INFECTION CONTROL AND

PREVENTION
MED-SURG I

LECTURER
MR. SENGHORE

Introduction
What is 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

Aim of Infection Control

reduce risk of transmission of pathogens from a
known or unknown source

Introduction
Hospital Acquired Infection /Nosocomial
Healthcare associated infection (HCAI) - An infection
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. This
includes infections acquired in the hospital, but
appearing after discharge, and also occupational
infections among staff of the facility
Hospital associated infection infection the
manifests within 48 hours of infection

Epidemiology
HCAIs most frequent adverse event in health-care
delivery worldwide (its true global burden remains
unknown)
Hundreds of millions of patients are affected each year,.
Of every 100 hospitalized patients at any given time, 7 in
developed and 10 in developing countries will acquire at
least one HCAI
HCAI burden higher in low- and middle-income than in
high-income countries

Epidemiology
Common HCAI
urinary tract infection in high-income countries,
surgical site infection in settings with limited
resources, affecting up to one-third of operated
patients; this is up to nine times higher than in
developed countries

In high-income countries, approx. 30% of patients in

ICUs are affected by at least one HCAI
In low- and middle-income countries it is at least 23
fold higher

Epidemiology
Prevalence of health care-associated infection in low- and
middle-income countries, 1995-2010

Epidemiology
HCAI results
prolonged hospital stays
long-term disability
increased resistance of microorganisms to
antimicrobials
massive additional costs for health systems
high costs for patients and their family
and unnecessary deaths

Epidemiology
Risk factors
Age - >65 and new born
admission as an emergency and to the ICU
longer hospital stay (> 5 days)
placement of a central venous catheter, indwelling
urinary catheter, or an endotracheal tube
undergoing surgery
immunosuppression
impaired functional or coma status
COPD and Diabetic patients

Chain of Infection Transmission

Chain of infection the series of steps required for infection
to occur. There are six links in the chain of transmission and
each link must connect for an infection to occur.
Infectious Agent micro-organisms capable of producing
infection.
Reservoir a place in which the infectious agent lives.
Portal of Exit - the point where the agent leaves the
reservoir.
Mode of Transmission - The way that organisms travel
from the reservoir to a host
Portal of Entry - the point at which the agent enters the
host e.g., non-intact skin, respiratory or GI tract, mucous
membranes.
Susceptible host - any person at risk of infection

Chain of Infection Transmission

Routes of Transmission
1. Contact divided into:
Direct Contact occurs through touch
Indirect Contact occurs when micro-organisms are
transferred by contaminated object coming into contact with
another surface. (e.g. scabies and pediculosis)
1. Droplet Transmission occurs when large droplets exit
the respiratory tract by coughs or sneezes. Can also be
generated by some procedures e.g., suctioning.
Droplets are projected a short distance of usually < 2m.
They may enter eyes, nose, mouth or fall onto
surfaces.(e.g. Neisseria meningitidis, pertussis, influenza)

Routes of Transmission
4. Airborne Transmission Occurs when very tiny droplets, <5
microns (PHAC, 1999) exit the respiratory tract when a person
talks, coughs or sneezes and then remain suspended in the air.
These droplet nuclei must be inhaled by a susceptible host to
cause infection e.g. chicken pox, TB, measles
5. Parenteral Transmission the spread of an agent through intact
skin by a sharp e.g., needle stick injury.

6. Common Vehicle Transmission the spread of an agent through a

common contaminated source e.g., multi-dose vials.
7. Vector Transmission occurs when a host is bitten by an animal
or insect carrying the infectious agent e.g., mosquito, tsetse fly

Breaking the Chain of Infection

Source control measures
Cough etiquette, cleaning, disinfection

Modes of transmission

Contact: hand hygiene

Droplet: distance from source >1 m and PPEs
Airborne: ventilation and PPEs
Vector: barrier such as bed nets

Portal of entry into the host

Adding barriers, e.g., PPE

Host
Strengthen host defences, e.g., vaccination

Precautions
Guidelines for hospital-based infection precautions.
Two levels of precautions
Standard Precautions which apply to all patients
at all times
Transmission-Based Precautions which are
intended for individuals who have a known or
suspected infection with certain organisms
The Centers for Disease Control and Prevention (CDC) and the Hospital
Infection Control Practice Advisory Committee (HICPAC)

Standard precautions
Standard Precautions define all the steps that should
be taken to prevent spread of infection from person
to person when there is an anticipated contact with:

Blood
Body fluids
Secretions, such as phlegm
Excretions, such as urine and feces (not including sweat)
whether or not they contain visible blood
Non-intact skin, such as an open wound
Mucous membranes, such as the mouth cavity and nostrils

Standard precautions
Standard Precautions includes

Hand washing,
Use of latex or other protective gloves
Masks, eye protection and/or face shield
Gowns
Proper handling of soiled patient care equipment
Proper environmental cleaning
Minimal handling of soiled linen
Proper disposal of needles and other sharp equipment
such as scalpels
Placement in a private room for patients who cannot
maintain appropriate cleanliness or contain body
fluids.

Transmission based precautions

May be needed in addition to Standard Precautions
for selected patients who are known or suspected to
harbor certain infections.
Three categories mode of transmitted
Airborne precautions
Droplet precautions
Contact precautions

Airborne Precautions
Protection against inhalation of tiny infectious
droplet nuclei E.g. TB, Measles, Chickenpox, herpes Zoster,
SARS

In addition to Standard Precautions:

Use particulate respirator
Place the patient in adequately ventilated room
The door must be closed at all possible times
Limit patient movement
If a patient must move from the isolation room to
another area of the hospital, the patient should
wearing a mask

Airborne Precautions
Anyone entering the isolation room to provide
care to the patient must wear a special mask
called a respirator (N95 respirator or powered airpurifying respirator )

Droplet Precautions
Protection against respiratory pathogens transmitted by
large droplets E.g. meningococcal meningitis, influenza, mumps,
and German measles (rubella)

In addition to Standard Precautions:

Use a medical mask when < 1 m of patient
Maintain a distance 1 meter between infectious
patient and others
Place patient in a single room or cohort with similar
patients
The door to the room may remain open
Limit patient movement
Patients moving away from the isolation room should
wear a mask

Contact Precautions
Protection against contact (i.e., hand contamination
or self-contact)with large droplets
In addition to Standard Precautions:
Use non-sterile, clean, disposable gloves, gown, apron (only
if gown is not impermeable)
Use disposable or dedicated reusable equipment (which
must be cleaned and disinfected before use on other
patients)
Limit patient contact with non-infected persons
Place patient in a single room or cohort with similar
patients

Contact Precautions
Change gloves if they touch material that contains large
volumes of organisms such as soiled dressings
they may need to wear protective gowns if there is a
chance of contact with potentially infective materials such
as diarrhea or wound drainage that cannot be contained
or if there is likely to be extensive contact with the patient
or environment
Patient care items, such as a stethoscope, should not be
shared with other unless properly cleaned and disinfected
Prior to leaving the room, health care workers should
remove the gloves and wash their hands with medicated
soap
Patients should leave the isolation room infrequently.

Hand Hygiene
Use alcohol-based hand rub or wash hands with
soap and water
Five moments of hand hygiene:

Before any direct contact with a patient

Before a procedure
After a procedure or body fluid exposure risk
Before touching patients
After contact with items contaminated with blood,
body fluids, secretions and excretions, including
respiratory secretions and patients surroundings

Respiratory Hygiene and Cough Etiquette

Part of standard precautions
Education of health care workers, patients and
visitors
Source control measures (e.g., cover cough to
prevent dissemination of infectious droplets)
Hand hygiene
Spatial separation (> 1 meter) of persons with
acute febrile respiratory symptoms

Personal Protective Equipment (PPE)

General Principles
The use of PPE does not replace the need for proper
hand hygiene.
PPE is used to prevent contact with non-intact skin,
blood, body fluid, excretions and secretions.
PPE is also used to prevent the transmission of
particular organisms that may be transmitted via the
air, or by contact with intact skin.
PPE is only effective in infection control and
prevention when applied, used, removed and disposed
of properly

Personal Protective Equipment (PPE)

General Principles
Avoid any contact between contaminated (used) PPE and
surfaces, clothing or people outside the patient care
area.

Discard used PPE in appropriate disposal bags, and

dispose waste appropriately.
Do not share PPE.
Remove PPE completely and thoroughly perform hand
hygiene each time you leave a patient to attend to
another patient or move to a non-patient care area.

Cleaning and Disinfecting the

Environment
Aseptic Technique - Aseptic technique is undertaken in order
to keep patients as free from communicable microorganisms
as possible. Only sterile equipment and fluids should be used
during invasive procedures
Generally there are two types of asepsis (medical and surgical
asepsis)
Medical or clean asepsis reduces the number of organisms
and prevents their spread.
Surgical or sterile asepsis includes procedures to eliminate
microorganisms from an area and is practiced in settings
such as operating theatres.

Cleaning and Disinfecting

Cleaning
General removal of debris, physical removal
of dirt with running water and detergent
action. Should be Done for all items prior to
disinfection/ sterilization

Low-level
Disinfection
Removal of most of the
organisms present on
the surface that can
cause infection. For
equipment that does not
touch mucous
membranes and only
touches intact skin e.g.,
blood pressure cuff.

high-level
Disinfection
For items that come in
contact with patients
non-intact skin and/ or
mucous membranes
but does not penetrate
them. e.g. laryngoscopes,
NG-Tubes, Catheters

Sterilization
Killing of all disease
causing organisms.
For items that
penetrate sterile
tissue e.g., surgical
equipment.

Management of Contaminated
Needles and Sharps
General Principles
Never use sharps if a safe and effective alternative is available.
Always use safety needles, if available.

Never recap used needles

Sharps should never be passed directly form hand to hand,
use a carrying container (e.g. kidney dish)
Collect and store used needles and sharps in sharps
containers
The sharps container must be marked with the universal
biohazard

Waste Management
Bio-hazardous waste.
Bio-hazardous waste includes both anatomical
and non anatomical waste.
Hazardous anatomical waste includes
human tissues, blood, and body fluids but excludes teeth,
hair, nails, urine and feces.

Hazardous non-anatomical waste includes

needles, blades and sharps that have come into contact with
blood or body fluids.

Waste handlers should use routine practices and appropriate

PPE to manage their risk when handling medical waste

Waste Management
Option
Category 1

Waste Category
Human anatomical waste

Treatment & Disposal

Incineration /deep burial

Category 2

Animal waste

Incineration /deep burial

Category 3

Incineration /deep burial

Category 4

Microbiology & biotechnology

waste
Sharps

Category 5

Medicines and cytotoxic drugs

Category 6

Solid waste (Blood and Body

fluids)
Solid waste (disposable items)

Incineration / destruction and disposal in secured

landfill
Autoclave/chemical treatment/burial

Category 7

Incineration / disinfection /chemical treatment

/mutilation

Autoclave/chemical treatment/burial

Category 8

Liquid waste ( blood & body

fluids)

Disinfection by chemicals/discharge into drains

Category 9

Incineration Ash

Disposal in municipal landfill

Category 10

Chemical waste

Chemical treatment/ secure landfill

Biomedical wastes Containers

Biohazard fibre drum

Use: Large anatomical parts

Biohazard box

Use: Biohard solids & cell culture.

END