Infections prevention and control as the program aiming to prevent hospital acquired infections

1. : Clinical Laboratory
semester II
CMT 04211
BY JACOB NOAH LAB SCIENTIST, BSC IN HEALTH LAB SCIENCE, ACADEMIC TUTOR II
,RESEARCH OFFICER
TAIFA INSTITUTE OF HEALTH AND ALLIED SCIENCES
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2. LEARNING OBJECTIVES
 At the end of this session each student is expected to be able
to;-
 Define IPC, health care acquired infections and Standard precaution
 Outline objectives of IPC
 Outline four major types of health care acquired infections
 Explain risk factors for health care acquired infections
 Explain components of standard precautions in IPC (consider every person, hand
hygiene, personal protective equipment, handle sharps, safe dispose of wastes
and process instruments)
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3. INTRODUCTION
 In healthcare settings, there is a need for a practical,
evidence-based approach for preventing patients and health
workers from being harmed by avoidable infections
 IPC is the aspect of health care which aims to ensure that
patients do not contract infections as a result of attending
health care facility for assessment, examination or treatment.
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4. DEFINITIONS
 HAIs, also termed nosocomial infections, are infections
occurring in a patient during the process of care in a
hospital or other health-care facility, which was not
present or incubating at the time of admission. HCWs
are also at risk for developing HAIs.
 IPC programs are implemented to prevent HAIs from
occurring and spreading within health facilities.
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5.  Standard precaution, are a simple set of effective
practice guidelines (creating a physical, mechanical
or chemical barrier) to protect health service
provider and clients/patients from infection with a
range of pathogens including blood borne.
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6.  Infection is the successful entrance into the body by
pathogenic microorganisms and the reaction of the body to
the presence of these microorganisms.
 OR Infection is the entry and development of many parasites
or multiplication of an infectious agent in the body of
humans or other animals.
 Prevention is behaviors designed to avoid disease
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7.  Standard precaution, are a simple set of
effective practice guidelines (creating a
physical, mechanical or chemical barrier) to
protect health service provider and
clients/patients from infection with a range of
of pathogens including blood borne
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8. Objectives of Infection Prevention and Control
(IPC) in Health care Facility
 To protect patients/ clients from nosocomial
infections
 To protect health care workers from occupational
infections
 To protect communities from infectious diseases
 To prevent the environment from pollution
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9. Components of Standard Precautions in IPC
 Consider every person (patient or health workers) as potentially infectious and
susceptible to infection
 Consider dead bodies as also potentially infectious
 All items from all clients must be handled as if they are contaminated and all
clients treated as if they may be infected
 Use appropriate hand hygiene e.g. hand washing, Hand hygiene- this includes
hand washing and hand antisepsis, antiseptic and hand scrub.
 Wear personal protective equipment (PPE) including gloves, masks, goggles, caps,
gowns, boots and aprons.
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10.  Handle sharps, patient resuscitation and patient care equipment,
linen appropriately.
 Manage patient placement and patient environmental cleaning
appropriately
 Safe disposal of infectious waste materials to protect those who
handle them and prevent injury or spread to the community.
 Process instruments by decontamination, cleaning and then either
sterilize or HLD using recommended procedures
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11. CLASSIFICATIONS OF HAIs
 Endogenous infection. Many microorganisms that
cause HAIs come from the patient’s own body (the
term normal flora/endogenous flora can be used to
describe this).
 Eg; bacteria normally present in the colon can gain
entry to the urinary tract and cause urinary tract
infections.
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12.  Endogenous infection. Many microorganisms that
cause HAIs come from the patient’s own body (the
term normal flora/endogenous flora can be used to
describe this).
 Eg; bacteria normally present in the colon can gain
entry to the urinary tract and cause urinary tract
infections.
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13. CLASSIFICATIONS OF HAIs Cont…
 Exogenous infection. Result from the transfer of
microorganisms to the patient or HCW from an external
reservoir.
 Eg; microorganisms can be transferred through direct contact
with contaminated hands of HCWs and other patients (cross-
contamination), contaminated instruments and needles, or
the environment (exogenous flora).
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14.  Practicing hand hygiene at the right moment and other
elements of standard precautions can greatly reduce the
frequency of cross contamination between patients and
HCWs and thus reduce the incidence of infection. As
with endogenous infection, measures to protect a
persons natural resistance to infection can also help to
reduce the likelihood of infection if cross transmission
does occur.
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15. COMMON HAIs
 Urinary Tract Infection (UTI)
 Urinary tract infection is one of the most common HAIs.
Preventing UTI is a major factor in decreasing the overall
incidence of HAIs in HCFs. Healthcare-associated UTIs
are frequently related to urinary catheterization. Many
patients with a urinary catheter develop bacteriuria
(bacteria in the urine) because the catheter creates a
pathway for bacteria to enter the bladder.
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16.  However, it is important to make the distinction between
bacteriuria and an actual urinary tract infection. Patients
should not be considered to have a catheter related urinary
tract infection and should not receive antimicrobial treatment
solely because the urine is discoloured, has an odour, or
because the laboratory has cultured bacteria from the urine.
Unless the patient has clinical features of infection (e.g. fever,
rigors, other systemic features) they should not be
considered to have catheter related UTI.
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17. Factors that lead to UTI
 Factors that can lead to bacteriuria and may lead to UTIs include:-
 Urinary catheterization which creates a pathway that allows for endogenous
transfer of microorganisms (e.g. bacteria from the patient’s GI tract can be
transmitted to the urinary tract)
 Passage of organisms from the urine bag to the bladder (retrograde contamination)
can occur in patients with indwelling catheters
 Some microorganisms that can grow on the outside or inside of the catheter’s
tubing and in the urine itself
 Handling of the urinary catheter and urine bag by HCWs
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18. Reducing Hospital-Acquired Urinary Tract
Infections:
 Introducing an indwelling urinary catheter should be
done only when necessary and no other options are
effective. It is particularly important to limit the
duration of catheterization as much as possible
 Following appropriate procedures for inserting and
removing urinary catheters will also reduce the risk
of UTI
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19. B: Infections (SSI
 Surgical site infections is often the result of
contamination during the surgical procedure or
contamination of the surgical wound after the
procedure. SSIs are very common HAIs and often
require additional surgical procedures to treat the
infection.
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20. The following factors predispose a patient to
development of a SSI:
 Obesity
 Infection at another body site at the time of surgery
 Immunosuppression
 Malnutrition and anaemia
 Old age and chronic diseases such as diabetes and
malignancy
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21. Reducing SSIs in patients:
 Avoid prolonged preoperative hospitalization and recommend ambulatory surgery as often as
possible
 Avoid preoperative hair removal. If hair must be removed, clip it with scissors or electric
clippers just before the surgery. Do not shave using a razor blade (shaving has been attributed
to microscopic cuts in the skin that later serve as foci for bacterial multiplication)
 In the surgical room prepare a wide area around the proposed incision site with antiseptic
solution (2% alcohol chlorhexidine is generally appropriate)
 Practice good surgical techniques that minimize tissue trauma, control bleeding, eliminate
dead space, use minimal sutures, and maintain adequate blood supply and oxygenation
 Keep the duration of surgical procedures as short as possible. The rate of infection doubles
with each hour of surgery
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22. C. Health Care-Associated Pneumonia
 Healthcare associated pneumonia (HAP) is a
common HAI with a significant risk of a fatal
outcome. Most of these infections occur by
aspiration of bacteria growing in the back of the
throat or in the stomach. Pneumonia associated with
mechanical ventilation may be referred to as
ventilator associated pneumonia (VAP).
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23.  The range of microorganisms associated with
HAP/VAP is much wider than is the case for
community acquired pneumonia (CAP) and many of
these microorganisms are much more likely to be
resistant to antimicrobials. Therefore HAP/VAP may
be much harder to treat effectively with
antimicrobial agents than CAP.
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24. General activities employed in prevention and
control of diseases
 Standard precautions include:
 Hand Hygiene
 Personal Protective Equipment (PPE) appropriate for the level
of care being given or the potential infection risk associated
with an activity, even when there is no known risk of infection
 Respiratory hygiene and cough etiquette
 Injection and phlebotomy safety and sharps injury prevention
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25. General activities employed in prevention and
control of diseases
 Safe decontamination and sterilization of
medical equipment
 safe handling of Linen and laundry
 Environmental decontamination
 Healthcare waste management
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26. Risk Factors in Nosocomial Infection
 The longer the client is in a health care facility, the greater is
her/his risk of infection.
 Exposure to the facility environment changes the client own
normal body flora
 Risk factors that contribute to the development of
nosocomial infections can be grouped into three categories:
environment, therapeutic regimen, and resistance of the
client
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27. Environment
 Hospital, outpatient clinics, extended care facilities, the home, and schools
are reservoir of organisms that pose threat to the increasing number of
clients who have decreased resistance.
 The source of these organisms includes the air, other clients, families, and
visitors, contaminated equipment, food and personnel.
 Pneumonia and influenza can spread rapidly among clients and other
people in all types of facilities.
 Equipment that is not thoroughly cleaned, disinfected or sterilized can
spread many pathogens.
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28. Therapeutic regimen
 Multiple factors involved in therapies used to cure clients also can
contribute to the risk of infection.
 Drugs such as steroids, immunosuppressive agents, and cancer therapy,
as well as prolonged use of antibiotics predispose clients to infection.
 Equipment such as IV catheter, urinary catheters and feeding tubes that
invade orifices provides routes for bacterial invasion
 Inadequate dressing techniques for wound can provide media for
bacterial growth.
 Identifying treatments that pose risk and discontinuing their use as soon
as possible decrease the chance of nosocomial infection
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29. Client resistance
 Changes in the physical or psychological status of a
client can affect his/her resistance to infection.
 Any break in the integrity of the skin or mucous
membrane increase the chance of infection. Stress,
fatigue, poor nutrition and chronic illness also can
decrease the client ability to ward off infection.
 Adequate hygiene is important to decrease
microorganisms on the skin that could contribute to
infection risk.
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30. Key Points
 Nosocomial infections means infections acquired in health
care delivery settings
 Risk factors that contribute to the development of infections
must be considered when making attempts to decrease the
clients risk
 The incidence of infections associated with health care
delivery (nosocomial infections) can be decreased with good
infection practices
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31. Session Evaluation
Any questions?????
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32. References
 Greenwood, D., Slack, R. C. B., & Peutherer, J. F. (2002). Medical microbiology: A guide to
microbial infections: Pathogenesis, immunity, laboratory diagnosis and control (6th ed.).
Edinburgh: Churchill Livingstone.
 MOHSW. (2004). National infection prevention and control guidelines for health care services
in Tanzania. Dar es Salaam: Ministry of Health and Social Welfare.
 MOHSW. (2018). National infection prevention and control guidelines for health care services
in Tanzania: A pocket guide for health care providers. Dar es Salaam: Ministry of Health and
Social Welfare.
 Nester, E. W., Anderson, D. G., Roberts Jr., C. E., Pearsall, N. N., Nester, M. T., & Hurley, D.
(2004). Microbiology: A human perspective (4th ed.). Boston:
 McGraw Hill. Rosdahl, C. B. (1999). Textbook of basic nursing (7th ed.). Philadelphia:
Lippincott.
 Tietjen, L., Bossemeyer, D., & McIntosh, N. (2003). Infection prevention guidelines for
healthcare facilities with limited resources. Maryland: JHPIEGO Corporation.
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