce after action debriefing and report
102

103. Exposure and its impacts Control
1. BBP and Sharp injuries
• Standard Precautions
• Hep B vaccine at no cost
• Hand Hygiene
• Safer Sharp devices
• Biohazardous labeling
103
In case of exposure
• Wash area
• Notify supervisor immediately
• Fill out appropriate forms
• See a health care professional
within 1-2 hours of exposure

104. 2. Aerosol Transmissible Diseases (ATD)
• ATD Exposure Control Plan
• Exposure Prevention and
Hierarchy of Controls
• TB Surveillance/Screening
• Fit testing
ATD Exposure Control Plan
• OSHAATD Standard
• Preventing the transmission of various
ATD including Tuberculosis
• Collaboration with Employee Health
Services and Environmental Health and
Safety (EH&S) in the implementation
and management of program
104

105. ATD Exposure Prevention
• Prompt identification of suspect and confirmed ATD cases
• Respiratory etiquette practices
• Patients wearing surgical mask during transport or in waiting
rooms
• PPE during provision of care
• Use of airborne infection isolation rooms for suspect or
confirmed cases
105

106. Break the Chain of Infection with Routine Practices!
• Hand hygiene
• Point of Care Risk Assessment (PCRA)
• Personal Protective Equipment (PPE)
• Resident Placement/Accommodation
• Respiratory Hygiene/Cough Etiquette
• Handling Resident Items & Equipment
• Linen & Dishes
• Environmental Cleaning
• Waste and Sharp Handling
Routine Practices!
106

107. A. Point of Care Risk Assessment
• Assess the task, the resident and the
environment prior to each resident
interaction.
• this will help you decide what, if any,
personal protective equipment (ppe),
you will need to wear to protect
yourself.
Personal Protective Equipment
• Based on the job you are about to do (i.e.,
Point of Care Risk Assessment)
• What PPE is needed to protect you and
the resident/participant
• Additional Precautions
• Public Health/Government mandates
107

108. Accommodation
• When a single room is NOT possible,
cohorting of residents should be
based on transmission risk factors:
• Compromised immunity
• Infectious state e.g., Antibiotic
Resident Organisms
• Open wounds or medical devices
• Cognitive status, and hygiene
Respiratory Hygiene/Cough
Etiquette
108

109. Handling Care Items and Equipment
If reusable equipment cannot be dedicated for a single
resident use, clean and disinfect it between residents.
Do not share personal items (e.g., shampoo, soaps, lotions,
razors, nail clippers) between residents.
Encourage use of recreational equipment (e.g., toys, shared
electronic games) that are non-porous, easily cleanable and
able to withstand rigorous cleaning.
109

110. Linen & Dishes
• Used meal trays and dishes do not require special
handling.
• All used linen is considered contaminated and
handled the same way.
• Used linens should be put directly into a laundry
bag in the area it’s removed.
• Do not overfill bags. Double bag only if leaking.
• Remember to remove items e.g.needles.
110

111. Environmental cleaning
Clean resident care areas on a regularly
scheduled basis and increase cleaning to high
touched surfaces if there is suspected/
confirmed infectious illness in home
Always follow proper cleaning
and disinfection processes
111

112. Waste and Sharp Handling
Handling waste
• Wear gloves to remove waste from resident rooms, common care areas (e.g.,
resident tub rooms) and if the outside of bag is soiled.
• Remove gloves and perform hand hygiene.
• Avoid contact with body when removing waste.
Handling sharps
• Remember: New Needle, New Syringe, Every Time!
• Dispose of sharps immediately after use in puncture-proof biohazard
container.
• Do not overfill waste or sharps container.
112

113. Triage, early recognition, and source
control
113

114. Manage ill patients seeking care
Timely and
effective
triage and
infection
control
Admit
patients to
dedicated area
Specific
case and
clinical
manageme
nt
protocols
Safe
transport
and
discharge
home
• Use clinical triage in health
care facilities for early
identification of patients with
acute respiratory infection
(ARI) to prevent the
transmission of pathogens to
health care workers and other
patients.
114

115. • Prevent overcrowding.
• Conduct rapid triage.
• Place ARI patients in dedicated waiting areas with adequate
ventilation.
• In addition to standard precautions, implement droplet precautions
and contact precautions (if close contact with the patient or
contaminated equipment or surfaces/materials).
• Ask patients with respiratory symptoms to perform hand hygiene,
wear a mask and perform respiratory hygiene.
• Ensure at least 1 m distance between patients
115

116. The triage or screening area requires the following equipment:
• Screening questionnaire​
• Algorithm for triage​
• Documentation papers​
• PPE​
• Hand hygiene equipment and
posters​
• Infrared thermometer​
• Waste bins and access to
cleaning/disinfection​​
• Post signage in public areas with
syndromic screening questions to
instruct patients to alert HCWs.
116

117. Set up of the area during triage:
 Ensure adequate space for triage​ (maintain at least 1 m distance
between staff screening and patient/staff entering​)
 Waiting room chairs for patients should be 1m apart
 Maintain a one way flow for patients and for staff
 Clear signage​ for symptoms and directions
 Family members should wait outside the triage area-prevent triage area
from overcrowding
117

118. • Place patients with ARI of potential concern in single, well ventilated
room, when possible
• Cohort patients with the same diagnosis in one area
• Do not place suspect patients in same area as those who are
confirmed.
• Assign health care worker with experience with IPC and outbreaks.
Hospital admission
118

119. System change - “Build it” (cont’) , Necessary infrastructure and resources
• Allocated budget
• Standard operating procedures,
protocols, local policies and
tools/mechanisms for training
• An IT system (or paper) for monitoring
and feedback on infrastructure and
resources and other improvement steps
• Laboratory services
• Human resources including a
dedicated, competent team for
ensuring SSI prevention activities
working to an action plan
• Supplies for surgical hand preparation
119

120. 120
• Sterile drapes and gowns
• The correct antibiotics - easily
accessible
• Clippers (if hair removal essential)
• Chlorhexidine- alcohol-based (skin
prep) solution*
• Standard postoperative wound dressings
• Antimicrobial-coated sutures
• Negative pressure wound therapy
devices
• Nutritional formulas
• Warming devices
• Fluid therapy
• Aqueous povidone iodine solution
(irrigation)

121. 121
Performance Improvement
Patient Care Services and

122. • What are the patient care services?
– Treatment /service
– Facility
– Education
– Safety
– Etc.
122

123. Performance Improvement
• PI-Performance Improvement
– A planned systematic approach to
monitoring, analyzing, and
improving performance to achieve
optimal outcome and experience.
• Outcomes
• Measures by which we compare
ourselves to other providers
123
Quality
• Providing the best experience
• Six elements of quality:
Effectiveness
Efficiency
Equity
Safety
Timeliness
Patient centered

124. • Core Measures.
–The Core Measures are the
Foundation of how we deliver care
using Evidenced-based practice
• Value Based Purchasing
• Outcomes Based Reimbursement
– Patient Safety Indicators
– Hospital Acquired Infections
124

125. 125
Patient Safety Indicators
• Pressure Ulcer Rate
• Postoperative Fracture Rate
• Accidental Puncture or Laceration
Rate
• Transfusion Reaction Count
• Death Rate in Low-Mortality
Diagnosis Related Groups
Hospital Acquired Infections
• Central Line Associated
Bloodstream Infections
• Catheter Associated Urinary Tract
Infections
• Surgical Site Infections
• Methicillin resistant Staphylococcus
aureus
• Clostridium Difficile (C-Diff)

126. 126
Strategies to Keep Quality Affordable
• DMAIC process
• Define, Measure, Analyze,
Improve and Control.
• Six Sigma
• Improvement teams use the
DMAIC methodology to root
out and eliminate the causes of
defects
• Population Health:
• Clinical Documentation

127. The entire organization has a role in quality.
• What can you do?
– Document accurately & timely
– Educate the pt and the family
– Minimize waste (time & resources)
– Keep the pt safe (from injury & infections)
– Participate in UBC, unit projects, LSS, staff mtgs, huddles & Nsg councils
– Vaccinate and Immunize your pts and yourself
– Use appropriate d/c instructions to prevent readmission.
– Remember, if you didn’t document it, you didn’t do it!!
127

128. 128
Hierarchy of IPC Approaches
Break the Chain of Infection & Keep Yourself and Others Safe!

129. What is the hierarchy of control?
It is a system for controlling risks in the workplace.
The hierarchy of controls is a way of determining which actions will best
control exposures
It ranks risk controls from the highest level of protection and reliability to
the lowest and least reliable protection
Eliminating the hazard and risk is the highest level of control in the
hierarchy
Reducing the risk through the use of PPE is the lowest level of control.
129

130. Why hierarchy of controls:-
• Used to help implement effective controls and reduce the spread of
infections
• To the implementation of safer systems, where the risk of illness or
injury has been substantially reduced
• Demand multiple measures
• The idea behind this hierarchy is that the control methods at the top
of graphic are potentially more effective and protective
130

131. Hierarchy of
Controls
131

132. 1. Eliminate hazards and risks
• It is the highest level of protection
and most effective control.
• It is the most effective control
measure.
• This requires
organizations/employers to redesign
the activity
• i.e Staff should not attend work if
symptomatic/infectious
132
• Elimination removes the
hazard at the source.
• This could include:-
 Changing the work process to
stop using a toxic chemical, heavy
object, or sharp tool.
 It is the preferred solution to
protect workers because no
exposure can occur.

133. 2. Substitution
Substitution is using a safer alternative to the source of the hazard.
Substitute the risks with lesser risks
Reduce the risk with one or more of the following controls
When considering a substitute, it’s important to compare the potential new
risks of the substitute to the original risks
It should consider how the substitute will combine with other agents in the
workplace
Effective substitutes reduce the potential for harmful effects and do not
create new risks.
133

134. • Elimination and substitution can be the
most difficult actions to adopt into an
existing process
– These methods are best used at the
design or development stage of a work
process, place, or tool.
– At the development stage, they may be
the simplest and cheapest option.
– Another good opportunity to use
elimination and substitution is when
selecting new equipment or procedures.
134
• Prevention through design is an
approach to proactively include
prevention when:-
– Designing work equipment
– Tools
– Operations, and
– Spaces

135. • Reduce or prevent hazards from
coming into contact with workers
• For example:
– ensuring ventilation systems
– mechanical or natural,
– meet recommendations.
135
3. Engineering controls (control, mitigate or isolate people from the
hazard)
• Engineering controls are used to
reduce or control the risk of
exposure at source.
• They include design measures such
as ventilation, barriers, and screens.
• Priority should be given to measures
that provide collective; maximal
protection

136. The most effective engineering controls:-
Are part of the original equipment design
Remove or block the hazard at the source before it comes into
contact with the worker
Prevent users from modifying or interfering with the control
Need minimal user input for the controls to work
Operate correctly without interfering with the work process or
making the work process more difficult
136

137. 3. Administrative controls
137
Use administrative actions to minimize exposure to hazards and to reduce the
level of harm.
Low level of protection and less reliable control
Change the way people work
Provision and use of suitable work equipment and materials
Appointment or clinic scheduling to reduce waiting
Appropriate patient placement for infectious patients in isolation or cohorts

138. Regular assessments of physical distancing and bed spacing
Provision of appropriate education for staff, patients and visitors in IPC
Provision of additional hand hygiene stations (alcohol-based hand rub)
Providing safe spaces for staff breaks areas/changing facilities.
Ensuring regular cleaning regimes are followed, and compliance
monitored.
Ensuring staff and patients’ adherence with IPC guidance.
138
Cont...

139. In general administrative control include:-
– Work process training
– Job rotation
– Ensuring adequate rest breaks
– Limiting access to hazardous areas or machinery
– Adjusting line speeds
139

140. 4. Personal protective equipment
It is considered to be the least effective measure of the hierarchy of
controls.
Lowest level of protection and least reliable control
PPE is considered in addition to all previous mitigation measures in
the hierarchy of controls
Not all elements of the hierarchy of controls will be possible in some
settings
i.e example in a patient’s home
140

141. Elements of the PPE program depend on the work process and the
identified PPE; the program should address:
Workplace hazards assessment
PPE selection and use
Inspection and replacement of damaged or worn-out PPE
Employee training
Program monitoring for continued effectiveness
141

142. • When other control methods are unable to reduce the hazardous
exposure to safe levels, employers must provide PPE.
 While other controls are under development
 When other controls cannot sufficiently reduce the hazardous
exposure
 When PPE is the only control option available
142

143. Administrative controls and PPE
 Require significant and ongoing effort by workers and their
supervisors.
 They are useful when employers are in the process of implementing
other control methods from the hierarchy.
 They are often applied to existing processes where hazards are not
well controlled.
143

144. In general:-
– Training and evaluation can help ensure selected controls are
successful.
– Employers should correctly train workers and supervisors on how
to use controls.
– Workers and their supervisors should evaluate controls on a
regular basis.
– Regular evaluation can check whether controls are effective in
reducing workers’exposures and identify potential improvements.
144

145. 145
Risk Assessment and management
Risk Management
• The types of risk management are quite different and cover a wide
range of scenarios.
• They are not equally appropriate for every risk assessment
• They are an important part of initial risk management decisions
• It is important for businesses to examine risk in the context of existing
systems and processes.

146. • Risk avoidance – avoidance of risk means withdrawing from a risk
scenario or deciding not to participate.
• Risk reduction – the risk reduction technique is applied to keep risk
to an acceptable level and reduce the severity of loss through.
• Risk transfer – risk can be reduced or made more acceptable if it is
shared.
• Risk retention – when risk is agreed, accepted and accounted for in
budgeting, it is retained
146
Types of risk management

147. Refusal of proposal
• If due diligence reveals the contract risk
to be too high during the first stage of the
contract life
Renegotiation
• When risk has increased during the
course of the contract life cycle,
opportunities to review and renegotiate
terms may be taken
147
Non-Renewal
• At the end of the initial contract life
cycle, the business may decline to
renew the contract if the risk is too
high
Cancellation
• Where circumstances increase risk to
beyond acceptable levels during the
course of the contract life cycle
1. Risk Avoidance
There are four elements of risk avoidance.

148. 2. Risk Reduction
• An effective contract lifecycle management system reduces the contract risk in its
initial stages.
148
Contract Negotiation
• When necessary, renegotiation
at later contract life cycle stages
can be effective in contract risk
reduction, including at the
renewal stage.
• This should always be aimed
toward the mitigation of risk
and the reduction of loss.
Standardization
• Creating a library of standardized
terms, conditions and clauses is an
important method of contract risk
reduction.
• It ensures a cohesive approach by all
personnel and enables teams

149. 3. Risk Transfer
• The transfer or sharing of contract risk in contract management is
accomplished through due diligence on third parties and subsequent
outsourcing
• This is an effective strategy for both manufacturing and service
provision businesses where certain aspects of the operation can be
contracted out to another company.
149

150. 4. Risk Retention
• Every time a business signs, renegotiates, or renews a contract, there
is an element of risk retention because every contract incurs risk at a
some level.
– This includes customers as much as suppliers
• When entities and individuals know that their interests are a priority,
the business benefits from repeat business and loyalty.
150

151. What is a risk assessment?
Risk assessment is the process of:
• Identifying hazards,
• Analyzing / evaluating the
associated risk
•Determining appropriate ways
to eliminate or control the
hazard
The main aim of risk Assessment
 To protect workers’ health and
safety.
 To minimize the possibility of the
workers and environment harmed
due to work-related activities

152. Risk assessment helps to….
•Determine if existing control measures are adequate or if
more should be done
•Prevent injuries or illnesses when done at the design or
planning stage
•Prioritize hazards and control measures

153.  How do you do a risk assessment?
• Identify hazards,
• Evaluate the likelihood of an
injury or illness and severity,
• Consider normal operational
situations as well as non-
standard events such as
shutdowns, power cuts,
emergencies, etc.,
• Review available health and
safety information
• Identify actions necessary to
eliminate or control the risk
• Monitor and re-evaluate to
confirm the risk is controlled,
• Keep any documentation or
records that may be necessary

154. Basic principles of risk management
What are the 5 principles of controlling risk?
•Risk identification
•Risk analysis
•Risk control
•Risk financing
•Claims management
154

155. 1: Risk identification
• This first principle is just what it
sounds like
• What risks are presented to me, my
organization, my customers, etc.?
• Consider the kinds of jobs
employees perform and where they
work in order to identify the
greatest risks.
155
• Are employees lifting things,
operating heavy machinery, using
sharp objects to administer patient
care, cutting down trees, flying on
airplanes, or seated at desks?
• What dangers might they be
exposed to in their daily work
environment?

156. 2: Risk analysis
• This stage involves gathering data and
considering the meaning of the data
points over a span of time.
• An analysis of the identified risks begs
one to ask:
• How often could this adverse event
happen (frequency)?
• And if it does happen, what’s the
worst way it could turn out (severity)?
156
• Examine loss runs by
occupation, injury
type/frequency, root cause and
more
• Drill down to identify what
kinds of workplace incidents
are happening more often and
the possible exposure

157. 3: Risk control
• Risk control offers opportunities to
implement solutions that support risk
avoidance, prevention and reduction.
• In reality, a minimal amount of risk
still exists
• Risk prevention aims to reduce the
frequency or likelihood of the event
or loss.
• Risk reduction aims to lower the
severity of a particular loss that has
already occurred.
157
• Look at the solutions the organization
currently has in place to avoid, prevent,
and reduce workers’compensation
illness and injury.
• This can include everything from loss
control to safety programs.
• Then, focus on prioritization and
implementing effective solutions to fill
the gaps.

158. 4: Risk financing
 This fourth principle focuses on the economics of risk.
 Risk financing is a way to cover any financial losses that the
implemented risk control techniques did not prevent from
happening.
 Determine the optimal financial structure for the organization’s
workers’ compensation program.
 Is self-insurance right for them, or would it be better to transfer
some of the risk to an insurance carrier.
 Work with an experienced broker for professional guidance.
158

159. 5: Claims management
• Claims are about managing the harm done.
• When a loss occurs, a claim may be filed to recover damages.
• Develop a program that ensures employees harmed on the job are
compensated appropriately
– Receive access to high-quality, cost-effective care and the additional support
they need to realize maximum recovery and resume productivity.
• Consider how the organization and its employees could benefit from
partnering on the administration of their workers’ compensation
claims.
159

160. Principle of Crocodile
• Identify the risk
• Evaluate the risk
• Eliminate the risk
• Substitute the risk
• Isolate the risk
• Use PPE
Or else….Run away !

161. Epidemiology and
Statistics in IPC

162. A Public Health Approach
Surveillance
Risk Factor
Identification
Intervention
Evaluation
Implementation
162

163. Public Health Core Sciences
163

164. Epidemiology
• Study of the distribution and determinants of health-related states
among specified populations and the application of that study to the
control of health problems
164

165. Epidemiology Purposes in IPC
• Discover the agent, host, and environmental factors that affect
health
• Determine the relative importance of causes of illness, disability,
and death
• Identify those segments of the population that have the greatest risk
from specific causes of ill health
• Evaluate the effectiveness of health programs and services in
improving population health
165

166. Solving Health Problems
Step 1
Data
collection
Action
Solving health
problems
Assessment
Hypothesis
testing
Action
Step 2
Step 3
Step 4
Step 1 -
Surveillance; determine
time, place, and person
Inference
Determine how and why
Intervention
Step 1 -
Step 2
Step 3
Step 4
166

167. Epidemiology key terms
• Epidemic or outbreak: disease occurrence among a population that
is in excess of what is expected in a given time and place.
• Cluster: group of cases in a specific time and place that might be
more than expected.
• Endemic: disease or condition present among a population at all
times.
• Pandemic: a disease or condition that spreads across regions.
• Rate: number of cases occurring during a specific period; always
dependent on the size of the population during that period.
• 167

168. • Rates help us compare health
problems among different
populations that include two or
more groups who differ by a
selected characteristic
Comparing Population Characteristics
168

169. Rate Formula
• the number of cases of the illness or condition
• the size of the population at risk
• the period during which we are calculating the rate
To calculate a rate, we first need to determine the
frequency of disease, which includes
169

170. Epidemiology Study Types
Epidemiology
study
types
Experimental
Observational
Descriptive
Analytic
170

171. Descriptive and Analytic Epidemiology
Descriptive epidemiology Analytic epidemiology
When was the
population affected?
How was the
population affected?
Where was the population affected? Why was the
population affected?
Who was affected?
171

172. Epidemiology Data Sources
and Study Design
172

173. Data Sources and Collection Methods
Source Method Example
Individual persons • Questionnaire
• Survey
• Foodborne illness outbreak
• CDC’s National Health and
Nutrition Examination Survey
• Health data on U.S. residents
Environment • Samples from the
environment (river
water, soil)
• Sensors for
environmental changes
• Collection of water from area
streams — check for chemical
pollutants
• Air-quality ratings
Health care
providers
• Notifications to health
department if cases of
certain diseases are
observed
• Report cases of meningitis to
health department
Nonhealth–related
sources (financial,
legal)
• Sales records
• Court records
• Cigarette sales
• Intoxicated driver arrests
173

174. • Studies are conducted in an
attempt to discover
associations between an
exposure or risk factor and a
health outcome
Conducting Studies
174

175. Study Design — Cross-Sectional Study
Subjects are selected because
they are members of a certain
population subset at a certain
time
175

176. Study Design — Cohort Study
Subjects are categorized on the
basis of their exposure to one or
more risk factors
176

177. Study Design Type — Case-Control Study
• Subjects identified as having
a disease or condition are
compared with subjects
without the same disease or
condition
177

178. Investigating an Outbreak
178

179. • Establishing the existence of an outbreak
• Preparing for fieldwork
• Verifying the diagnosis
• Defining and identifying cases
• Using descriptive epidemiology
• Developing hypotheses
• Evaluating the hypotheses
• Refining the hypotheses
• Implementing control and prevention measures
• Communicating findings
Ten steps are involved in outbreak investigations, including
179

180. • Use data from data sources
Step 1 — Establishing the existence
of an outbreak
• Research the disease
• Gather supplies and equipment
• Arrange travel
Step 2 — Preparing for field work
180

181. • Speak with patients
• Review laboratory findings and
clinical test results
• Establish a case definition by
using a standard set of criteria
Step 3 — Verifying the
diagnosis
Step 4 — Defining and identifying
cases
181

182. Step 5 — Using descriptive
epidemiology
• Describe and orient the data
182

183. Step 6 — Develop a focused hypothesis
Step 7 — Evaluate the hypothesis for
validity
Step 8 — Refine the hypothesis as
needed
183

184. Step 9 — Implement control and prevention
measures
• Determine who needs to know
• Determine how information will be
communicated
• Identify why the information needs to
be communicated
Step 10 — Communicate findings
• Control and prevent additional cases
184

185. 185
Infection Prevention and Control Program Management

186. Successful IPC programs in health care facilities are based on
– Understanding the facility’s problems
– Needs, prioritizing activities, and using available resources
effectively
– Infection surveillance systems, microbiology laboratory
– Resources to identify the cause of HAIs, and treatment options for
– Best strategy available to protect patients and limit the spread of
disease within health care facilities.
186

187. Key Attributes for Effective Infection Prevention and Control Programs
• A successful IPC program must be able to effectively guide, support, and assess
IPC at the facility.
• To achieve this, the program must acquire and retain the following attributes:
 Designated staff member who is responsible and accountable for IPC at the facility
 Competent IPC leaders with appropriate training and education
 Formal authority granted to the IPC program
 Tangible support from facility leadership
 Adequate resources for IPC activities
 Partnerships with key stakeholders and front-line HCWs
 Effective communication about IPC
187

188. • Designated staff member responsible and accountable for IPC at the
facility:
• Designated as having the responsibility and accountability for overseeing
the facility’s IPC activities
• Preventing HAIs is the responsibility of all HCWs who provide services
• It includes monitoring current practices, clinical results, and surveillance
data and intervening to provide education and change the culture and
behavior when problems and risks are identified.
• The number of IPC staff and their level of prior experience and training in
an IPC program will vary depending upon the size and type of health care
setting.
188

189. • Competent IPC leaders with appropriate training and education:
Once one or more people are designated as responsible and
accountable for a facility’s IPC program;-
– It is important for these individuals to pursue and/or maintain
some type of IPC training and education.
– Depending upon the setting and resources, this training can be as
simple as reading published literature, guidelines and policies,
and manuals and gaining on-the-job
189

190. Formal authority granted to the IPC
program
– Regulatory authorities should create an
IPC infrastructure from the national
level down to the health care facility
– The IPC staff are responsible for
ensuring that all other health care
facility staff follow, and evidence-based
IPC practices
– IPC staff can influence the behavior of
HCWs by building relationships
190
Such administrative statements may
include the following:
• Official endorsement of the
facility’s IPC program
• IPC program organizational
structure at the facility level as per
national guidelines

191. • Conduct surveillance and respond to outbreaks.
– Implement antimicrobial stewardship programs.
– Develop, implement, and update facility IPC policies and practices as per
the national guidelines.
– Initiate surveillance of HAIs and prevention and control measures
– Notify regulatory authorities of any potential outbreak
– Provide technical updates and competency-based trainings to HCWs on a
regular basis
– Availability of resources for IPC programs
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The roles and authority of the program staff to perform designated duties

192. • Tangible support from facility leadership
– it is important that the facility leadership openly demonstrates
support for the IPC program’s staff, priorities, and policies
– This may include leadership discussions of IPC at staff and leadership
meetings, senior leadership support for IPC directives, and other
visible ways of demonstrating support.
– Leadership support lends credibility and importance to IPC initiatives
and helps to obtain the cooperation and focused effort of HCW.
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193. • Adequate resources for IPC activities (time and budget):
– The IPC program must work with facility leadership to define the
facility’s priorities and to obtain and allocate resources.
– Identified priorities and problem areas can guide the allocation of
scarce resources.
– Most HAIs can be prevented with readily available, relatively
inexpensive strategies.
– This means that investment in people, rather than equipment, is the
primary resource needed to oversee and optimize IPC practices
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194. • Partnerships with key stakeholders and front-line HCWs:
– IPC staff cannot prevent HAIs alone. Effective implementation of
IPC
– Partnerships and collaboration between the IPC program staff and
a variety of other stakeholders and front-line HCWs
– Ideally, the IPC staff provide guidance, expertise, data, education,
encouragement, support, and communication to their colleagues at
all levels of the facility.
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195. • Effective communication about IPC:
– Good communication between the IPC program and the rest of the
health care facility staff.
– Communications should be structured so that the information is
readily accessible and understandable
– Regular feedback of IPC data is one of the most important
communication activities.
– Visual displays of the data with clearly marked goals and progress
are powerful IPC tools
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196. Key Staff and Groups Involved in Infection Prevention and
Control Programs
• Administrative leadership
– The reporting structure can be adapted to fit local culture and
needs
– Ideally, one or more health care administrators will supervise the
leader of the IPC program and will take an active role in helping
to shape and support the program’s priorities and plans.
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197. • IPC committee
– Partnerships between the IPC staff and others in the health care
facility are necessary.
– The purpose of the committee is to guide and support the use of
recommended practices and to review and resolve related
problems
– The committee advocates for resources required for effective
implementation of the IPC program
– This committee should include representatives from different
wards
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198. • Task forces/working groups: Task forces or working groups, or
similar structures that interact with the IPC team, may, at times, be
needed.
• These may be permanent or temporary groups, and may be created as
needed to provide input and
• Task forces/working groups should consist of individuals with
multidisciplinary expertise and should be granted authority to make
decisions and advise and oversee the IPC leadership and team
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199. • Structure and Organization of Infection Prevention and
Control Programs
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200. Structure and Organization of Infection Prevention and Control
Programs
• IPC at the facility level receives support from the highest-level
public health authorities with a planned and effective national IPC
structure
• Having a robust structure and capacity in IPC at national and local
levels strengthens the ability to plan and implement IPC and
respond to communicable disease emergencies
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201. • The WHO Core Components of IPC:
1. IPC programs at national and facility level
2. IPC guidelines at national and facility level
3. IPC education and training at national and facility level
4. Surveillance of HAIs at national and facility level
5. Multimodal strategies for implementing IPC activities at national and
facility level
6. Monitoring and evaluations and feedback at national and facility level
7. Workload, staffing, and bed occupancy at the facility level
8. Built environment, materials, and equipment for IPC at facility level
201

202. Thank you
202