Infection control program Concept

Key Definitions (1)
 Infection Control—The process by which health care
facilities develop and implement specific policies and
procedures to prevent the spread of infections among
health care staff and patients
 Nosocomial Infection—An infection contracted by a
patient or staff member while in a hospital or health
care facility (and not present or incubating on
admission)
March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid King
Khalid University KSA
3

Key Definitions (2)
 Disinfection—The process of microbial inactivation
that eliminates virtually all recognized pathogenic
microorganisms, but not necessarily all microbial
forms (e.g., spores)
 Sterilization—The use of physical or chemical
procedures to destroy all microbial life, including
large numbers of highly resistant bacterial
endospores. Procedures include—
 Steam sterilization
 Heat sterilization
 Chemical sterilization
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Patient may acquire infection before admission to the
hospital = Community acquired infection.
Patient may get infected inside the hospital =
Nosocomial infection.
It includes infections
not present nor incubating at admission,
infections that appear more than 48 hours after admission,
those acquired in the hospital but appear after discharge
also occupational infections among staff.
The risk of infection is always present.
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INFECTION
• Definition: Injurious contamination of body or parts
of the body by bacteria, viruses, fungi, protozoa and
rickettsia or by the toxin that they may produce.
Infection may be local or generalized and spread
throughout the body.
Once the infectious agent enters the host it begins to
proliferate and reacts with the defense mechanisms
of the body producing infection symptoms and signs:
pain, swelling, redness, functional disorders, rise in
temperature and pulse rate and leucocytosis.
6

Frequency of NosocomialFrequency of Nosocomial
InfectionInfection
 Nosocomial infections occur worldwide.
 The incidence is about 5-8% of hospitalized
patients, 1/3 of which is preventable.
 The highest frequencies are in East
Mediterranean and South-East Asia.
 A high frequency of N.I. is evidence of poor
quality health service delivered.
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Impact of NosocomialImpact of Nosocomial
InfectionsInfections
They lead to functional disability and
emotional stress to the patient.
They lead to disabling conditions that reduce
the quality of life.
They are one of the leading causes of death.
The increased economic costs are high:
Increased length of hospital stay (SSI - 8.2
days), extra investigations, extra use of drugs
and extra health care by doctors and nurses.
8

Organisms causing N.I. can be
transmitted to the community
through discharged patients,
staff and visitors. If organisms
are multi-resistant they may
cause significant disease in the
community.
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Introduction—Why Infection Control? (1)
 Hospital acquired infections are a common problem—
prevalence about 9%
 Hospital acquired infections contribute to Antimicrobial
resistance
 Overuse of antimicrobials (development)
 Poor infection control practices (spread)

Introduction—Why Infection Control? (2)
 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 IC programs are beneficial
 They decrease spread of nosocomial infections,
morbidity, mortality, and health care costs
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Nosocomial Infections CostNosocomial Infections Cost
The cost varies according to the type and
severity of these infections.
An estimated 1 to 4 extra days for a urinary
tract infection, 7 – 8 days for a surgical site
infection, 7 – 21 days for a blood stream
infection, and 7 – 30 days for pneumonia.
The CDC has recently reported that US$5
billion are added to US health costs every
year as a result of NI.
 In Egypt one LE spent for infection control
saves LE 60 spent on NI.March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid King
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Nosocomial Infection SitesNosocomial Infection Sites
Urinary tract infection: most common type of
N I (30-40% of reported cases), associated
with an indwelling urinary catheter or
instrumentation.
Lower respiratory and surgical wound
infections are the next ( each about 15%).
Less frequent include bacteraemia (5%),
intravenous site infection, gastrointestinal
tract and skin infections.
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Criteria of Nosocomial Infections
Surgical site infection Any purulent discharge, abscess or
spreading cellulitis at the surgical
site during the month after operation
Urinary infection Positive urine culture (1 or 2
species) with at least 100000
bacteria/ml, with or without clinical
symptoms
Respiratory infection Respiratory symptoms with at least
2 signs: cough; purulent sputum;
new infiltrate on chest, appearing
during hospitalization
Vascular catheter
infection
Inflammation, lymphangitis or
purulent discharge at the insertion
site
Septicaemia Fever or rigours and at least one
positive blood culture
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Factors InfluencingFactors Influencing
N.IN.I..
The microbial agent
Patient susceptibility
Environmental factors
March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid
King Khalid University KSA
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Microbial AgentMicrobial Agent
Many sick people are treated in a closed
area; micro-organisms, frequent contact
between carriers & susceptible, contaminated
waste, equipment and supplies to be
handled.
Developing of clinical disease depends on
organism s virulence, infective dose and
patient resistance
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Bacteria are the most common pathogens.
1. Commensal bacteria: found in normal flora of
healthy humans, prevent pathogenic bacterial
colonization eg skin, colon, vagina
2. Pathogenic bacteria: have great virulence and
cause infection as :
- Anaerobic gram +ve rods e.g Clostridium
causing gangrene.
- Gram +ve bacteria: Staph. aureus found on skin
&nose. - Beta -hemolytic Strep.
- Gram -ve bacteria as E.coli, Proteus, Klebsiella.
- legionella species.
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Viruses: HIV, HBV, HCV can be also be
transmitted through blood & B F (transfusion,
injections, dialysis)
respiratory syncytial virus, rota virus, ebola,
infleunza, herpes simplex viruses.
Parasites & Fungi: e.g. Giardia lamblia is
easily transmitted between adults or children,
Aspergillus sp. affecting imunocompromised.
Scabies an ectoparasite causing outbreak.
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Patient SusceptibilityPatient Susceptibility
Age: infants and old age have decreased
resistance to infection.
Immune status: Patients with chronic
diseases as malignancy, leukaemia,
diabetes mellitus, renal failure or AIDS
have increased susceptibility to infection.
Immunosuppressive drugs or irradiation
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Environmental FactorsEnvironmental Factors
 Healthcare settings are environment
where both infected persons and persons
at high risk of infection congregate.
 Crowded conditions within hospital,
frequent transfers of patients between
units.
 Microbial flora may contaminate objects,
devices and materials which subsequently
contact susceptible body sites of patients.
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TransmissionTransmission
• Where do nosocomial infection come from?
Endogenous infection: When normal
patient flora change to pathogenic bacteria
because of change of normal habitat,
damage of skin and inappropriate antibiotic
use. About 50% of N.I. Are caused by this
way.
Exogenous cross-infection: Mainly
through hands of healthcare workers, visitors,
patients.March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid
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Exogenous environmental infections: several
types of micro-organisms survive well in the hospital
environment (hospital flora):
* In water, damp areas and occasionally in sterile
products or disinfectants eg pseudomonas,
Acinetobacter, Mycobacterium.
* On items such as linen, equipment and supplies
* In food.
* In fine dust and droplet nuclei
Some procedures that save life may increase risk
of infection e.g urinary catheters, I.V.L inhalation
therapy, surgery.
Inappropriate use of antibiotics.
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25

Basics of InfectionBasics of Infection
ControlControl
 Prevention of nosocomial infection is the
responsibility of all individuals and services
provided by healthcare setting.
 To practice good asepsis, one should
always know: what is dirty, what is clean,
what is sterile and keep them separate.
 Hospital policies & procedures are applied
to prevent spread of infection in hospital.
26

Infection ControlInfection Control
ProgramProgram
• A comprehensive, effective and supported
program is essential for reducing infection
risk and increasing hospital safety.
• It should include surveillance, preventive
activities and staff training.
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I. National program developed by
Ministry of Health: to support hospital
programs. It sets national objectives,
develops and updates guidelines
recommended for health care.
II. Hospital programs including:
1) major preventive efforts; keeping in mind
patients and staff.
2) It must be supported by senior management and
provided with sufficient resources.
3) It must develop a yearly work plan to assess and
promote all good health care activities.
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March 31, 2019
Infection C onrtol Team Infection control com m ittee Infection control m anual
H ospital P rogram
Prof: Dr Muhammad Tauseef Jawaid King
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Infection Control TeamInfection Control Team
• The optimal structure varies with hospitals
types, needs and resources.
• Hospital can appoint epidemiologist or
infectious disease specialist, microbiologist
to work as infection control physician.
• Infection control nurse who is interested
and has experience in infection control
issues.
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Team responsible for IC training for HCW.
Team formulate IC policies & prepare the
annual action plan for implementation.
Team should have authority to manage an
effective control program.
Team should have a direct reporting with
senior administration.
Infection control team members or are
responsible for day-to-day functions of IC and
preparing the yearly work plan.
They should be expert and creative in their
job.
31

Team should have authority to manage an
effective control program.
Team should have a direct reporting with
senior administration.
Infection control team members or are
responsible for day-to-day functions of IC and
preparing the yearly work plan.
They should be expert and creative in their
job.
32

Infection Control CommitteeInfection Control Committee
It is a multidisciplinary committee responsible for
monitoring program policies implementation and
recommend corrective actions.
It includes representatives from different concerned
hospital departments & management. They meet
bimonthly.
It establishes standards for patient care, it reviews and
assesses IC reports and identifies areas of intervention.
33

Committee componentCommittee component
Chairman
• The director of the facility or his Deputy
Members
• Three directors of clinical departments
• The head nurse
• All members of the infection control team in facilities that have
more than 30 beds
• Director of the pharmacy
• Director of the medical supply unit
• The financial and administrative director of the hospital
• Others as appropriate, e.g., occupational health specialist,
microbiology laboratory professional, surgeon, etc.
34

Infection Control ManualInfection Control Manual
Every Hospital should have a nosocomial
infection prevention manual compiling
recommended instructions and practices for
patient care.
This manual should be developed and
updated in a timely manner by the infection
control team.
It is to be reviewed and accepted by
infection control committee.
35

ResponsibilityResponsibility
 Role of every hospital department and
service units must be identified, documented
as manuals kept in accessible place.
 Job description of every hospital staff;
defining details of his duties must be
discussed before employment. Infection
control precautions should be part of the
routine work and stressed for that.
36

S urveillance P reventive A ctivities S taff T raining
P rogram C om ponents
37

NOSOCOMIAL INFECTION
SURVEILLANCE
• Nosocomial infection rate in a hospital is an
indicator of quality and safety of care.
• Surveillance to monitor this rate is essential to
identify problems and evaluate control activities
• The ultimate aim is the reduction of infection rate
and their costs.
• The term surveillance implies that observational
data are regularly analyzed.
38

Key points in Surveillance
• Active surveillance (Prevalence and incidence studies)
• Targeted surveillance (site, unit, priority-oriented)
• Appropriately trained investigators
• Standardized methodology
• Risk- adjusted rates for comparisons
39

Organization for surveillance
W a r d a c t iv ity
d e v ic e s o r p r o c e d u r e s
f e v e r & in f . s ig n s
a n t ib io t ic s & c h a r ts
L a b o r a t o r y r e p o r ts
c u lt u r e & s e n s it iv ity
r e s is t a n c e p a t t e r n s
s e r o lo g ic t e s t s
D a t a e le m e n t s & a n a ly s is
p a t ie n t d a t a & in f e c t io n
p o p u la t io n & r is k s
c o m p u t e r iz a t io n o f d a ta
D a t a c o lle c t io n a n d a n a ly s is
40

Organization for surveillance
prom pt, relevent to target group M eetings & disscussions Dissem enation by com m ittee
Feedback & dissem enation
41

Scope of InfectionScope of Infection
ControlControl
Aiming at preventing spread of infection:
Standard precautions: these measures must be
applied during every patient care, during
exposure to any potentially infected material
or body fluids as blood and others.
Components:
A. Hand washing.
B. Barrier precautions.
C. Sharp disposal.
D. Handling of contaminated material.
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A.HAND WASHINGA.HAND WASHING
Hand washing is the single most effective
precaution for prevention of infection
transmission between patients and staff.
Hand washing with plain soap is
mechanical removal of soil and transient
bacteria (for 10- 15 sec.)
Hand antisepsis is removal & destroy of
transient flora using anti-microbial soap or
alcohol based hand rub (for 60 sec.)
43

Surgical hand scrub: removal or
destruction of transient flora and reduction of
resident flora using anti-microbial soap or
alcohol based detergent with effective
rubbing (for least 2-3 min)
Our hands and fingers are our best
friends but still could be our enemies if they
carry infective organisms and transmit them
to our bodies and to those whom we care
for.
Sinks & soap must be found in every
patient care room. Doctors, nurses must
comply to hand washing policy.
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When to Wash ourWhen to Wash our
HandsHands
1. Before & after an aseptic technique or
invasive procedure.
2. Before & after contact with a patient or
caring of a wound or IV line.
3. After contact with body fluids & excreta
removal.
4. After handling of contaminated equipment
or laundry.
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5. Before the administration of medicines
6. After cleaning of spillage.
7. After using the toilet.
8. Before having meals.
9. At the beginning and end of duty.
10. Gloves cannot substitute hand washing
which must be done before putting on gloves
and after their removal.
46

How to Wash our HandsHow to Wash our Hands
Jewelry must be removed. If unable to
remove rings, wash and dry thoroughly
around them.
Wet your hands with running warm water,
dispense about 5 ml of liquid soap or
disinfectant into the palm of the hand.
Rub hands together vigorously to lather all
surfaces and wrist paying particular attention
to thumbs, finger tips and webs.
47

Rinse hands thoroughly.
Turn off water using elbow-on elbow taps,
dry hands thoroughly on a paper towel OR
where elbow taps are not present, first dry
hands, thoroughly, then turns off the taps
using fresh paper towel.
Hand cream can be used on persona basis.
If a staff member develops a skin problem,
he or she must consult dermatologist.
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51

B. Barrier PrecautionsB. Barrier Precautions
1. Gloves:
Disposable gloves must be worn when:
a) Direct contact with B/BF is expected.
b) Examining a lacerated or non-intact skin
e.g wound dressing.
c) Examination of oropharynx, GIT, UIT
and dental procedures.
52

d) Working directly with contaminated instruments
or equipment.
e) HCW has skin cuts, lesions and dermatitis
Sterile gloves are used for invasive procedures.
GLOVES MUST BE of good quality, suitable size
and material. Never reused.
53

PPE and A septicPPE and A septic
TechniquesTechniques
1. Gloves:
Disposable gloves must be worn when:
a) Direct contact with B/BF is expected.
b) Examining a lacerated or non-intact skin
e.g wound dressing.
c) Examination of oropharynx, GIT, UIT
and dental procedures.
54

2) Masks & Protective eye wear:
• MUST BE USED WHEN: engaged in
procedures likely to generate droplets of
B/BF or bone chips.
• During surgical operations to protect
wound from staff breathings, …
• Masks must be of good quality, properly
fixed on mouth and nasal openings.March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid King
55

3) Gowns/ Aprons:
Are required when:
• Spraying or spattering of blood or body
fluids is anticipated e.g surgical
procedures.
• Gowns must not permit blood or body
fluids to pass through.
• Sterile linen or disposable ones are
used for sterile procedures.March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid King
56

A Septic techniques;-
refer to the practices performed just before or
during a clinical or surgical procedure in order to
reduce the patient’s risk of infection. These
practices include:
• Surgical scrub and gloving, Surgical Gown
• Establishing and maintaining a sterile field,
• Using good surgical technique, and
• Employing measures to minimize contamination
of medical devices during insertion, care and
maintenance.
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58

C.Sharp precautionsC.Sharp precautions
 Needle stick and sharp injuries carry the risk of blood born
infection e.g AIDS, HCV,HBV and others.
 Sharp injuries must be reported and notified
 NEVER TO RECAP NEEDLES
 Dispose of used needles and small sharps immediately in
puncture resistant boxes (sharp boxes).
 Sharp boxes: must be easily accessible, must not be
overfilled, labeled or color coded.
 Needle incinerators can be another safe way of disposal.
 Reusable sharps must be handled with care avoiding
direct handling during processing.
59

D. Handling ofD. Handling of
Contaminated MaterialContaminated Material
1. Cleaning of B/BF spills:
a- wear gloves.
b- wipe-up the spill with paper or towel.
c- apply disinfectant.
2. Cleaning & decontamination of equipment:
protective barriers must be worn.
3. Handling & processing lab specimens:
must be in strong plastic bags with biohazard
label
60

4. Handling and processing linen:
Soiled linen must be handled with barrier
precautions, sent to laundry in coded bags.
5. Handling and processing infectious waste:
a. must be placed in color coded, leakage
proof bags, collected with barrier
precautions
b. contaminated waste incinerated or better
autoclaved prior to disposal in a landfill.
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62

Environmental control:
1. Including physical facility plans must meet
quality and infection control measures. Patient
equipment positioning and installation, traffic flow.
2. Cleaning of hospital environment and dis-
infection according to policies.
3. Proper air ventilation.
4. Water pipes examination, check its quality.
5. Proper waste collection and disposal.
6. Cleaning and dis-infection of equipment.
7. Proper linen collection, cleaning, distribution
63

8. Food : ensure quality and safety.
9. Sterilization:
Central sterilization department serving
all hospital departments compiling with
infection control precautions.
64

.
Patient protection :
* corrective measures before major
procedure,
vaccination, proper use of antibiotics.
* Isolation precautions.
* Limiting endogenous risk
65

Isolation
• Contact Precautions
– Private room, if possible
• Cohorting might be necessary
– Gloves &Gowns
– Wash hands
– Limit the use of non-critical
patient care equipment to
single patient
– Clean/Disinfect common
equipment used between
patients
66

Isolation
• Droplet Precautions
– Private room
– Wear surgical mask within 3 feet of
patient or when entering room
– Patient transport
• Limit movement of patients to essential
purposes
• Place surgical MASK on patient if transport
is necessary
• Always notify all staff involved in a transfer
of the precautions
67

Staff health promotion and education:
1. HCW are at risk of acquiring infection, they
can also transmit infection to patients and
other employee.
2. Employee health history must be reviewed,
immunizations recommendations to be
considered.
3. Release from work if sick, occupation injury
must be notified.
4. Continuous education to improve practice,
better performance of new techniques.March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid
68

Sterilization
Central sterilization department
serving all hospital departments
compiling with infection control
precautions.
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71

DESIGNING AND
IMPLEMENTING
HOSPITAL
INFECTION
CONTROL
PROGRAM

74

Interruption of the chain of infection is
a strategy to limit the spread of
infection.
• Infection requires three main elements
– a source of the infectious agent,
– a mode of transmission
– a susceptible host.
75

The modes of transmission
• In healthcare settings infectious agents can
be transmitted by:
– Contact
– Droplet
– Airborne
76

Contact transmission
• Direct transmission occurs when the transfer of
microorganisms results from direct physical contact
between an infected or colonised individual and a
susceptible host,
– for example a HCW’s contaminated hands touch a
vulnerable site (such as a wound) on a patient.
• Indirect transmission involves the passive transfer
of an infectious agent to a susceptible host via an
intermediate object or fomite.
– Examples of intermediate objects include instruments,
bed rails, bed, tables and other environmental surfaces.
77

Droplet transmission
• Droplet transmission occurs when respiratory
droplets generated via coughing, sneezing or talking
makes contact with susceptible mucosal surfaces,
such as the eyes, nose or mouth.
– Transmission may also occur indirectly via contact
with contaminated fomites with hands and then
mucosal surfaces.
• Respiratory droplets are large and are not able to
remain suspended in the air thus they are usually
dispersed over short distances.
78

Airborne transmission
• Airborne transmission refers to infectious
agents that are spread via droplet nuclei
(residue from evaporated droplets) containing
infective microorganisms.
• These organisms can survive outside the body
and remain suspended in the air for long
periods of time.
• They infect others via the upper and lower
respiratory tracts.
79

Methods of reducing the spread of
infection
• Standard Precautions
• Transmission based Precautions
80

Standard precautions
• refer to those work practices that are applied to
everyone, regardless of their perceived or confirmed
infectious status
• and ensure a basic level of infection prevention and
control.
• Implementing standard precautions as a first-line
approach to infection prevention and control in the
healthcare environment minimises the risk of
transmission of infectious agents from person to
person, even in high-risk situations.
81

Standard precautions include:
• 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.
82

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.
83

If contact transmission:
• Place the patient in an isolation room and limit access.
• Wear gloves during contact with patient and with
infectious body fluids or contaminated items.
• Reinforce handwashing throughout the health facility.
• Wear two layers of protective clothing.
• Limit movement of the patient from the isolation room to
other areas.
• Avoid sharing equipment between patients.
• Designate equipment for each patient, if supplies allow.
• If sharing equipment is unavoidable, clean and disinfect it
before use with the next patient.March 31, 2019 Prof: Dr Muhammad Tauseef Jawaid King
84

If droplet transmission:
• Place the patient in an isolation room.
• Wear a HEPA or other biosafety mask
when working with the patient.
• Limit movement of the patient from the
room to other areas.
• If patient must be moved, place a surgical
mask on the patient.
85

If airborne transmission
• Place the patient in an isolation room that is not air-
conditioned or where air is not circulated to the rest
of the health facility.
• Make sure the room has a door that can be closed.
• Wear a HEPA or other biosafety mask when working
with the patient and in the patients room.
• Limit movement of the patient from the room to other
areas.
• Place a surgical mask on the patient who must be
moved.
86

Hospital infections
• Patients with infections are always on hospital
admission
• Hospital patients are immunosuppressed
• Cross-infection is common
• Determine magnitude of infection (important)
• Preventive measures to keep infection rates to a
minimum
87

INFECTION CONTROL (IPC)
• Infection prevention and control
– Is a process where activities, policies and
procedures are designed to control and prevent
the transmission of infectious diseases within
the healthcare environment and the community
88

FOR an effective IPC
• HCWs should understand the modes of
transmission of infectious organisms
– knowing how and when to apply the basic
principles of infection prevention
– is critical to the success of an infection control
program.
89

RESPONSIBILITY
• This responsibility applies to everybody
working and visiting a healthcare facility
– including administrators, staff, students,
patients, their family.
INFECTION PREVENTION
AND CONTROL IS
EVERYBODY’S BUSINESS
90

Infection Control Program
• To be effective, control programs should
include:
– Adequate number of infection control staff
– Education
– Organised surveillance and control activities
– A system of reporting infection rates back to
the concerned medical care staff
91

Human resources
• Training for all health-care personnel
• Specialized training of infection control
professionals
• Adequate staff responsible for IPC
activities.
• Address biological risk and implement
preventive measures.
92

Infection control staff
• Infection control program is usually
directed by the:
– infection control team
– infection control committee
93

Infection control team
• consists of
– a doctor with a special interest in infection
– a nurse whose primary occupation is infection
control
– A technologist if the doctor is not a laboratory staff
• This small team does the day to day
surveillance and takes action when outbreaks
occur.
94

Infection control committee
• The committee should represent the major
medical specialties, nursing staff, catering,
engineering (maintanance) and hospital
administration
• provides a forum to discuss policies and
gives authority for control measures
95

Surveillance
• Regular collection, collation and analysis of
information on infection events and rates
either continuously or at regular interval
and the timely dissemination and feedback
to those who need to know
96

Types of surveillance
• 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)
97

Continuous alert organism
surveillance
• Review of lab tests for the presence of
significant organisms as an indicator of the
status of infection in the hospital
• Alert org – bacteria specifically noted on
lab reports as requiring immediate
intervention by the IPC team –MRSA,
MDR –GNB or M. tuberculosis
98

Continuous alert condition surveillance
• Focused on groups of patients most likely to
acquire an infection or who are particularly
vulnerable should they acquire infection
• Requires close liaison between IPC staff
and ward staff and relies on ward staff
being able to
– identify those patients who should be
monitored and
– recognise an infection from the patient’s
condition e g
99

• ICU
–where blood stream infections, IV
therapy infections or SSIs are
recorded,
• diarrhoeal disease
• TB occurring in a particular ward
100

Point prevalence
• – surveys taken at a point in time
• Of patients according to certain
characteristics
• Can be applied to a single unit or nationally
• e g antenatal survey for HIV among
pregnant women in LUTH to assess
prevalence of HIV in this group
101

Selective laboratory based ward
liaison survey
• Lab and staff ward review selected
surveillance data
• Can reveal an increase in the incidence of
infection in a healthcare setting before it
becomes a problem
• Useful where resources are short in both
staff and funds
• Can be set up in a unit which requires the
most attention
102

Hospital wide surveillance
• Review hospital culture results
• Follow up to assess patients to determine
whether hospital or community acquired
• Review with clear definitions of hospital
acquired infection for the type of infection
• Calculate monthly rates
103

INFECTION RATE
= No of infected patients x 100
Total no of patients in hops
104

• There must be clear definition of infections
• There must be appropriate denominators to
calculate rate of infection
• Data entry must be accurate
• Communication and reporting structures must
be clear
• Data must be analysed periodically and
presented to the infection control committee to
be used to develop policies and for IPC
structural support
105

Uses of surveillance
• 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
106

Role of the laboratory in infection
control program
• 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.
107

Bacteriological investigation
• 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.
108

• 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.
109

ENDING AN OUTBREAK
• 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
110

ICT
• preparing the yearly work plan for the program, for review by
the infection control committee and administration
• They have a scientific and technical support role: e.g.
surveillance and research, developing and assessing policies
and practical supervision, evaluation of material and products,
control of sterilization and disinfection, implementation of
training programmes.
• They should also support and participate in research and
assessment programmes at the national and international
levels.
111

Role of hospital management
• 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
112

• 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
113

Role of the physician
• 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.
114

Physician
• 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
115

• 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.
116

Role of the hospital pharmacist
• 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
117

Pharmacist
• 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.
118

Pharmacist
• 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.
119

Role of the nursing staff
• 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.
120

• 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
121

• 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.
122

• 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
123

– 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.
124

Role of the central sterilization
service
• 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
125

CSSD
• 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.
126

The head of catering services is
responsible for:
• 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
127

• 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
128

The laundry is responsible for:
• 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
129

• 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.
130

Biohazard Waste
• Red Bag = Blood
131

Where Does All The Garbage
Go?
• 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.
132

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:
133

Patient Safety is very important for
infection control:
• “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!
134

Role of maintenance
• 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
135

Guidelines
• 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.
136

Environment
• 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
137

MONITORING AND
EVALUATION
• 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
138

Entrenching IPC policies and
practices?
• 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
139

Entrenching IPC policies and
practices?
• 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
140

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
141

Quiz
1. Infection prevention and control programs have been
proven to be effective. T/F?
2. IP&C is important in health care because of its:
a) Focus on patient health and safety
b) Focus on healthcare worker safety
c) Focus on decreasing costs
d) All of the above
3. IP&C programs are relevant to all healthcare settings.
T/F?
142

Infection control program Concept

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