Brian Kristensen: Why do we need an Infection Control Program

1. THE NEED OF AN INFECTION
PREVENTION AND CONTROL
PROGRAMME
Brian Kristensen
Head, senior consultant, phd
National Center for Infection Control
Infection preparedness

2. AGENDA
The problem
The basics
What is an Infection Prevention and Control
Programme (IPC programme)
What is needed
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3. HOSPITAL ACQUIRED INFECTIONS
Hospital acquired infections is prevalent
Hospital acquired infections contribute to AMR
Overuse of antimicrobials (development)
Impair infection control practices (spread)
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4. HOSPITAL ACQUIRED INFECTIONS IN EUROPE
Point prevalence survey of healthcare-associated infections and antimicrobial use in
European acute care hospitals 2011–2012, ECDC 2013
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5. BURDEN OF HAI I
Hospital cost
- Increased length of stay + additional investigations and
treatment
Private cost
- Pain, death, discomfort
Societal cost
- Loss of productivity
Cost not accounted for:
- Infections at health care workers
- Outbreaks
- Transfusion-related infections
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6. BURDEN OF HAI II
Six healthcare-associated infections according to their number of cases per
year (x-axis), number of deaths per year (y-axis), and DALYs per year (width of
bubble), DALY, disability-adjusted life year; HA, healthcare-associated.
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Cassini A, T, et al. (2016) Burden of Six Healthcare-Associated Infections on European Population Health: PLoS Med 13(10): e1002150.2013

7. THE NEED FOR INFECTION CONTROL
Hospital-acquired infections increase the cost of
health care
World Bank studies have shown that two-thirds of
developing countries spend more than 50% of their
health care budgets on hospitals
Effective infection control programs are beneficial
They decrease spread of nosocomial infections,
morbidity, mortality, and health care costs
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8. DEVELOPMENT OF AMR
Poor or absent infection control practices results in
cross-transmission of antibiotic-resistant bacteria.
Resistant bacteria prompts even greater antibiotic
use by physicians.
Perception of knowledge by physicians of poor
sterilization, disinfection, or patient care practices
prompts increased antibiotic use
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9. THE VICIOUS CIRCLE OF HAI AND AMR
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Antibiotic
Stewardship
Infection
Control
Antibiotic Stewardship and Infection Control act together

10. SPREAD OF MICROORGANISMS
Chain of transmission
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MODE OF
TRANSMISSION
CAUSATIVE
AGENT

11. CHAIN OF TRANSMISSION: E.G., MRSA
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12. THE MODES OF TRANSMISSION
Contact
- E.g. MRSA, CPO
Droplet
- E.g. TB
Airborne
- Measles
Alimentary/feco/oral
- Norovirus, Hepatitis A
Bloodborne
- Hepatitis B
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Prevalence and significance

13. STANDARD PRECAUTIONS
Hand hygiene, before and after every episode of
patient contact (ie 5 Moments for Hand Hygiene)
Use of personal protective equipment (PPE)
Safe use and disposal of sharps
Routine environmental cleaning
Respiratory hygiene and cough etiquette
Aseptic non-touch technique
Waste management
Appropriate handling of linen.
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14. TRANSMISSION BASED PRECAUTIONS
The first line of prevention of infection is the use of
standard precautions.
Transmission-based precautions are additional work
practices for specific situations where standard
precautions are not sufficient to interrupt
transmission
These precautions are tailored to the particular
infectious agent and its mode of transmission.
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15. INFECTION PREVENTION AND CONTROL PROGRAMME
Is a systematic approach where activities, policies
and procedures are designed to control and prevent
the transmission of infectious diseases within the
healthcare environment and the community
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16. CORE COMPONENTS
16
Core components at national and/or regional/local level
Organisation (IPC Programme, and Antibiotic policy)
Guidelines
Education and training
Surveillance
Multi-modal strategies
Monitoring/audit of IPC practices and feedback
Core components at regional/local level
Workload, staffing and bed occupancy (acute health care facility only)
Built environment, materials and equipment for IPC at the facility level
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17. TARGET AUDIENCE OF IPC PROGRAMME
National level
- Policy makers, Staff within ministeries of health
Facility level
- Hospital managers, local teams
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18. CORE COMPONENTS (SHORT VERSION)
Organisation
- ”.. Clearly defined objectives.. ,.. Dedicated trained professionals.. ,.. Good quality
microbiological laboratory support..”
Guidelines
- ”..Evidence based.., …adaption to local conditions.., ..monitoring adherence..
IPC education and training
- ”.. Part of the overall education strategy.. ,.. Regardless of level and position.. ,.. Postgraduate
curricula..”
Surveillance
- ”..National recommendations and standard defintion.., ..early detection of some outbreaks..,
…allocation of human and financial ressources..,
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19. CORE COMPONENTS (SHORT VERSION)
Multimodal strategies
- ”.. using multimodal´strategies should be implemented to improve practices and
reduce HAI and AMR.. ,.. Support facility level improvement…”
Monitoring/audit
- ”.. achieve behaviour change.. to improve quality of care and practice with the goal
of reducing the risk of HAI and AMR spread.., ..sharing the audit results…, .. IPC
programmes should be periodically evaluated..”
Workload, staffing, bed occupancy
- ”.. Standards for bed occupancy.. ,.. Overcrowding…”
Built environment
- ”.. Ensuring an adequate hygienic environment..”
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20. IMPORTANT ISSUES FOR IPC AND AMR
Establishing a national action plan
The laboratory capacity
Data management and infrastructure
Sales of antibiotics without prescription
Public awareness
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21. DENMARK: FACTS
5.6 million inhabitants
5 regions
Each person has a unique
Central Person Registry-number
(CPR)
The National Disease Control is
based upon use of the CPR
SSI offer service to all hospitals
and GP’s in Denmark
In each region, at least 1 Dept of
Clinical microbiology and an
Infection Control Unit
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22. THE SETTING IN DENMARK
Hospital activity in Denmark
Average beddays is 3.6 (2017)
Total expenditures of GNP on Health care services:
≈ 10.5 % (USA 17%)
22
Per 1000 inhabitants
Admissions
Ambulatory care
Beddays
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23. ICP AND AMR IN DENMARK (SHORT VERSION)
A national action plan on AMR, but none formalized
action plan for infection control
An extensive laboratory capacity (e.g. approx. 8% of all citizens in
Denmark are blood cultured each year)
Well established data management and
infrastructure, but…..
Hospital service is free of charge, and antibiotic had
to be prescribed
A high level of public awareness
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24. INTERACTION: NATIONAL AND REGIONAL
National level:
- setting the framework by guidelines from National Board
of Health and National Center for Infection Control
- Definining the economic framework
Regions
- Hospital-based and regions-based infection control
comittees
- Antibiotic guidelines
Municipality
- Most have an infection control comittee,
- Some have defined action plans
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25. FUTURE OF INFECTION PREVENTION AND CONTROL
Megatrends affecting Infection Prevention and Control
- Globalisation
- Changes in production and societal organisation
- Behavioural changes
- More elderly population
Important developments
- Better understanding of microorganisms (Diagnostics, transmission, outbreak)
- New technologies (eg., robot surgery)
- More research of how to interrupt transmission
- Implementation of how to improbe basic knowledge of hygiene
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26. SUMMARY I
Infection control procedures are vital to preventing nosocomial
infections and for controlling hospital costs.
Simple, inexpensive strategies can prevent many infections.
Your local infection control comittee can support many IC activities.
- Hand washing and use of appropriate antiseptics and disinfectants
- Monitoring IV and injection preparation and administration
Your local infection control comittee should actively promote better
use of antimicrobials.
- Guidelines for treatment and surgical prophylaxis
- Selection of appropriate antimicrobials for the formulary
- Antimicrobial use reviews
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27. SUMMARY II
Infection Control Committees or programs, when
functioning effectively, will
Reduce the spread of infectious diseases
Decrease morbidity and mortality due to nosocomial
infections
Maintain employee health and morale
Decrease the incidence of AMR
Decrease health care costs
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28. ICP AND AMR IN NORTH WEST RUSSIA?
Is there an national/regional action plan on
- AMR
- Infection control
What is the laboratory capacity
How is the hospital service organized: public vs
private
Is antibiotic sold without prescription/ over the
counter sales
Is infection control an issue debated in the
public
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