Infection Prevention and Control

Asmamaw Abera

Feb 23, 2023

Debre Berhan, Ethiopia
 Chapter outline

➢Basic Concepts in Infection Prevention and Control

➢Factors Influencing Healthcare associated Infection
➢ IPC precautions
➢Surveillance of Healthcare associated infections
➢Processing reusable textiles and laundry services
➢Practical aspects of Infection Prevention & Control
 Basic Concepts in Infection Prevention and Control

Introduction
➢ no country can claim to be free from health care associated infections,
therefore, improvement of infection prevention and control (IPC)
strategies is essential

➢ WHO recommends the use of multimodal improvement strategies to

implement IPC interventions

➢ Healthcare Associated Infection (HCAI) is an infection in a patient

during the process of treatment within in any healthcare facility

This term replaces both Hospital acquired infections and nosocomial infections
 Basic Concepts in Infection Prevention and Control

WHO, the 4 commonest HCAIs in low-and middle-income countries are

➢ Surgical Site Infections (SSI)
➢ catheter-associated urinary tract infection (CAUTI)
➢ central line associated blood stream infection (CLABSI)
➢ ventilator associated pneumonia (VAP)

The most common microorganisms causing HCAI include:

➢ Staphylococcus aureus, especially Methicillin-resistant Staph
➢ Vancomycin Resistant Enterococci (VRE)
➢ multi-drug resistant Gram-negatives
➢ Carbapenem-resistant Enterobacteriaceae [CRE] e.g., Escherichia
coli, Acinetobacter baumannii and Pseudomonas aeruginosa
 Sources of infections

Infections can be acquired from two sources

i. an endogenous route
➢the source of microorganisms is from the patient’s own
microflora, e.g. from the gut due to break in intestinal mucosal
barriers caused by chemotherapy in cancer patients

ii. an exogenous route

➢the microbes are from outside sources, e.g. from contaminated
hands of healthcare workers, items, equipment, and/or the
environment
 Factors Influencing HCAI

Factors related to microorganisms

➢each microorganism has an infective dose defined as the
number of microorganisms required to cause an infection

➢microorganisms with low infective doses spread more rapidly

➢ if the person is immunosuppressed, the infective dose required
to cause infection becomes reduced

➢pathogenicity of microorganisms is the capacity of a microbial

strain to produce disease
➢natural defence mechanisms for resisting the entry and
multiplication of pathogens
Fig. Susceptibility of an individual to healthcare associated infections
 Modes of transmission
Transmission-based precautions

Contact transmission
➢is the most frequent mode of transmission in any
healthcare facility

➢microorganisms can also spread by direct contact via

contaminated hands and gloves

➢hand-hygiene is among the most important and effective

methods of preventing cross infection

➢indirect contact transmission occurs when pathogens are

transmitted through an intermediate object
 Modes of transmission

Droplet transmission
➢occurs when microorganisms come into direct contact with
mucous membranes in the mouth, eyes, and nose

➢coughing, sneezing and during certain medical procedures

➢most of the aerosol particles generated during coughing can be

found in the air in proximity of 1m (∼ 3 feet)

➢ within a few seconds, large-size particles (> 5 μm) fall quickly

to the ground due to gravitational force
 Modes of transmission
Airborne transmission
➢airborne transmission efficiency depends on particle size
➢smaller size particles (<5μm) remain suspended in the
environment for a significantly longer time and a long distance
➢common microorganisms include Mycobacterium tuberculosis,
varicella-zoster virus (chickenpox) and measles
➢ Fig. Host defence mechanisms in the respiratory tract and use of PPE
Fig. Sources of exogenous healthcare associated infections
 Chain of transmission of infections

➢microorganisms responsible for infectious diseases include

bacteria, viruses, rickettsia, fungi, protozoa, and helminths
 Chain of transmission of infections

➢ Microorganisms: bacteria, virus, fungus or protozoa; and the

transmission depends on the type, virulence, and infective dose of the
microorganisms
➢ Reservoir: a place where microorganisms can multiply and/or survive
This could be in humans, animals, water

➢ Portal of Exit: means by which microorganisms can leave the

reservoir (through the mouth, respiratory and gastrointestinal tract
➢ Mode of Transmission: Microorganisms move from one person to
another rough direct contact via hands, respiratory droplets/secretions

➢ Portal of Entry: An opening that allows the microorganism to gain

access to a new person (host)
➢ Susceptible Host: A person that is susceptible to infection
 IPC precautions

Standard Precautions
➢were developed in 1996 to combine the main elements of the
universe and isolation precautions

➢standard precautions are the basic level of IPC precautions

which are to be used routinely
Core elements of Standard precautions
1. Hand Hygiene
2. Patient placement
3. Use of appropriate personal protective equipment
4. Reprocessing of reusable medical equipment and
instruments
5. Environmental cleaning
6. Safe injection practices-including safe use of sharps and
management of sharp injuries
7. Aseptic technique
8. Respiratory hygiene and cough etiquette
9. Waste management – including safe disposal of sharps
10. Appropriate handling of linen
 Rationale Standard Precautions

Application of standard must be done to all patients at all

times for the following reasons:
➢patients may be incubating the disease and may not show
signs or symptoms of infection
➢patients may be asymptomatic carriers (hepatitis B & C,
Salmonella Typhi, etc.) or colonized with MDROs which are
unknown

➢infectious status of the patients is not confirmed by

laboratory diagnosis due to:
(i) lack or limited availability of the microbiology laboratory facility
(ii) infection is not suspected during the initial assessment of the patient
 1. Hand hygiene
➢Hand hygiene (HH) is a major component of the Standard
precautions and among the most effective methods of preventing
transmission of pathogens associated with healthcare facility
➢Table moments for hand hygiene and examples of clinical situations
moments for hand hygiene and examples of clinical situations
moments for hand hygiene and examples of clinical
situations
 Hand hygiene
Parts of the hands most frequently
missed during hand decontamination

Importance of hand hygiene. Number of

microbes before and after hand hygiene
Steps on how to properly perform hand hygiene using soap and water
Steps on how to properly perform hand hygiene using soap and water
Steps on how to properly perform hand hygiene Alcohol Based Hand
Rub--Total Duration 20-30 Second
 2. Patient placement
➢is to assess risk and segregate suspected and/or confirmed
infected patients with transmissible infections

➢is essential that all healthcare workers in the Accident &

Emergency department must be trained and educated in IPC

➢patients should be provided educational materials about hand

hygiene and respiratory hygiene/cough etiquette in emergency

➢infected patients are nursed in single rooms preferably with en

suite toilet and shower facilities
➢some patients with infectious diseases, which are spread by an
airborne route, e. g. tuberculosis, measles, and
chickenpox/varicella-zoster
 3. Personal Protective Equipment

➢PPE acts as a physical barrier that prevents healthcare staff,

including nurses

Masks With Or Without Face Shield When to wear

➢assess risk and wear to protect the mouth and nose from
inhalation of respiratory droplets/splashing

➢ wear a face shield (eye visor, goggles) to protect mucous

membranes of the eyes, nose, and mouth

➢very important during activities that are likely to generate

splashes or sprays of blood, body fluids, secretions, and
excretions
 Comments on musk
➢surgical masks should be changed when wet
➢a flexible band should be fitted to the nose bridge
➢the mask should fit comfortably on the face and under the chin
➢masks should be discarded directly into a waste bin after use
and never left

➢N95 masks can be used for up to 8 h by the same HCW

➢Respiratory masks are unsuitable for HCWs with facial hair, as it

affects the seal between the mask and the face
 4. Use and management of sharps, safety engineered
devices and medication vials

➢use of sharp devices exposes healthcare workers to the risk of

injury and potential exposure to blood borne infectious agents

Injuries most often occur

➢during use of a sharp device on a patient (41%)
➢ after use and before disposal of a sharp device (40%)
➢during or after appropriate or inappropriate disposal of sharp
devices (15%)
Table Examples of sharps associated with sharps injuries
5. Routine management of the physical environment

➢environmental surfaces can be safely decontaminated using less

rigorous methods than those used on medical instruments

➢level of cleaning required depends on the objects involved and

the risk of contamination-for example, surfaces that are likely to be
contaminated with infectious agents

➢however, all surfaces require regular cleaning

Routine environmental cleaning

➢general surfaces and the cleaning requirements for each can be
divided into two groups:
Routine environmental cleaning
 6. Respiratory hygiene and cough etiquette

➢respiratory hygiene and cough etiquette must be applied as a

standard infection control precaution at all times

➢covering sneezes and coughs prevents infected persons from

dispersing respiratory secretions into the air

➢hands must be washed with soap and water after coughing,

sneezing, using tissues, or after contact with respiratory
secretions
 7. Aseptic technique

➢Aseptic technique is a set of practices aimed at minimising

contamination and is particularly used to protect the patient
from infection during procedures

➢many of the other work practices that form standard

precautions are required for aseptic technique

➢Sterile single-use equipment or instruments must be used

according to manufacturer’s instructions
The five essential principles of aseptic technique are:
1. Sequencing:
➢ Performing a risk assessment, Pre-procedure preparation, Performing
the procedure, Post procedure practices, handover and documentation
 7. Aseptic technique
2. Environmental control:
➢Prior to aseptic procedures, healthcare workers must ensure there
are no avoidable nearby environmental risk factors, such as bed
making or patients using commodes
3. Hand hygiene:
➢ Perform hand hygiene before a procedure and after a procedure or
body fluid exposure
4. Maintenance of aseptic fields:
➢ Cleaning and/or disinfection of equipment and patient prior to
procedure(s)
➢ Establishing an aseptic field and use of sterile equipment
➢ Maintenance of the aseptic field, including protecting the key sites
➢ Use of a non-touch technique
5. PPE:- Correct selection and use of sterile and non-sterile PPE
 8. Waste management

When handling waste:

➢apply standard precautions to protect against exposure to blood
and body substances during handling of waste

➢segregation should occur at the point of generation

➢waste should be contained in the appropriate receptacle

(identified by colour and label)

➢healthcare workers should be trained in the correct procedures

for waste handling
 Surveillance of Healthcare associated infections
➢HCAI is a patient safety and quality of healthcare issue which
contributes to poor patient outcomes and additional costs to the
healthcare system

➢ Surveillance is defined as the ongoing systematic collection,

analysis and interpretation of health data essential

to the planning, implementation and evaluation of public health

practice

➢cliniciansand other stakeholders, surveillance and feedback of

infection rates is a cornerstone of HCAI prevention
programmes
Surveillance of Healthcare associated infections
Cornerstone of all successful hospital IPC program
➢IPC Surveillance is only the starting point and benchmark for
assessing the need for intervention strategies
➢ Effective surveillance involves
– Counting cases and then
– Calculating rates of various infections
– Analyzing these data
– Reporting the data in an appropriate use
➢Challenges
– Changing healthcare delivery system
– Emerging and reemerging infectious diseases
– Mandatory reporting requirements
 Surveillance of objectives

➢ultimate aim of the surveillance is to prevent and/or reduce

HCAIs
➢process of surveillance must incorporate four key stages:
collection, validation, analysis, and interpretation of data
main objectives of the surveillance are summarized as
➢Establish endemic/baseline HCAIs rate
➢Compare HCAI rates within/between healthcare facilities
➢Reduce infection rates by convincing the clinical team to change
and adopt evidence-based IPC practices
➢Implement cost-effective interventions based on local priorities,
resources, and institutional objectives
➢Identify, monitor and control outbreaks
➢Evaluate the success and sustainability of IPC interventions
 Surveillance of objectives

➢There are two types of surveillance: 1) outcome and 2) process

1. Outcome surveillance:
➢Monitoring of specific HCAIs (Surgical site infections, device
associated infections (e.g. infection associated with the IV and
urinary catheters), diarrhoeal diseases, etc.)

2. Process surveillance:
➢Monitoring of patient care practices, including IPC practices as
part of the HCAI Care bundle
 Processing reusable textiles and laundry services

➢Detergent/Soaps is a cleaning agent that makes no antimicrobial

claims on the label Detergents (liquid or powder) are composed of a
hydrophilic (water-seeking) component and a lipophilic (fatseeking)
component
➢Textiles cloth items used in healthcare facilities by housekeeping
staff (bedding and towels), cleaning staff (cleaning cloths, gowns and
caps), and surgical personnel (caps, masks, scrub suits, surgical
gowns, drapes and wrappers)
➢Health care textiles are made from woven textile materials, either
natural or synthetic fibers or a mix of fibers, and material prepared
from non-woven fibers
 Minimum Requirements for Standard Laundry

➢maintain the receiving area for contaminated textiles at

negative pressure compared with the clean areas of the
laundry
➢ensure that laundry areas have hand washing facilities
and products and appropriate PPE available for workers
➢use and maintain laundry equipment according to
manufacturers' instructions
➢do not leave damp textiles/fabrics in machines overnight
 Maintenance Issue of Laundry

➢use and maintain laundry equipment according to manufacturers'

instruction
➢make sure that spare parts are available for parts which can easily be
damaged and needing replacements on regular basis
➢train the laundry staffs on users` maintenance and assign focal
person for managing the machine and reporting
Practical aspects of Infection Prevention & Control
Table Summary of the hierarchy of IPC
Table Summary of the hierarchy of IPC
Table Summary of the hierarchy of IPC
Table Summary of the hierarchy of IPC
Thank you!!