#دكتور_حاتم_البيطار #دحاتم_البيطار #timodentist 📞01005684344 💬 واتس 01202389028 Dr Hatem ElBitar د حاتم البيطار أستشاري وجراح أسنان زميل الزمالة المصرية محاضر ادارة المستشفيات ومكافحة العدوى 01005684344 #دحاتم_البيطار http://bit.ly/2xzMIlo

1. Infection prevention and control
Infection prevention and control (IPC) is a practical,
evidence-based approach preventing patients and health
workers from being harmed by avoidable infections.
Effective IPC requires constant action at all levels of the
health system, including policymakers, facility managers,
health workers and those who access health services. IPC is
unique in the field of patient safety and quality of care, as it
is universally relevant to every health worker and patient, at
every health care interaction. Defective IPC causes harm
and can kill. Without effective IPC it is impossible to achieve
quality health care delivery.
Infection prevention and control effects all aspects of health
care, including hand hygiene, surgical site infections,
injection safety, antimicrobial resistance and how hospitals
operate during and outside of emergencies. Programmes to
support IPC are particularly important in low- and middle-
income countries, where health care delivery and medical
hygiene standards may be negatively affected by secondary
infections.

2. The germ theory, disease and dying
• The germ theory (medical bacteriology), a belief that
disease was caused by the transmission of micro-
organisms from patient to patient, evolved over many
years.
• In the 1840s, the Hungarian physician, Dr Ignaz
Semmelweis, discovered that the simple act of
handwashing between patients all but eliminated the
high infection rate in obstetric patients, drastically
reducing the mortality of women
following birthing (Best & Neuhauser, 2004; Dossey,
Selanders, Beck, & Attwell, 2005; Nuland, 2003

3. The germ theory, disease and dying
• This work was further expanded upon by Louis
Pasteur and Robert Koch in the 1870s (Ullman,
2007) and antibiotics, specifically penicillin,
discovered by Alexander Fleming in 1928
(Fleming, 1929) some 20-70 years after the
beginning of the Crimean War, respectively

4. • Therefore, little was available for the
treatment of infection and disease in the mid-
19th century, not even antiseptics.
• Although Joseph Lister successfully utilised
carbolic acid (phenol), a poisonous, caustic
compound, to relieve and eliminate infection
in wound care and surgery in the 1860s (Lister,
1867), it was also unavailable during the
Crimean War.

5. • Treatments for wound infection and infectious
diseases were therefore limited to
medications such as quinine, which was
originally recognised in the 17th century
(Butler, Khan, & Ferguson, 2010) for the
treatment of malaria, and tincture of opium
for the relief of diarrhoea, because of
its gastrointestinal motility properties

6. • t also contained the opioid morphine, useful for pain relief
(Gill & Gill, 2005).
• Furthermore, anaesthetics were basic at this time, with
chloroform being the mainstay (Manring, Hawk, Calhoun, &
Andersen, 2009).
• Apart from the high rate of infection, overcrowded
conditions allowed disease to run rampant,
with cholera, typhoid, typhus, respiratory
infections and dysentery ever present, the latter accounting
for at least 50% of deaths. This explains the overall high
mortality rate from disease, at almost four times greater
than deaths from wounds acquired on the battlefield
(Bostridge, 2009,

7. The beginnings of healthcare reform
• Such historical accounts of the extraordinarily
high death rate from disease and infection
emphasise the urgency with which Nightingale
set about influencing rudimentary health reform,
firstly in Scutari, then in the British Army and
general population on her return to England. The
subsequent development and practice of her
Environmental Theory, now thought to be
individual ideals or philosophies initially
presented as fundamental elements to promote
good health (Hegge, 2013), strengthened her
advocacy for Army and Public Health

8. Nightingale's Environmental Theory
• Nightingale's Environmental Theory was developed over
time, commencing some years before the Crimean War,
followed by two difficult years of service during the War
and approximately four years post-war, up to the point of
publication of Notes on Nursing: What it is and what it is
not (Nightingale, 1860) in which she details her concepts on
sanitary conditions, aligned with holistic patient care.
Nightingale's assessment of the ‘health of houses’, hospital
design and planning and nursing practice provide strong
evidence of the ongoing development of her Environmental
Theory across her lifetime, much of which was written
while she was bed-ridden in her senior years.

9. Nursing practice informs infection
control:
• Nurses and nursing practice, as Nightingale saw them, were an
integral part of daily hospital life, as they are today.
• Patient wellbeing always came first, and, as a by-product, was
closely followed by cleanliness and good sanitary practices.
• This was aided by the proper use of antiseptic; carbolic solutions
being utilised as ‘the only safe method of disinfection’.
• Nightingale stated, ‘Absolute cleanliness is the true disinfectant.
• The nurse must be taught the nature of contagion and infection, and
the distinctions between deodorants, disinfectants and
antiseptics (McDonald, 2010).
• It is interesting to note here that although Ignacz Semmelweiss had
introduced handwashing with disinfectant between obstetric
patient examinations in Vienna in 1847-1848 to reduce the
mortality rate,

10. Contemporary infection control
• Although current understanding of the ‘germ theory’ and infection
control seems common knowledge, much is owed to Nightingale's
solid sanitary foundations.
• Healthcare workers today are responsible for the health and safety
of their patients, their colleagues and themselves, suggesting that
basic infection control is the responsibility of all, including
individuals at the community level.
• Hospital-acquired, or nosocomial infections, which unfortunately
are still active today, primarily come from healthcare workers
themselves, often due to a lack of adherence to basic hand hygiene.
Guidelines have been developed to assist healthcare workers in
maintaining robust sanitary conditions and practices in support of
patient wellbeing, whilst also attending to their own health and
safety.

11. Universal precautions
• These guidelines were introduced in 1985 by the
Centers for Disease Control (CDC), primarily in
response to the human
immunodeficiency virus (HIV), to prevent the
transmission of
bloodborne pathogens (Broussard & Kahwaji,
2020).
• They were subsequently replaced by the
Standard precautions which remain in use today.

12. Standard precautions
• n 1996, Standard Precautions were subsequently
adapted from Universal Precautions and one other set
of guidelines relating to Body Substance Isolation.
Standard precautions were developed as a set of basic
infection prevention and control strategies for
everyone, regardless of their infection status.
• They include such things as handwashing, personal
protective clothing, cleaning and disposal of sharps, in
relation to contact with body fluid, compromised skin
surfaces and mucous membranes (ACSQHC,
2019, Broussard and Kahwaji, 2020; WHO, 2007). These
standards make up the current guidelines for infection
control.

13. Coronavirus (COVID-19)
• In view of the unprecedented global coronavirus pandemic, declared by the World
Health Organisation (WHO) on 11th March 2020 (WHO, 2020b), it is important to
include comment here, particularly considering the WHO also declared 2020 as
the Year of the Nurse and the Midwife (WHO, 2020a).
• The latter would have to be an unparalleled and unexpected understatement of
enormous proportions due to the presence and nature of the former.
• Frontline healthcare workers, including nurses, willingly put themselves at great
risk every day of contracting COVID-19 from their patients and their colleagues,
but, like Nightingale, are completely dedicated to the care and wellbeing of others
(Fedele, 2020, Koven, 2020, Stokowski, 2020).
• Worldwide shortages of personal protective equipment (PPE) have placed
healthcare workers in an unenviable position (Fedele, 2020, Koven,
2020, Stokowski, 2020), some even making the ultimate sacrifice, with loss of life,
for example, in China, Italy, Iran, France, UK and the USA (Amnesty International,
2020; Mhango, Dzobo, Chitungo, & Dzinamarira, 2020; Sahu et al., 2020; Xiao,
Fang, Chen, & He, 2020; Xiang, Li et al., 2020).

14. Germinal and Somatic Mutations
• Eukaryotic organisms have two primary cell types
--- germ and somatic. Mutations can occur in
either cell type. If a gene is altered in a germ cell,
the mutation is termed a germinal mutation.
Because germ cells give rise to gametes, some
gamete s will carry the mutation and it will be
passed on to the next generation when the
individual successfully mates. Typically germinal
mutations are not expressed in the individual
containing the mutation. The only instance in
which it would be expressed is if it negatively (or
positively) affected gamete production.

15. • Somatic cells give rise to all non-germline
tissues.
• Mutations in somatic cells are called somatic
mutations.
• Because they do not occur in cells that give
rise to gametes, the mutation is not passed
along to the next generation by sexual means.

16. • To maintain this mutation, the individual
containing the mutation must be cloned. Two
example of somatic clones are navel oranges
and red delicious apples. Horticulturists first
observed the mutants. They then grafted
mutant branches onto the stocks of "normal"
trees. After the graft was established, cuttings
from that original graft were grafted onto tree
stocks. In this way the mutation was
maintained and proliferated.

17. • Most tissues are derived from a cell or a few
progenitor cells. If a mutation occurs in one of
the progenitor cells, all of its daughter cells
will also express the mutation. For this reason,
somatic mutations generally appear as a
sector on the mutated individual.

18. • Cancer tumors are a unique class of somatic
mutations. The tumor arises when a gene
involved in cell division, a protooncogene, is
mutated. All of the daughter cells contain this
mutation. The phenotype of all cells
containing the mutation is un controlled cell
division. This results in a tumor that is a
collection of undifferentiated cells called
tumor cells.

19. Modes of Transmission
• Pathogens may be transferred from the source to a
host by direct or indirect
• contact transmission .
• Respiratory transmission may result from inhalation of
droplets; or from inhalation of droplet nuclei, i.e.,
airborne transmission.1
• Droplets and droplet nuclei are generated when people
talk, breath, cough, or sneeze; or when water is
converted to a fine mist by medical/dental devices,
such as high-speed handpieces, ultrasonic instruments,
or by lasers and electrosurgical units.1

20. Direct contact transmission
• occurs when pathogens are transferred between
individuals without a contaminated intermediate
person, object, or environmental surface.1 For
example, when blood or other potentially
infectious materials from an infected person
enters the body of a susceptible person through
direct contact with mucous membrane or breaks
in the skin, e.g., when pathogens are transferred
from a patient to a HCP during ungloved contact
with mucous membrane or skin.

21. Indirect contact transmission
• occurs when pathogens are transferred between
individuals via a contaminated intermediate
person, object, or environmental surface.1 For
example, when the hands of HCP become
contaminated and hand hygiene is not performed
prior to touching the next patient; when
contaminated patient-care items are shared
between patients without having been
adequately cleaned, disinfected, or sterilized; or
in association with contaminated sharps and
needlestick injuries.

22. Respiratory transmission
• associated with the inhalation of droplets, i.e.,
airborne particles of moisture greater than 5 µm
that may contain potentially infectious
pathogens, is generally limited to within 3 feet of
the source; but it may also result from physical
transfer of pathogens from a body surface, such
as the hands contaminated with respiratory
secretions; or contact of a susceptible host with
contaminated intermediate objects or
environmental surfaces.1

23. Airborne transmission
• Airborne transmission is a form of respiratory
transmission associated with inhalation
of droplet nuclei, i.e., residuals of droplets
ranging in size from 1-5 µm that remain
infective over time and space.1 In a cool
setting, droplet nuclei may remain in the air
indefinitely and travel long distances, i.e.,
extend beyond 3 feet of the source. Droplet
nuclei may also contaminate intermediate
objects or environmental surfaces.