DESIGNING INFECTION CONTROL PROGRAM

Infection control refers to all policies,
procedures and activities, which aim to
prevent or minimize the risk of
transmission of infectious diseases.
3/24/2019Prof Dr Muhammad Tauseef Jawaid 2

 Each year 5-10% of hospitalized patients acquire at least
one infection while hospitalized.
 90-100 thousand die of those infections.
 One third of these are believed preventable.
 An almost equal number acquire infections while
receiving health care in outpatient facilities or nursing
care at home.
 Conservatively HAI cost $33 billion each year.

 Are among leading cause of death.
 Account for 20% of ICU costs.
 May persist for years in patients who survive the initial
infection.
 Can be reduced by consistent application of well understood
practices.

Cost Per Infection
Wound infections $3,000-$27,000
Sternal wound infections $20,000-$80,000
Catheter-associated
bloodstream infection
$5,000-$34,000
Pneumonia $10,000-$29,000
Urinary $700

 Increasing emerging infections
 Increasing resistant organisms
 Increasing drug costs
 New medical procedures
 New technology
 Nursing shortage
 Reuse of single-use devices

 Requires cooperation, understanding and
support of hospital administration and
medical/surgical/nursing leadership
 There is no simple formula:
 Every facility is different
 Every facility’s problems are different
 Every facility’s personnel are different
 The facility must develop its own unique
program
83/24/2019Prof Dr Muhammad Tauseef Jawaid

Everyone plays a role, even non-
clinicians
• Administration & management need
to take the lead :-
-Ensure appropriate policies are in
place
-Allocate sufficient resources for
infection prevention & control
-Provide ongoing staff training &
supervision
-Ongoing monitoring & evaluation

The ICT should have a range of expertise
covering knowledge of infection control,
medical microbiology, infectious diseases and
nursing procedures. The team should have a
close liaison with the microbiology laboratory
and ideally a microbiologist should be a
member of the team.
The team is responsible for day to day
decisions on infection control as well as long
term planning of infection control policy.

 Advise staff on all aspects of infection
control and maintain a safe environment for
patients and staff
 Provide educational programmes on the
prevention of hospital infection for all
hospital personnel
 Provide a basic manual of policies and
procedures and ensure that local written
guidelines based on these are in existence.

 Establish systems of surveillance of hospital
infection in order to identify at-risk patients
and problem areas that need intervention.
Methods for surveillance may include case
finding by ward rounds and chart reviews,
reviews of laboratory reports, and targeted
prevalence or incidence surveys.
 Advise management of patients requiring
special isolation and control measures.

 Investigate and control outbreaks of
infection in collaboration with medical and
nursing staff.
 Ensure that an antibiotic policy is in
existence.
 Provide relevant information on infection
problems to management and the ICC.
 Perform other duties as required, e.g.,
kitchen inspections, pest control, waste
disposal.

Multidisciplinary
Authorized
Regular meetings
Effective communication

3/24/2019
Prof Dr Muhammad Tauseef Jawaid
15

 To identify and reduce risks of infections in patients
and healthcare workers.
 Furthermore, there must be a functioning program
coordinating all activities related to surveillance,
prevention, and control of infections.
 The goal of an effective infection control program must
be to then improve clinical outcomes using a
multidisciplinary team approach.

 Goals of the infection control program need to be incorporated into the
mission statement of the facility.
 A mission statement should tell who you are, what you do, and should
communicate a clear view of purpose and set a strategy for
accomplishing the goals.
“Our mission is to promotea healthy and safe environment by preventing transmission
of infectious agents among patients, staff and visitors”

 To reduce the risks of Health care–Associated
Infections (HAIs)
 All patient,
 Staff,
 visitor areas
 Use a risk-based approach in establishing the focus of
the health care associated infection prevention and
reduction program.
 Identify the procedures and processes associated with
the risk of infection and implements strategies to
reduce infection risk.

 To run a comprehensive program addressing health
care -associated infections, stratified by centres ,
departments/units, and procedures.
 To monitor procedure /device related infections (VAP,
SSI, CLABSI and CAUTI) and to implement needed
improvement program.
 To monitor epidemiologically important and
antibiotic-resistant organisms, MRSA, VRE, and Multi-
drug resistant bacteria in addition to emerging and
remerging infections.
 To implement the antibiotics stewardship program.
 To design and monitor implementation of all measures
needed for prevention and infection control

 To monitor the staff compliance with approved
Infection Control Policy.
 To implement effective hand hygiene program .
 To oversee Antiseptic and disinfectant use
 To monitor employee health regarding the
following:
 Pre-employment medical exam
 Employee vaccination program
 Employee exposure to sharps, needles and
body fluids
 Having infectious /communicable diseases

 To monitor environmental and patient protection during
construction and renovation projects.
 To monitor sterilization and disinfection process.
 To monitor the implementation of effective program related to:
CSSD, Food safety, Water safety, Air safety, Safe medical
waste disposal, Safe and effective pest/pets control , Effective
housekeeping program, laundry and linen management

 ICPs should assess the infection control program for compliance
with written standards and guidelines, areas that need
improvement and available resources.
 Review standards from regulatory or accreditation agencies (e.g.,
CBAHI,MOH,JCI , Occupational Health and Safety Administration
[OSHA], to ensure compliance with requirements
 Make lists of any practices that the institutional policy is not in
compliance with and fix them.

 Guidelines written by organizations specializing in infection control
(e.g., APIC, Society for Healthcare Epidemiology of America [SHEA],
CDC)--although not regulatory--are considered standards of care by
regulatory surveyors.
 These guidelines should be followed unless newer literature
provides scientific rational for not using them.
 ICPs should be sure that they are using the most current guidelines
available
 The Internet is useful for this purpose.

 Administrative
 Authority Statement
 Vision/Mission Statement
 Program Goals and Objectives
 Risk Assessment
 Personnel Job Description
 Surveillance Plan
 Improvement programs
 Environmental Monitoring
 Antibiotic Utilization
 Outbreak Management
 Occupational Health
 Medical Waste
 Post-exposure
Communicable Disease
Management
 Communicable Disease
Reporting
 Education
 Policies and Procedures

 Every infection control program should develop a well-defined written
plan
 outlining the organizational philosophy regarding infection prevention
and control.
 The plan should take into account the goals, mission statement, and an
assessment of the infection control program.
 It should include a statement of authority, and should review patient
demographics including geographic locations of patients served by the
healthcare system.
 The scope of responsibilities for actions to be taken to accomplish the
goals should be included.

 This plan usually called as quality improvement (QI) infection control
(IC) plan and should be reviewed and revised every 2-3 years.
 Each revision should include defining the objectives of the goals, with
due dates and responsible parties

Will be dictated by the
no of IPC staff available to collect the information
the resources
skills to interpret data once collected
Continuous (total or selective)
Periodic (point prevalence)
31 March 2019Prof: Dr Muhammad Tauseef Jawaid 27

 Active
 patient based
 Prospective
 priority directed
 risk adjusted

The key to ongoing monitoring is surveillance for HAIs.
Various techniques for surveillance have been described and
evaluated including :
 total house surveillance
 targeted surveillance
Kardex
 laboratory-based

 Many ICPs have become disenchanted with hospital-wide surveillance
and question the value of generating data without measurable
changes.
 Haley, borrowing from the business world, suggested a concept of
surveillance-by-objective that selects a different surveillance strategy
for different sites of infection.
 Surveillance-by-objective allowed the ICPs more time for other
responsibilities and provided a method for setting measurable goals for
the reduction of infections.

 ICPs should evaluate their institutional needs and develop a
surveillance plan to present to the infection control committee on a
yearly basis.
 Choosing one or two specific surveillance problems and setting a goal
for reduction will focus the efforts of the ICP .

 Trends
 Risk
 Rate
 Benchmark
 Reporting
 Feedback

Provides data to
identify infected patients
determine the rate of infection
the factors that contributed to the infection.
When infection problems are recognized, the hospital is able to
institute appropriate intervention measures and evaluate their
efficacy
Helps to assess the quality of care in the hospital

Outcome
measures
HAIs Rate Identify the
risk &trend
Process
measures
Compliance
with bundles
Identify area
for
improvement
Feedback
Infection
control
bulletin
Infection
control
meeting
New plan FOCUS -PDCA

microbiology data for surveillance and IPC activities.
To make lab results available in an organized, accessible and timely
manner through proper record keeping systems.
Monitor lab results for
Unusual findings e.g. cluster of pathogens that may indicate an outbreak
Emergence of multi-drug resistant organisms
Isolation of highly infectious, unusual and virulent pathogens
Environmental cultures to assess microbial contamination of
inanimate objects or the level of contamination in certain areas
of the hospital.

This is done according to the circumstance of the outbreak and
nature of the causative organism
In staphylococcal or streptococcal sepsis, attention will be
focused on humans
but in outbreaks due to Gram negative bacilli, attention will be
focused on utensils, apparatus or fluids.
There is need for supporting epidemiological evidence that
infected patients had significant contact with the source of
infection.

Whether infections were caused by identical
bacteria or various organisms.
Infections due to identical bacteria may suggest
a human carrier while an outbreak due to
various organisms suggest a breakdown in
the theatre or ward ventilation
aseptic techniques
sterilization of dressings or instruments.

 Unlike scheduled activities, occasional clusters of
patients who are colonized or infected will trigger
further investigation including a case-control study.
 New laboratory methods developed and refined within
the last decade can now determine how related the
strain is at the molecular level.
 The QI/IC plan should include special problem-focused
studies that describe personnel or environmental
sampling, including what circumstances and who has the
authority to order.

An outbreak will be brought to an end by
by effectively treating or removing to isolation infected
persons whether cases or carriers by destroying micro-
organisms that are environmental sources of infection by
detecting and correcting specific technical lapses in
hospital procedures

 The institution usually makes the infection control
program responsible for reporting communicable
diseases required by MOH.

The fundamental roles of healthcare
epidemiology are to:
 Identify risks
 Understand risks
 Eliminate or minimize risks
3/24/2019Prof Dr Muhammad Tauseef Jawaid

 Education programs for HCWs ,volunteers ,patients and visitors are
one method to ensure competent infection control practices.
 It is a unique challenge since employees represent a wide range of
expertise and educational background
 The ICP must become knowledgeable in adult education principles
and use educational tools and techniques that will motivate and
sustain behavioral change.
 Some of the tools used to educate HCWs successfully include
newsletter, posters and videos.

 ICPs must oversee the ongoing review and evaluation of written policies and
procedures outlining prevention and control mechanisms in all patient care and
service areas.
 The policies and procedures should be based on recognized guidelines and
applicable laws and regulations.
 The policies should address the prevention of infection transmission among patients,
employees, medical staff, contractors, volunteers, visitors, and environmental
issues.
 Policies must be reviewed on regular basis (e.g. every 3 years )
 Infection control manual ( hard and soft copies )

 ICPs should monitor antibiotic use through utilization
studies focusing studies on high cost, high risk, or high
volume antibiotic usage.
 Actions relative to the findings from these studies
should be coordinated with the pharmacy and medical
staffs.
 Monitoring MDRO

 The ICP can also expect to be called upon on a daily basis to
provide consultation on a wide variety of patient care issues.
 Therefore, collecting and maintaining updated infection control
references and guidelines reflecting scientifically-based practices
and current standards is essential.
 Despite time constrains, it is important for the ICP to schedule
time for regular reviewing of new information.
 One way to accomplish this is with a journal club during which
scientific articles and new guidelines are critically reviewed.

“Stopping the epidemics spreading in our hospitals is
not a problem of ignorance-- of not having the know-how
about what to do. It is a problem of compliance—a failure
of an individual to apply that know-how correctly.”

The administration hospital must provide leadership by supporting the
hospital infection programme.
They are responsible for:
establishing a multidisciplinary Infection Control Committee
identifying appropriate resources for a programme to monitor infections and
apply the most appropriate methods for preventing infection

delegating technical aspects of hospital hygiene to appropriate staff, such as:
nursing
housekeeping
maintenance
clinical microbiology laboratory
periodically reviewing the status of nosocomial infections and effectiveness of
interventions to contain them
reviewing, approving, and implementing policies approved by the Infection Control
Committee
ensuring the infection control team has authority to facilitate appropriate
programme function
participating in outbreak investigation

Physicians have unique responsibilities for the prevention and control of
hospital infections:
by providing direct patient care using practices which minimize infection
by following appropriate practice of hygiene (e.g. handwashing, isolation)
serving on the Infection Control Committee
supporting the infection control team.

protecting their own patients from other infected patients and from
hospital staff who may be infected
complying with the practices approved by the Infection Control
Committee
obtaining appropriate microbiological specimens when an infection is
present or suspected
notifying cases of hospital-acquired infection to the team, as well as the
admission of infected patients

complying with the recommendations of the Antimicrobial Use Committee
regarding the use of antibiotics
advising patients, visitors and staff on techniques to prevent the
transmission of infection instituting appropriate treatment for any
infections they themselves have, and taking steps to prevent such
infections being transmitted to other individuals, especially patients.

obtaining, storing and distributing pharmaceutical preparations using
practices which limit potential transmission of infectious agents to
patients dispensing anti-infectious drugs and maintaining relevant
records (potency, incompatibility, conditions of storage and
deterioration)
obtaining and storing vaccines or sera, and making them available as
appropriate maintaining records of antibiotics distributed to the medical
departments providing the Antimicrobial Use Committee and Infection
Control Committee with summary reports and trends of antimicrobial
use

The hospital pharmacist may also participate in the hospital sterilization
and disinfection practices through:
participation in development of guidelines for antiseptics, disinfectants, and
products used for washing and disinfecting the hands
participation in guideline development for reuse of equipment and patient
materials
participation in quality control of techniques used to sterilize equipment in the
hospital including selection of sterilization equipment (type of appliances) and
monitoring.

having available the following information on disinfectants, antiseptics
and other anti-infectious agents:
active properties in relation to concentration, temperature, length of action,
antibiotic spectrum toxic properties including sensitization or irritation of the
skin and mucosa — substances that are incompatible with antibiotics or reduce
their potency physical conditions which unfavourably affect potency during
storage: temperature, light, humidity harmful effects on materials.

participating in the Infection Control Committee
promoting the development and improvement of nursing techniques, and
ongoing review of aseptic nursing policies, with approval by the Infection
Control Committee
developing training programmes for members of the nursing staff
supervising the implementation of techniques for the prevention of
infections in specialized areas such as the operating suite, the intensive
care unit, the maternity unit and newborns
monitoring of nursing adherence to policies.

The nurse in charge of a ward is responsible for:
maintaining hygiene, consistent with hospital policies and good nursing practice on
the ward
monitoring aseptic techniques, including handwashing and use of isolation
reporting promptly to the attending physician any evidence of infection in patients
under the nurse’s care

limiting patient exposure to infections from visitors, hospital staff, other
patients, or equipment used for diagnosis or treatment
maintaining a safe and adequate supply of ward equipment, drugs and
patient care supplies.

The nurse in charge of infection control is a member of the infection
control team and responsible for :
identifying nosocomial infections
investigation of the type of infection and infecting organism
investigation of the type of infection and infecting organism
participating in training of personnel

surveillance of hospital infections
participating in outbreak investigation
providing expert consultative advice to staff health and
other appropriate hospital programmes in matters relating
to transmission of infections.

The director of this service must:
oversee the use of different methods — physical, chemical, and bacteriological —
to monitor the sterilization process
ensure technical maintenance of the equipment according to national standards
and manufacturers’ recommendations
report any defect to administration, maintenance, infection control and other
appropriate personnel

maintain complete records of each autoclave run, and ensure long-term
availability of records
collect or have collected, at regular intervals, all outdated sterile units
communicate, as needed, with the Infection Control Committee, the nursing
service, the operating suite, the hospital transport service, pharmacy service,
maintenance, and other appropriate services.

defining the criteria for the purchase of foodstuffs, equipment use, and
cleaning procedures to maintain a high level of food safety
ensuring that the equipment used and all working and storage areas are
kept clean
issuing written policies and instructions for hand washing, clothing, staff
responsibilities and daily disinfection duties

ensuring that the methods used for storing, preparing and distributing
food will avoid contamination by microorganisms
issuing written instructions for the cleaning of dishes after use, including
special considerations for infected or isolated patients where appropriate

selecting fabrics for use in different hospital areas, developing policies
for working clothes in each area and group of staff, and maintaining
appropriate supplies
distribution of working clothes and, if necessary, managing changing
rooms
developing policies for the collection and transport of dirty linen
defining, where necessary, the method for disinfecting infected linen,
either before it is taken to the laundry or in the laundry itself

developing policies for the protection of clean linen from contamination
during transport from the laundry to the area of use
developing criteria for selection of site of laundry services:
ensuring appropriate flow of linen, separation of “clean” and “dirty” areas
recommending washing conditions (e.g. temperature, duration)
ensuring safety of laundry staff through prevention of exposure to sharps or
laundry contaminated with potential pathogens.

Red Bag = Blood

Sharps: Needles, lancets, surgical staples, rods, pins, intravenous
catheters, protected sharps, syringes with attached needles, scalpels,
scissors, guide wires, etc
Sharps Container – Must be emptied when ¾ full. They become a
danger when overfilled.

Isolation status does not affect Red Bag Waste Guidelines:
Regular trash from an isolation room is still regular trash.
Trash Can
Liquid Human Waste from reusable containers like urine, feces,
sputum, blood etc.
Toilet
(Use splash precautions)
Isolation Room Waste:

“Reduce the risk of health care acquired
infections”
(Nosocomial Infections-Hospital Acquired Infections)
Number one way…Good Hand Hygiene
Practices…WASH,WASH, and WASH AGAIN!

inspections and regular maintenance of the plumbing, heating, and
refrigeration equipment, and electrical fittings and air conditioning;
records should be kept of this activity
developing procedures for emergency repairs in essential departments
ensuring environmental safety outside the hospital, e.g. waste disposal,
water sources.
Additional special duties include:
participation in the choice of equipment if maintenance of the equipment
requires technical assistance

Infection control manual
Compilation of recommended instructions and practices for
patient care (polices & procedures)
The manual should be developed and updated by the infection
control team, with review and approval by the committee.
It must be made readily available for patient care staff
updated in a timely fashion.

Minimum requirements for IPC:
clean water
ventilation
hand washing facilities
patient placement and isolation facilities
storage of sterile supply
conditions for building and/or renovation

ICC must hold meetings periodically to review
infection rates and ICT activities
Plan and conduct audits
to determine compliance
Check actual practice against known standards and guidelines
Identify risks of infections and unsafe practices for both patients and
staff
Communicate areas for improvement to the hospital

Enough materials and infrastructure
Be our brother’s keeper (fight ignorance,
nonchalance) Monitoring and evaluation –ICT
Training -ICC
Formulate guidelines and use them ICC & Everybody
It is the duty of every healthcare worker to know the
hospital infection control policies and apply them

Monitoring and evaluation –ICT
Training -ICC
Formulate guidelines and use them ICC & Everybody
It is the duty of every healthcare worker to know the hospital
infection control policies and apply them

Practical classification of hospital waste andmethods of
treatment
Source: Prüss A, Giroult E and Rushbrook P, eds. Safe Management of Wastes from
Health-care Activities. Geneva, World Health Organization, 1999, page 168. Electronic
access: http://whqlibdoc.who.int/publiations/9241545259.pdf
Hospital Waste
InorganicBiodegradable
(kitchen,
landscape)
Clinical Waste
(infectious)
Hazardous
Cytotxic drugs, toxic
chemicals, radioactive
waste stored in cement
tanks until half life is over
Steam sterilize,
shred deep burial
encapsulation
Sharps Non sharps
To compost
Recyclable Other
To Market
Laboratory
Clinical waste -
from patient care
Plastics Non Plastics Specimens
Microbiology
lab waste
Anatomical
parts Animal
carcesses
Steam sterilize
and shred
Disposables
Syringes IV sets
catheters ET
tubes
Blood, body
fluids,
secretions
and
excretions
Steam
sterilize
and shred
Incineration/
Cremation
Landfill Landfill
Landfill
Steam
sterilize
Sewer or
landfill
Ash to
landfill
Hazardous Non-hazardous
Steam sterilize
and shred
Cotton, gauze
dressings
contaminated with
blood, purulent
exudate, secretions
excretions.
Steam sterilize
and shred or
Incineration

Infection prevention and control programs have been
proven to be effective. T/F?
IP&C is important in health care because of its:
Focus on patient health and safety
Focus on healthcare worker safety
Focus on decreasing costs
All of the above
IP&C programs are relevant to all healthcare settings.
T/F?

 Increase infection control resources are a win-win-win
investment
 Reduced patient morbidity and mortality
 Net cost savings to institution, society and patient
 Improve patient satisfaction
 From the standpoint of the hospital and society, the benefits
exceed the costs
 Hospitals should support a ratio of ICP per beds of 1:150

An infection control program with a firm
structure should be in existence in all
institutions that provide health care in order
to establish a managed environment that :-
 Secures the lowest possible rate of hospital
acquired infection
 Protects staff and visitors from unnecessary
risks

DESIGNING INFECTION CONTROL PROGRAM

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