Infection prevention and control FULL COURSE(2).pdf

INFECTION PREVENTION
AND CONTROL (IPC)
By:
Dr. Mohammed Salah, Ph.D.
Lecturer of Microbiology and Immunology
Faculty of Pharmacy, Al-Azhar University
E-mail: Mohammed_salah@Azhar.edu.eg
1
Dr. Mohammed Salah, PhD
5/19/2023

 Course outlines
1. Introduction
2. Definition of infection control
3. Infection Spread in Healthcare settings
4. Chain of infection
5. Breaking the chain of infection
6. Standard infection control precautions (SICPs)
7. Decontamination (cleaning, disinfection and sterilization)
8. Isolation precautions
9. Controlling Infectious Diseases Within Communities
Dr. Mohammed Salah, Ph D 2
5/19/2023

 Introduction
 There are many diseases that can spread easily in our community if controls
are not in place.
 To protect your own health as well as the health of those around you, an
understanding of infectious diseases, how they are spread and how to control
them is fundamental.
5/19/2023

 Infectious diseases
 Infectious diseases are disorders that are caused by organisms, usually
microscopic in size, such as bacteria, viruses, fungi, or parasites that are
passed, directly or indirectly, from one person to another
Bacteria T.B
Virus Influenza
Fungi Oral thrush
Parasite Bilharzia
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 Definition of infection
• The invasion and growth of pathogen in the body, followed by
multiplication and producing its metabolites, leading to harmful effects
• Infections can begin anywhere in the body and may spread all through it.
So, what is the pathogen?
• A pathogen is defined as an organism causing
disease to its host, with the severity of the disease
symptoms referred to as virulence.
• Pathogens are taxonomically widely diverse
and comprise viruses and bacteria as well as
unicellular and multicellular eukaryotes
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Host cell
MO
1. Adhesion
Target receptor
Ligand
2. Invasion
 General mechanism of infection
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3. Multiplication
Host cell
MO MO
MO
MO
MO MO
4. Colonization
…………..
…………..
……
……..
……
……
..
Release of toxins & Virulance factors
Cell rupture & Disease occur
 General mechanism of infection
5/19/2023

 Infection and colonization
Infection:
Means that germs are in or on the body
and make you sick, which results in
signs and symptoms such as fever, pus
from a wound, a high white blood cell
count, diarrhea, or pneumonia.
• Colonization:
Means germs are on the body but
do not make you sick.
People who are colonized will
have no signs or symptoms
5/19/2023

 Occurrence of infection
 Three things are necessary for an infection to occur:
1) Source:
Places where infectious agents (germs) live (e.g., surfaces, human skin)
2) Susceptible Person
with a way for germs to enter the body
3) Transmission:
a way germs are moved to the susceptible person
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 Nosocomial infection (HAI)
 Nosocomial infections also referred to as healthcare-associated infections
(HAI), are infection(s) acquired during the process of receiving health care
that was not present during the time of admission.
 Some of the common nosocomial infections are:-
1. Urinary tract infections
2. Respiratory pneumonia
3. Surgical site wound infections
4. Bacteremia
5. Gastrointestinal infections
6. Skin infections
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 Asepsis
Definition:
Asepsis is a condition in which no living disease-causing microorganisms are present
including procedures designed to reduce the risk of bacterial, fungal or viral
Contamination, using:
1. Sterile instruments.
2. Sterile draping.
3. The gloved 'no touch' technique.
a. Medical asepsis
is the state of being free from disease causing microorganisms.
Medical asepsis is concerned with prevention of the spread of microorganisms through
facility practices
b. Surgical asepsis
is practices that completely kill and eliminate microorganisms.
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 Epidemiological Triad
1. The Agent - The microorganism that
causes the infection
2. The Host - The target of the disease
3. The Environment - The surroundings
and conditions (these are external to the
host)
The spread of infectious disease requires three variables,
known as the epidemiological triad
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 Infection Spread in Healthcare settings
• In a healthcare setting, the three components required for infection spread
are the following:
1. Source:
places where infectious agents survive.
a) Environment: patient care areas, sinks, hospital equipment,
countertops, medical devices.
b) People: patients, healthcare workers, or visitors.
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2. Susceptible Person:
Someone (Patient, Healthcare Worker, or Visitor) who is not vaccinated or
immune to a, or an individual with a compromised immune system for
particular infectious disease
In addition, susceptibility can be heightened in individuals due to underlying
medical conditions, medications, and necessary treatments and procedures
that increase the risk of infection (for example, surgery).
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3. Transmission:
The way that germs are moved from source to the susceptible person
• Touch, including via medical equipment or a susceptible person (for
example, MRSA or VRE)
• Sprays or splashes (for example, Pertussis)
• Inhalation of aerosolized particles (for example, TB or Measles)
• Sharps injuries introducing blood-borne pathogens (for example, HIV, HBV, HCV)
5/19/2023

Infection prevention and control
(IPC)
• Infection control refers to the policy and procedures implemented to control and
minimize the spread of infections in hospitals and other healthcare settings to
reduce the infection rates.
• In other words, infection control is a
set of methods used to control
and prevent the spread of infection among
patients and health workers
• The main purposes of infection control:
1. Reduce occurrence of infectious diseases
2. Prevent transmission of communicable
diseases
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 Successful infection control
A. Maintaining a safe environment for
people, patients and Health Care
Workers (HCWs) in a healthcare
setting.
B. Identifying hazards and classifying
the associated risks.
This task requires cooperation between management, HCWs
and support staff.
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 Infection cycle
To prevent the spread of
infection, break any one of
the links in the chain.
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 Infection cycle
1. Infectious agent:
For example, bacteria, virus and fungi, are disease causing agents
factors affect the potential of microorganism to causes a disease are:
a. number of organism
b. host immune response
c. length of contact between host and causative M.O
2. Reservoir:
The reservoir is where the infectious agent lives and multiplies.
A reservoir could be a body of water, food, human, or animal.
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 Infection cycle
3. Portal of exit:
The portal of exit is the way that the infectious agent leaves its reservoir.
Common routes:
a. respiratory: coughing, sneezing
b. genitourinary tract: folly catheter, sexually transmitted diseases
c. GIT: feces and vomiting
d. Skin and mucous membranes: skin breaks and wounds
e. blood and tissue: needle stick and blood transfusion
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 Infection cycle (cont.)
4. Mode of transmission:
Microorganisms can not travel on their own they require a vehicle to carry them to other people and
places
The mode of transmission explains how the infectious agent gets from the reservoir to the new host.
Common ways:
a. Direct
Direct contact
Droplet spread
b. Indirect
Airborne
Vehicle borne (oral feacal)
Vectorborne (mechanical or biologic)
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 Infection cycle (cont.)
5. Portal of entry:
The portal of entry is how the
infectious agent enters into the new
host
6. Susceptible host:
A susceptible host is the recipient of
the infection
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 People at high risk of infection?
1. Staff:
because they are exposed to blood and other body fluids
2. Clients:
they are at high risk of post procedural infections
e.g. service provider don not wash hands between client and procedure
e.g. not cleaned instruments
3. Community:
inappropriate disposal of medical waste
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 Breaking the chain of infection
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 Breaking the chain of infection
Break the chain by:
1. Cleaning your hands frequently,
2. Staying up to date on your vaccines (including the flu shot),
3. Covering coughs and sneezes and staying home when sick,
4. Following the rules for standard and contact isolation,
5. Using personal protective equipment the right way,
6. Cleaning and disinfecting the environment,
6. Sterilizing medical instruments and equipment,
7. Following safe injection practices,
8. Using antibiotics wisely to prevent antibiotic resistance.
Preventing infection means breaking the links in the chain so that an
infection cannot spread
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 How to Implement Infection Control?
1. Promote infection control as standard practice.
2. Have processes and protocols in place.
3. Have appropriate facilities and consumables
(allocate funds).
4. Signage ‫الفتات‬ e.g. correct hand washing technique.
5. Provide and take part in training sessions.
6. Maintain records of training.
7. Promote vaccination.
8. Adopt a risk management approach to infection control.
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 Standard infection control precautions (SICPs)
Standard infection control precautions (SICPs) are to be
used by:
all staff, in all care settings, at all times, for all patients
whether infection is known to be present or not, to ensure
the safety of those being cared for, staff and visitors in the
care environment.
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SICPs are the basic infection prevention and control measures
necessary to reduce the risk of transmitting infectious agents from
both recognised and unrecognised sources of infection.
Sources of (potential) infection include blood and other body fluids,
secretions or excretions (excluding sweat), non-intact skin or
mucous membranes and
any equipment or items in the care environment that could have
become contaminated.
5/19/2023

 There are 10 elements of SICPs:
1. Patient placement/assessment of infection risk
2. Hand hygiene
3. Respiratory and cough hygiene
4. Personal protective equipment (PPE)
5. Safe management of the care environment
6. Safe management of care equipment
7. Safe management of healthcare linen
8. Safe management of blood and body fluids
9. Safe disposal of waste (including sharps)
10. Occupational safety/managing prevention of exposure (including sharps)
5/19/2023

AND CONTROL (IPC)
LECTURE II
Standard infection control precautions
(SICPs)
5/19/2023

 SICPs are the basic infection prevention and control (IPC) measures necessary to reduce
the risk of transmitting infectious agents from both recognised and unrecognised sources
of infection.
 Standard infection control precautions (SICPs) are to be used by:
 all staff,
 in all care area,
 at all times,
 for all patients
 whether infection is known to be present or not, to ensure the safety of those being cared
for, staff and visitors in the care environment.
 Sources of (potential) infection include:
 blood and other body fluids,
 secretions or excretions (excluding sweat),
 non-intact skin or mucous membranes and
 any equipment or items in the care environment that could have become contaminated.
5/19/2023

 There are 10 elements of SICPs:
1. Patient placement/assessment of infection risk
2. Hand hygiene
6. Safe management of care equipment
7. Safe management of healthcare linen
8. Safe management of blood and body fluids
9. Safe disposal of waste (including sharps)
10. Occupational safety/managing prevention of exposure (including sharps)
5/19/2023

1. Patient placement/assessment for infection risk
 Mean that patients must be promptly assessed for infection risk on arrival at
the care area, e.g. inpatient/outpatient, (if possible, prior to accepting a patient
from another care area) and should be continuously reviewed throughout
their stay.
 This assessment should influence placement decisions in accordance with
clinical/care need(s).
 Patients who may present a cross-infection risk include those:
1. with diarrhea, vomiting, an unexplained rash, fever or respiratory
symptoms
2. known to have been previously positive with a multi-drug resistant
organism (MDRO), eg MRSA, CPE
5/19/2023

2. Hand hygiene
 Hand hygiene is considered one of the most important ways to
reduce the transmission of infectious agents that cause
healthcare associated infections (HCAIs).
 Before performing hand hygiene:
I. expose forearms (bare below the elbow
II. remove all hand and wrist jewellery.
III. ensure fingernails are clean and short, and do not wear
artificial nails or nail products
IV. cover all cuts or abrasions with a waterproof dressing
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2. Hand hygiene (cont.)
 5 Moments for Hand Hygiene
a) before touching a patient.
b) before clean or aseptic procedures.
c) after body fluid exposure risk
d) after touching a patient; and
e) after touching a patient’s immediate surroundings
Always perform hand hygiene before putting on and
after removing gloves.
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2. Hand hygiene (cont.)
Hands should be washed using soap, water and then dried:
BEFORE
‒ handling, preparing or eating food
BEFORE AND AFTER
‒ assisting students with eating/meals
‒ assisting students with toileting
‒ providing first aid or medication
‒ contact with an ill or injured person
AFTER
‒ contact with blood or body fluids
(this includes your own e.g. sneezing/coughing)
‒ removal of protective gloves
‒ using the toilet; and
‒ after contact with animals.
5/19/2023

a) cover the nose and mouth with a disposable tissue when sneezing, coughing,
wiping and blowing the nose; if unavailable use the crook of the arm
b) dispose of all used tissues promptly into a waste bin
c) wash hands with non-antimicrobial liquid
soap and warm water after coughing,
sneezing, using tissues, or after contact
with respiratory secretions or objects
contaminated by these secretions
d) keep contaminated hands away from
the eyes nose and mouth
5/19/2023

 All PPE must be:
a. located close to the point of use.
b. stored in a clean, dry area until required
c. single-use only unless specified by the manufacturer
d. changed immediately after each patient and/or after completing
a procedure or task
e. disposed of after use into the correct waste stream, e.g. domestic
waste, offensive (non-infectious) or clinical waste
f. discarded if damaged or contaminated
Avoiding overuse or inappropriate use of PPE is a key principle
that ensures this is risk-based and minimizes its environmental
impact.
Reusable PPE such as non-disposable goggles/face shields/visors,
must be decontaminated after each use according to
manufacturer’s instruction. Dr. Mohammed Salah, Ph D 38
5/19/2023

• May include the following (task dependent):
• Gloves
• Aprons
• Full body gowns
• Eye / Face Protection
• Footwear
• Headwear
Single use only
5/19/2023

A) Gloves:
• Gloves must be:
a) worn when exposure to blood and/or other body fluids, non-intact skin or mucous
membranes is anticipated
b) changed immediately after each patient and/or after completing a procedure/task even
on the same patient
c) changed if a perforation or puncture is suspected
d) sterile when worn in operating theatres and for insertion of central venous catheters,
insertion of peripherally inserted central catheters, insertion of pulmonary artery
catheters and spinal, epidural and caudal procedures
e) low risk of causing sensitisation to the wearer
f) appropriate for the tasks being undertaken, taking into account:
a) the substances being handled,
b) type and duration of contact,
c) size and comfort of the gloves,
d) the task and requirement for glove robustness and sensitivity
5/19/2023

B) Aprons
• Aprons must be:
• worn to protect uniform or clothes when contamination is anticipated or
likely, e.g. when in direct care contact with a patient.
• changed between patients and/or after completing a procedure or task
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C) Full body gowns
Full body gowns or fluid-resistant coveralls must be:
1. worn when there is a risk of extensive splashing of
blood and/or body fluids, e.g. operating theatre, ITU
2. changed between patients and removed immediately
after completing a procedure or task
3. sterile when sterility is required in an operating theatre
and for some aseptic techniques e.g. for insertion of
central venous catheters.
5/19/2023

D) Eye or face protection
 Eye or face protection (including full-face visors ‫)أقنعه‬ must be worn:
 if blood and/or body fluid contamination to the eyes or face is anticipated or likely,
e.g. by members of the surgical theatre team
 always during aerosol generating procedures (ETI), bronchoscopy
1. not be impeded by accessories such as piercings or false eyelashes
2. not be touched when being worn.
5/19/2023

Types of masks
1. Surgical mask: used in wards, departments and operating rooms
2. N95 particulate masks: with patients with diagnosed or suspected airborne
infectious diseases
5/19/2023

E) Footwear
 Footwear must be:
1. visibly clean,
2. non-slip and well-maintained,
3. and support and cover the entire foot to
avoid contamination with blood or other
body fluids or potential injury from sharps
removed before leaving a care area where
dedicated footwear is used, e.g. theatre;
these areas must have a decontamination
schedule with responsibility assigned.
5/19/2023

F) Headwear
 Headwear must be:
1. worn in the theatre settings and clean rooms, e.g.
central decontamination unit
2. well-fitting and completely cover the hair
3. changed or disposed of between clinical
procedures/lists or tasks and if contaminated with
blood and/or body fluids
4. removed before leaving the theatre or clean room
5/19/2023

5. Safe management of care equipments
 Care equipment is easily contaminated with blood, other body fluids,
secretions, excretions and infectious agents Consequently, it is
easy to transfer infectious agents from communal care equipment during care
delivery.
5/19/2023

 Care equipment is classified as either:
1. single use equipment which is used once on a single patient then discarded.
This equipment must never be re-used.
The packaging will carry the symbol of:
2. single patient use: equipment which can be reused on the same patient and may require
decontamination in-between use such as nebulizer masks
3. reusable invasive
equipment:
used once then decontaminated, e.g. surgical instruments
4. reusable non-
invasive equipment:
reused on more than one patient following decontamination between each use, e.g.
commode, patient transfer trolley.
5/19/2023

5/19/2023

5. Safe management of care equipment (cont.)
 Before using any sterile equipment check that:
1. the packaging is intact
2. there are no obvious signs of packaging contamination
3. the expiry date remains valid
4. any sterility indicators are consistent with the process being completed
successfully.
5/19/2023

 Decontamination of reusable non-invasive care equipment must be
undertaken:
a) between each use/between patients
b) after blood and/or body fluid contamination
c) at regular predefined intervals as part of an equipment cleaning protocol
d) before inspection, servicing or repair.
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• Levels of decontamination
5/19/2023

 Always adhere to Control of Substances Hazardous to Health (COSHH)
guidance for use and decontamination of all care equipment:
1. all reusable non-invasive care equipment must be decontaminated between
patients/clients using either approved detergent wipes or detergent solution,
in line with manufacturers’ instructions, before being stored clean and dry.
2. decontamination protocols must include responsibility for; frequency of;
and method of environmental decontamination
3. an equipment decontamination status certificate will be required if any item
of equipment is being sent to a third party, e.g. for inspection ‫صيانه‬,
servicing or repair
5/19/2023

 The care environment must be:
a) visibly clean,
b) free from non-essential items and equipment to facilitate effective cleaning
c) well maintained,
d) in a good state of repair
e) with adequate ventilation for the clinical specialty.
5/19/2023

 Routine cleaning
a) the environment should be routinely cleaned in accordance with the National
Cleaning Standards (NCS).
b) use of detergent wipes are acceptable for cleaning surfaces/frequently
touched sites within the care area. a fresh solution of general-purpose neutral
detergent in warm water is recommended for routine cleaning. This should
be changed when dirty or when changing tasks
c) routine disinfection of the environment is not recommended however,
1,000ppm available chlorine should be used routinely on sanitary fittings
d) staff groups should be aware of their environmental cleaning schedules for their area and clear on
their specific responsibilities
e) cleaning protocols should include responsibility for, frequency of, and method of environmental
decontamination
5/19/2023

7. Safe management of linen
a) Clean linen
1. should be stored in a clean, designated area, preferably an enclosed cupboard
2. if clean linen is not stored in a cupboard, then the trolley used for storage
must be
a) designated for this purpose
b) completely covered with an impervious covering able to withstand
decontamination
3. do not:
‒ rinse, shake or sort linen on removal from beds/trolleys
‒ place used linen on the floor or any other surfaces e.g. a locker/table top
‒ re-handle used linen once bagged
‒ overfill laundry receptacles (not more than 2/3 full); or
‒ place inappropriate items in the laundry receptacle e.g. used
equipment/needles.
5/19/2023

7. Safe management of linen (cont.)
b) Used linen:
1. ensure a laundry receptacle is available
as close as possible to the point of use for
immediate linen deposit
2. should be placed in an impermeable bag
immediately on removal from the bed or
before leaving a clinical department.
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7. Safe management of linen (cont.)
c) Infectious linen (this mainly applies to
healthcare linen)
1. linen that has been used by a patient who is
known or suspected to be infectious
2. and/or linen that is contaminated with blood
and/or other body fluids, e.g. feces:
linen in this category must be sealed in a water
soluble bag (entirely water soluble ‘alginate’ bag,
which is then placed in an impermeable bag
immediately on removal from the bed and secured
before leaving a clinical area.
infectious linen bags/receptacles must be tagged
(e.g. hospital care area) and dated
all linen that cant not be reused, e.g.
torn or heavily contaminated, should be
categorised at the deemed point of use
and returned to the laundry for
assessment and disposal.
5/19/2023

INFECTION PREVENTION AND
CONTROL (IPC)
LECTURE III
Standard Infection Control Precautions (SICPs)
By
Dr. Mohammed Salah
Microbiology and Immunology Department
Mail: mohammed_salah@Azhar.edu.eg
Office: B19
5/19/2023

Standard Infection Control Precautions (SICPs)
elements
1. Patient Placement/Assessment Of Infection Risk
2. Hand Hygiene
3. Respiratory And Cough Hygiene
4. Personal Protective Equipment (PPE)
5. Safe Management Of The Care Environment
6. Safe Management Of Care Equipment
7. Safe Management Of Healthcare Linen
8. Safe Management Of Blood And Body Fluids
9. Safe Disposal Of Waste (Including Sharps)
10. Occupational Safety/Managing Prevention Of Exposure (Including Sharps)
5/19/2023

 8. Safe management of body fluid spillages
►Body fluids include:
☺Blood
☺Vomit
☺Sputum
☺Faeces and Urine
►Spillages of blood and other body fluids may
transmit blood borne viruses such as Hepatitis
B and other.
5/19/2023

 Important considerations:
1. Spillages must be treated immediately by
trained staff, to undertake this safely.
2. Responsibilities for the treatment of
blood/body fluid spills must be clear within
each area/care setting.
3. Appropriate personal protective equipment
(PPE) should be worn and standard infection
control precautions followed.
5/19/2023

 The five main steps in a safe management of body
fluid spillages
1. Cordoon the spillage off
2. Assess the type of spillage
3. Collect the correct equipments
4. Protect yourself with PPE
5. Disinfect and clean
5/19/2023

Dealing with body fluids spillages
►Disinfectant used:
1. Chlorine-based disinfection, e.g. Milton.
2. Hypochlorite tablets or granules can be used.
5/19/2023

►Method of disinfection
1. Protect the area
2. Clean hands and put on disposable apron and gloves (PPE)
3. Place solution or granules directly onto the spillage. Leave
for the required contact time 20 minutes..
4. Clear away the spillage and dispose of as infectious waste
(for blood spillage) / offensive waste (for non blood
spillage
5/19/2023

►Method of disinfection (cont.)
5. With pH neutral detergent and warm water and disposable
cloth, clean the area, then leave to air dry or dry with
paper towels.
6. Dispose of cloth and paper towels as infectious waste /
offensive waste (for non blood spillage)
7. Wash, rinse and dry hands thoroughly to prevent the
transmission of infection
5/19/2023

5/19/2023

Dealing with blood/blood stained spillages
5/19/2023 Dr. Mohammed Salah, Ph D 71

 9. Safe disposal of waste (including sharps)
Biohazard:- Viable micro-
organisms or their toxins
Contains a biologically active
pharmaceutical agent
Contain a sharps & blades
Hazard effects of healthcare (including clinical) waste:
5/19/2023

 Categories of waste:
5/19/2023

 Safe disposal of waste (including sharps)
Important considerations:
Always dispose of waste:
a) immediately after used
b) close to the point of use as possible;
c) into the correct segregated colour approved
waste bag or container (rigid container or
sharps box if sharp)
d) liquid waste, e.g. blood must be rendered safe
by adding a polymer gel before placing in an
orange lidded leak proof bin
5/19/2023

e) waste bags must be no more than 3/4
full and use a ratchet tag/or tape (for
healthcare waste bags only) using a
‘swan neck’ to close.
f) store all waste in a designated, safe,
lockable area while awaiting uplift.
g) Items like used gloves, aprons, swabs,
dressings and other non-sharps that
are contaminated with blood and
bodily fluids will need segregation.
5/19/2023

 healthcare waste colour coding
5/19/2023

5/19/2023

 Safe management of sharps
What are sharps?
“Sharps' are needles, blades and other instruments that are used in healthcare
work and could cause an injury by cutting or pricking the skin.”
To make a safe handling of sharps:-
5/19/2023

 First aid in case of sharps injury
1. Encourage the wound to gently bleed, ideally
holding it under running water
2. Wash the wound using running water and plenty of
soap
3. Don't scrub the wound while you are washing it
4. Don't suck the wound
5. Dry the wound and cover it with a waterproof
plaster or dressing
6. Seek medical advice
7. Report the injury to your employer.
5/19/2023

 10. Occupational safety:
Prevention of exposure (including sharps injuries)
 Occupational Hazards
are the problems that HCWs face due to their occupation
1. A percutaneous injury
e.g. injuries from needles, instruments, bone
fragments, or bites which break the skin; and/or
2. Exposure of broken skin
(abrasions, cuts, eczema, etc); and/or
3. Exposure of mucous membranes
including the eye from splashing of blood or other
high risk body fluids.
5/19/2023

 10. Occupational safety:
Prevention of exposure (including sharps injuries)
Occupational health should aims to the promotion and maintenance of the
highest degree of physical, mental, and social well being of all HCWs
It includes:-
1. Follow arrangements for the safe use
and disposal of sharps;
2. provision of information and
training to employees;
3. investigations and actions required
in response to
work related sharps injuries
5/19/2023

CONTROL (IPC)
LECTURE VI
“Decontamination methods for IPC”
5/19/2023

 Introduction
Decontamination :-
is the process of removing or neutralizing contaminants that have
accumulated on personnel and equipment. it is critical to health and
safety at hazardous waste sites.
Decontamination process describe a combination of:-
A. cleaning
B. disinfection
C. and /or sterilization of
healthcare equipment and environment
Dr. Mohammed Salah, Ph D
5/19/2023 83

 Introduction
Make the item safe for staff to
handle without presenting an
infection hazard;
Make the item safe for use on a patient,
(after any additional processing) including,
when relevant, ensuring freedom from
contamination that could lead to incorrect
diagnosis
The decontamination process is intended to:
5/19/2023 84

 Decontamination processes are:
1. Cleaning:
A process that removes dirt, dust, large numbers of micro-
organisms and the organic matter using detergent and
warm water or disposable detergent wipes, such as blood
or faeces that protects them.
Cleaning is a pre-requisite to disinfection or sterilization??
2. Disinfection:
The reduction of the number of viable microorganisms on
a product to appropriate level for its intended use, with the
exception of bacterial spores
3. Sterilization:
the process used to render an object free from viable
micro-organisms including viruses and bacterial spores.
5/19/2023 85

 Levels of decontamination
5/19/2023

 Choosing an appropriate method of decontamination
1. The type of material to be treated
2. Device’s intended use
3. The organisms involved
4. How many times can it be re-processed?
5. Does processing constitute a hazard to patients and staff?
6. Degree of soilage
7. Process must not damage the device
The appropriate method of decontamination, depends on a number of factors:-
5/19/2023

I. Cleaning
Overview
1. Definition of cleaning
2. Importance of cleaning process
3. The five principles of cleaning
4. Pre-Cleaning/Cleaning personell
5. Cleaning the equipments/environment
6. Cleaning the specialist instruments
7. Routine cleaning
5/19/2023

I. Cleaning
1. Cleaning:
A process that removes dirt, dust, large numbers of micro-organisms and
the organic matter using detergent and warm water or disposable detergent
wipes, such as blood or faeces that protects them.
5/19/2023

2. Importance of cleaning process
1. Cleaning removes grease, soil and approximately
80% of micro-organisms.
2. It is an important method of decontamination and
may be safely used to decontaminate low risk items such
as washbowls and commodes.
3. Medium and high risk items must be cleaned
thoroughly prior to disinfection and sterilization.
5/19/2023

3. The five principles of cleaning
5/19/2023

Everyone responsible for handling and reprocessing contaminated
items must:
• Receive adequate training and periodic retraining
• Wear appropriate personal protective equipment (PPE)
• Receive adequate prophylactic vaccinations
92
4. Pre-Cleaning/Cleaning
personell
5/19/2023 Dr. Mohammed Salah, Ph D

5. Cleaning the equipments
/environment
1. Use a designated sink ‫حوض‬ for cleaning (not a hand wash basin).
2. Wear protective clothing as appropriate.
3. Use disposable cloths and discard after use.
4. Use neutral detergent (e.g. Windex, Hospec Ecolab) and hot
water (maximum 42-43oC) for general cleaning.
5. Rinse well to remove detergent residue.
6. Work from clean areas to dirty.
7. Dry after cleaning (using disposable towels where appropriate).
8. Store cleaning equipment clean and dry.
9. DO NOT use chlorine solutions when implementing the initial
clean – neutral detergent must be used.
5/19/2023

6. Color coding of hospital cleaning
materials and equipment
Color coding of hospital cleaning materials and equipment ensure that these items
are not used in multiple areas, therefore reducing the risk of cross infection.
All cleaning materials and equipment, for example, cloths, mops, buckets, aprons
and gloves must be colour coded according to the cleaning code.
Buckets ‫الجرادل‬should be cleaned and left dry and inverted at the end of the task.
5/19/2023

Cleaning of equipment/Instruments
Requirements for cleaning of
Equipment/Instruments
1) Specialist equipment must be cleaned in
accordance with the manufacturer’s instructions.
2) Where written instructions are not available the
Unit / Department Manager (or designated person)
should contact the manufacturer for advice.
3) Ensure that cleaning agents used are compatible with the equipment
Instruments should not be cleaned manually, they should be
returned to sterile services for decontamination.
5/19/2023

Cleaning of reusable non-invasive care equipment must be
undertaken:
1. At regular predefined
2. Between each use
3. After blood or body fluid or other visible contamination
4. Before disinfection; and
5. Before inspection, servicing or repair.
5/19/2023

5/19/2023

II. Disinfection
Overview
Definition of disinfection
Methods of disinfection
Basic Principles of Disinfection
Chemical disinfectants
1. Alcohol
2. Chlorine compounds
3. Aldehydes
4. Hydrogen Peroxide (H2O2)
5. Phenolics
5/19/2023

Definition of Disinfection
Disinfection:
Is the reduction of the number of viable microorganisms on a product to
appropriate level for its intended use, with the exception of bacterial spores
5/19/2023

Disinfection methods
Disinfection methods include thermal and chemical processes.
1. Moist heat may be used for items such as linen and bedpans e.g. automated
processes in a machine.
2. Specific chemical disinfectants can be used to decontaminate heat sensitive
equipment and the environment.
Disinfectants are not cleaning agents as they are generally inactivated by
organic material, therefore all items must be cleaned thoroughly prior to
disinfection.
Misuse and overuse of chemical disinfectants may result in damage to the user,
service user or equipment and may also result in the development of
antimicrobial resistance. Dr. Mohammed Salah, Ph D 100
5/19/2023

Basic Principles of Disinfection
1. Do not use disinfection as a substitute for sterilization.
2. Only use chemical disinfectants if absolutely necessary. (Resistance)
3. Wear protective clothing (and respirators if required).
4. Ensure adequate ventilation.
5. Choose an appropriate disinfectant, compatible with the surface being disinfected
and approved by the Infection Prevention and Control Team.
6. Ensure that the correct dilution is used (check manufacturer’s instructions).
7. Discard disinfectant solution after use. Not reuse
8. Ensure that containers used for disinfection are stored clean, dry and inverted
between uses.
5/19/2023

Chemical Disinfectants
Mode of Action:
The most feasible explanation for the antimicrobial action of alcohol is denaturation of proteins.
This mechanism is supported by the observation that absolute ethyl alcohol, a dehydrating agent, is
less bactericidal than mixtures of alcohol and water
Microbicidal Activity:
A) Methyl alcohol (methanol) has the weakest bactericidal action of the alcohols and thus seldom is
used in healthcare.
B) Ethyl alcohol
i. 30-80% bactericidal activity
ii. 60-80% virucidal activity
iii. 70% the most effective concentration
C) Isopropyl alcohol (20%) is effective
1. Alcohol
5/19/2023

Uses of Alcohol
1. Alcohols are not recommended for sterilizing medical and surgical materials principally because
they lack sporicidal action and they cannot penetrate protein-rich materials.
2. Alcohols have been used effectively to disinfect:
1. oral and rectal thermometers
2. scissors and stethoscopes
3. used to disinfect endoscopes
4. used for disinfection of small surfaces such as rubber stoppers of multiple-dose medication vials or
vaccine bottles
Advantages
1. Fast acting. 2. No residue. 3. Non-staining.
4. Low cost. 5. Widely available.
Disadvantages
1. No sporicidal action
2. Volatile, flammable, and an irritant to mucous membranes.
3. Inactivated by organic matter.
4. May harden rubber. Dr. Mohammed Salah, Ph D 103
5/19/2023

104
2. Chlorine and chlorine compounds
• The most widely used is an aqueous solution of sodium hypochlorite 5.25-6.15% (domestic
bleach) at a concentration of 100-5000 ppm free chlorine
A. Mechanism of action:
They are believed to have the ability to oxidize
proteins, inhibit enzyme activity, and react with
nucleic acids
B. Uses
1. disinfecting tonometers ‫العين‬ ‫ضغط‬ ‫قياس‬ ‫جهاز‬
2. disinfection of countertops, Walls and floors.
3. Can be used for decontaminating blood spills.
4. dental devices, hydrotherapy tanks,
5. water distribution systems in haemodialysis centres

C. Advantages
1. Low cost,
2. fast acting
3. Readily available
4. Available as liquid, tablets or powders.
D. Disadvantages
1. Corrosive to metals in high concentration (>500 ppm).
2. Irritant to skin and mucous membranes.
3. Decolorizes or bleaches fabrics.
4. Releases toxic chlorine gas when mixed with ammonia.
5. Inactivated by organic material.
5/19/2023 105

106
3. Aldehydes
• The most common aldehyde is Glutaraldehyde: ≥2% alkaline or acidic solutions.
A. Mechanism of action:
1. rupture of the membrane, loss of permeability
2. coagulation of the cytoplasm
B. Uses
• Widely used as high-level disinfectant for heat-sensitive
semi-critical items such as endoscopes.
C. Advantages
• Good material compatibility.
D. Disadvantages
1. Allergenic and irritating to skin and respiratory tract.
2. Must be monitored for continuing efficacy levels
when reused.

107
4. Hydrogen peroxide H2O2
A. Agents
• Hydrogen peroxide 7.5%.
B. Mechanism of action
• producing destructive hydroxyl free radicals that can attack membrane lipids, DNA, and
other essential cell components.
C. Uses
• Can be used for cold sterilisation of heat-sensitive critical items.
• Requires 30 minutes at 20
o
C.
• For disinfecting haemodialysers.
D. Advantages
• No odour.
• Produce Environmentally-friendly by-products (oxygen, water).
• Fast-acting (high-level disinfection in 15 min.).
E. Disadvantages
• Not compatible with brass, copper, zinc, nickel/silver plating.

108
5. Phenolics
oMechanism of action
1. Protein coagulation
2. Inhibit microbial enzymes and simultaneously increase affinity to
cytoplasmic membranes.
oUses
1. Has been used for decontaminating environmental surfaces and
non-critical items.
2. Concerns with toxicity and narrow spectrum of microbicidal activity.
oAdvantages
• Not inactivated by organic matter.
oDisadvantages
1. Leaves residual film on surfaces.
2. Harmful to the environment.
3. No activity against viruses.
4. Not recommended for use in nurseries and food contact surfaces.

III. Sterilization
Overview
Definition of sterilization
Methods if sterilization in health care settings
Dry heat sterilization
Moist heat sterilization
Ethylene Oxide gas
Filtration sterilization
UV light sterilization
Microwave
Fumigation sterilization
5/19/2023

 Definition of sterilization
 Sterilization:
it is the process used to render an object free from viable micro-organisms
including viruses and bacterial spores.
5/19/2023 110

1. Dry Heat Sterilisation (hot air oven)
Require hot-air ovens
For glassware, metallic items, powders and oil/grease
Time two hours at 160°C and one hour at 180°C
Plastics, rubber, paper and cloth cannot be placed in them due to fire risk
Advantages
1. Can be used for powders, anhydrous oils
2. Inexpensive
3. No corrosive effect on instruments
Disadvantages
1. High temperature damages some items
2. Penetration of heat slow, uneven
111

• Advantages:
1. Most reliable
2. Non-toxic
3. Has broad-spectrum microbiocidal activity
4. Good penetrating ability
5. Cheap and easy to monitor for efficacy
• Raise temperature normally to 121°C at 15 pounds/square inch and
maintain it for 15-20 minutes
112
5/19/2023
2. Steam Sterilization (Autoclave)

• Colourless, flammable, explosive and toxic gas
• Used for heat or moisture sensitive items
• Prevents normal cellular metabolism and replication
3. Ethylene Oxide (EO)
Advantages
• Items not damaged by heat or
moisture
• Not corrosive,
• not damaging to delicate
instruments, scopes
• Permeates porous materials
Disadvantages
• Cost
• Toxic properties of ethylene oxide
• Aeration required
• Longer process

• Removal of microbes from air or
heat-sensitive liquids
• Disinfectant-impregnated filters may
inactivate trapped microorganisms
• Example: High-efficiency particulate
air (HEPA) filters
• All filters must be checked for
integrity and replaced as necessary
5/19/2023 114
4. Filtration

• UV lamps useful for chemical-free disinfection of air and water and
also possibly for decontamination of environmental surfaces
• Broad-spectrum microbicidal action
• Require regular cleaning and periodic replacement
115
5/19/2023
5. Ultraviolet (UV) Light

• Heating from rapid rotation of water molecules
• Limited use except for disinfecting soft contact lenses and urinary
catheters for intermittent self-catheterisation
• May be used in emergencies to treat water for drinking or to
‘disinfect’ small water-immersible plastic or glass items
116
5/19/2023
6. Microwaves

• For rooms contaminated with some pathogens
• Such as MRSA and Clostridium difficile
• Release of hydrogen peroxide, chlorine dioxide gas or possibly ozone
in sealed rooms
• Spore strips (biological indicators) placed strategically to monitor
process
• Special equipment required
• Risk of damage to sensitive items
117
5/19/2023
7. Fumigation

Infection prevention
and control (IPC)
LECTURE V
“isolation precautions”

 Overview
• Infection transmission in the hospital requires:
1. Source or reservoir of microorganisms
2. Susceptible host with a portal of entry receptive
to the microorganism
3. Means of transmission
• Sources of microorganisms can include:
1. Patients
2. Health care workers
3. Visitors
4. Inanimate objects such as furniture and medical equipment can also be sources of microorganisms.
• Hosts differ in susceptibility due to characteristics, some innate, such as:
1. Age (the elderly and infants are more susceptible to infection),
2. Immune status,
3. Genetic susceptibility factors,
4. Malnutrition, and
5. Factors, such as underlying illness (e.g., diabetes mellitus and HIV infection),

 Isolation precautions
• Definition:-
• Are additional precaution measures, practices or procedures designed on patients with
known or suspected contiguous infectious diseases to prevent transmission of infections
in the hospital setting.
• Require cooperation and responsibility from various units including administration,
education, other clinical services, and surveillance
• Stringent infection control precautions:- in cases of
1. Highly contagious diseases
2. Diseases with high mortality rate TB
3. Multidrug resistant M.O
4. Infection with multiple routes of infection Varecilla virus

 Quarantine ‫الصحي‬ ‫الحجر‬
• Definition:-
• Quarantine is for people who are not sick, but may have been exposed. Isolation
separates and restricts the movement of sick people so they can't spread disease to
healthy people.
• Aims:
1. Prevent spread of infection
2. Monitoring the development of signs and symptoms
• Duration
14 days from the first exposure
3

 Patient isolation precautions
• Patient isolation precautions in hospitals consist of
A. Standard precautions are used for all patient care: (Basic Level)
 Are used for care of ALL patients in a hospital all of the time regardless of diagnosis or
infection status
 Applied to blood, body fluids, excretions and secretions regardless of whether they
contain visible blood, mucous membranes and non-intact skin
 Level of use depends on anticipated contact with patient
 All other transmission-based precautions include (are in addition to) Standard
Precautions
B. Transmission based precautions: Consist of:
1. Direct and Indirect Contact Precautions
2. Airborne Precautions
3. Droplet Precautions

 Standard precautions
1. Hand hygiene after patient contact
2. Wear clean, non-sterile protective gloves when touching blood, body fluids, secretions, excretions
and contaminated items
3. Wear mask, eye protection or facial shield and gown during procedures likely to generate splashes
or spray of blood, body fluids, secretions or excretions. Use depends on anticipated exposure and
safe injection practices as well
4. Handle contaminated patient-care equipment and linen in a manner that prevents the transfer of
microorganisms to people or equipment
5. Use care when handling sharps and follow proper disposal of needles and other sharp instruments
6. Use a mouthpiece or other ventilation device as an alternative to mouth-to-mouth resuscitation
when practical
7. Place the patient in a private room when feasible if they may contaminate the environment

Transmission based precautions (Contact precautions)
• Intended to:-
• Intended to prevent spread of microorganisms from an infected patient through direct
means (touching the patient) and indirect means (touching surfaces or objects that have
been in contact with the patient).
• Examples of M.O spread by contact:-
1. MDR bacteria such as MRSA, VRE
2. Clostridium defficile
3. Herpes simplex virus
4. Scabis

Transmission based precautions (Contact precautions)
• Infection control measure:-
1. Use gloves when entering the room. Change gloves after contact with infective material.
Remove gloves before leaving the room. Wash hands or use appropriate gel after glove
removal.
2. Use protective gown when entering the room 1. if direct contact with patient or 2. potentially
contaminated surfaces or equipment near patient is anticipated
3. Ensure that patient care items, bedside equipment, and frequently touched surfaces receive
daily cleaning
4. Leak resistant bag for linens should be at bedside.
5. Placing the patient in a private room is preferred or when not available, cohorting with
someone with the same infection.
6. Limit the movement or transport of the patient from the room. Perform hand hygiene.
7. During transport, be sure clean PPE is used

Transmission based precautions (Airborne Precautions)
• Intended to:-
Used to prevent or reduce the transmission of microorganisms transmitted by small
particle droplets (smaller than 5 µ in size) or dust particles containing the infectious
agent.
They can be inhaled by or deposited on a host in the same room or further away.
• Examples of M.O spread by airborne:-
1. Pulmonary Tuberculosis TB
2. Rubeola (Measles) virus
3. Varicella virus
9

Transmission based precautions (Airborne Precautions)
• Infection control measures
1. Place the patient in an Airborne Infection Isolation Room (AIIR) private room with
anteroom if possible, that has negative air pressure, with 6-12 air changes/per hour.
2. Appropriate monitored, high-efficacy filtration of air (HEPA Filter) before it is discharged from
the room. Pressure should be monitored with visible indicator
3. Use of respiratory protection (e.g., fit tested N95 respirator) or Powered Air-purifying
Respirator (PAPR) when entering the room
4. Limit movement and transport of the patient.
5. Use surgical or N95 mask on patient if transport is needed
6. Use a mask on the patient if they need to be moved
7. If private room absolutely not available, consult infectious disease consultants before cohorting
patient
8. Keep patient room door closed.

Transmission based precautions (Droplet Precautions)
• Intended to:-
Used to reduce the risk of transmission of microorganisms transmitted by large particle
droplets (larger than 5 µ in size) during coughing, sneezing or talking, or during the
performance of procedures such as suctioning and bronchoscopy.
This type of transmission usually requires close contact between the source person and
the recipient (3 feets) because droplets do not remain suspended in the air
• Examples of M.O transmitted by droplets:-
1. Influenza
2. Rubella
3. Parvovirus B19
4. Mumps.

Transmission based precautions (Droplet Precautions)
• Infection control precautions:-
1. Place the patient in a private room. If not available, cohort with patient with active
infection with same microorganism
2. Use of respiratory protection such as a mask when entering the room recommended and
definitely if within 3 feet of patient
3. Limit movement and transport of the patient. Use a mask on the patient if they need to
be moved and follow respiratory hygiene/cough etiquette
4. Keep patient at least 3 feet apart between infected patient and visitors
5. Room door may remain open

 Infected Patient Transport Within the hospital
1. If patient has airborne or droplet transmitted infection should only leave
room, if essential
2. Patient should wear mask during transport
3. Patient should be in clean gown
4. Patient should wear or use appropriate barriers such as impermeable
dressings for wounds
5. Transport personnel should wear appropriate PPE
6. Transport route should avoid populated areas
7. Disinfect all transport equipment and linens
8. Protect stretchers ‫نقاله‬ or wheelchairs ‫متحرك‬ ‫كرسي‬appropriately
9. Receiving personnel should be aware of what PPE and infection control
procedures are needed and when patient is coming
10. Appropriate hand hygiene should be used

CONTROLLING
INFECTIOUS
DISEASES WITHIN
COMMUNITIES

 Overview
 Infection control and prevention is a global issue and there are many protocols
and guidelines that can be followed to minimize the spread
of infection between people, within a population and globally.
 Groups at high risk of infection such as:
1. Children,
2. Older People
3. Chronic Conditions

 Infection control by changing behavior, including:
1. Regular hand washing
2. The implementation of proper respiratory etiquette.
3. Appropriate use of Face-masks (protect from and
prevent spread of respiratory infections) specially during
crowded areas
4. Social distancing- Avoid close contact with others when displaying symptoms of an infection-
5. Using insect repellents
6. Maintaining a clean and hygienic environment is crucial for infection control in public
settings.
7. Ensuring up-to-date routine vaccinations and participating in immunization programs
16

 Infection control by changing behavior, including:
8. Using condoms when having sex, especially with a new partner
9. staying home when sick
10. avoid close contact with others when displaying symptoms of an infection
11. Public health authorities have a mission-critical function by promptly monitoring and
responding to infectious disease outbreaks.

 Infection control by Medical Interventions
• As well as simple steps to prevent and control infections, there are biochemical interventions
that can be implemented to speed up the recovery process and in some cases prevent viral
infections completely including:-
• The development of:
1. antibiotics,
2. antivirals and
3. vaccinations
• The introduction of regular vaccines:-
1. have slowed down and in some cases eradicated certain diseases such as polio, measles,
mumps, whooping cough and rubeola (measles).
2. have been shown to speed up recovery,
3. Complete immunization coverage can help prevent the agent from reaching a susceptible host

 Infection control by Medical Interventions
Herd immunity
• If a high proportion of individuals in the community are resistant to an agent, then
susceptible people will also be protected by the resistant majority. It could be produced
artificially by immunization, or naturally after infection
• The level of susceptibility increases as new infants are born, an epidemic will develop
after accumulation of susceptible

 Infection control by Improving Social Determinants
• There is a direct link between a person's health and their environment.
• WHO has identified three "common interventions" for improving health conditions
worldwide:
1. Education:- There is a strong link between health and education.
2. Social Protection:- Access to affordable healthcare and some form of social security
system can also determine the health and behaviors in a community
3. Urban Development:- How our villages, towns and cities are designed can have a big
impact on health and the spread of diseases. Living in overcrowded environments or
in housing that is damp and/or that does not have adequate facilities and sanitation
can increase the spread of infectious diseases

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