INFECTION CONTROL IN CLINICALS

INFECTION
The invasion of bodily tissue by
pathogenic microorganisms that
proliferate, resulting in tissue injury
that progress to disease. An infection
may cause no symptoms and be
subclinical, or it may cause symptoms
and be clinically apparent.
NATURE OF INFECTION
Bacteria
Bacteria are by far the most common
infection-causing microorganisms; several
hundred species can cause disease in humans
and can live and be transported through air,
water, food, soil, body tissues and fluids, and
inanimate objects.
Viruses
Viruses consist primarily of nucleic acid and
therefore must enter living cells in order to
reproduce; common virus families
include rhinoviruses (causes the common
cold), hepatitis, herpes, and human
immunodeficiency virus.
Fungi
Fungi includes yeast and Molds;
Candida albicans is a yeast considered
to be normal flora in the human
vagina.
Parasites
Parasites live on other living
organisms; they include protozoa
such as the one that causes
malaria, helminths (worms), and
arthropods (mites, fleas, ticks).
THE CHAIN OF INFECTION
Etiologic agent
The extent to which any microorganism is capable
of producing an infectious process depends on the
number of microorganisms present, the virulence
and potency of the microorganisms, the ability of
the microorganisms to enter the body, the
susceptibility of the host, and the ability of the
microorganisms to live in the host’s body.
Reservoir
Reservoirs are sources of microorganisms; common
sources are other humans, the client’s own
microorganisms, plants, animals, or the general
environment; a carrier is a person or animal
reservoir of a specific infectious agent that usually
does not manifest any clinical signs of the disease.
Portal of exit from
reservoir
Before an infection can establish itself in a host,
the microorganisms must leave the reservoir;
common human reservoirs include respiratory
tract, GI tract, urinary tract, reproductive tract,
blood, and tissues.
Method of transmission
After a microorganism leaves its source or reservoir, it requires a means of
transmission to reach another person or host through a receptive portal of
entry; there are three mechanisms: direct transmission, which involves
immediate and direct transfer of microorganisms from person to person
through touching, biting, kissing, or sexual intercourse; indirect
transmission may be either vehicle-borne (any substance that serves as an
immediate means to transport and introduce an infectious agent into a
susceptible host through a suitable portal of entry) or vector-borne (an animal
or flying or crawling insect that serves as an intermediate means of
transporting an infectious agent); airborne transmission may involve droplets
or dust such as a droplet nuclei (the residue of evaporated droplets emitted by
infectious host such as someone with tuberculosis, can remain in the air for
long periods
Portal of entry to
susceptible host
Before a person can become infected,
microorganisms must enter the body; often,
microorganisms enter the body of the host by the
same route they used to leave the source.
Susceptible host
A susceptible host is any person who is at risk
for infection; a compromised host is a person
at increased risk, an individual who for one or
more reasons is more likely than others to
acquire an infection.
TYPES OF INFECTION
 Local infection- A local infection is limited to a specific part of
the body where the microorganisms remain.
 Systemic infection- If the microorganisms spread and damage
different parts of the body, the infection is a systemic infection.
 Bacteraemia- When a culture of a person’s blood reveals
microorganisms, the condition is called bacteraemia.
 Septicaemia- When bacteraemia results in systemic infection, it
is referred to as septicaemia, which has become common over time.
 Acute infection- Acute infections generally appear suddenly or
last a short time.
 Chronic infection- A chronic infection may occur slowly, over a
very long period, and, at last months or years
ST
AG
ES
OF
IN F
ECT
ION
Incubation Period
The first stage is incubation. This begins when you
are exposed to a pathogen. During this stage, you
won’t be experiencing any symptoms. However, the
pathogen is now working its way throughout the
body and multiplying. This phase can last anywhere
from several days to several weeks, depending on
the type of infection.
Prodromal Period
The prodromal stage begins when a person starts to notice
symptoms of an infection. Symptoms begin when the
infection replicates enough to produce an immune response.
At this stage, the symptoms are usually mild and generalized.
This is also usually the stage where a person becomes
contagious.
Illness Period
The person enters the illness phase of their infection. This
is the period of infection that we all know about. During
this stage the person is experiencing symptoms that are
more specific to their type of infection. The person usually
feels unwell and may also still be contagious. However, his
or her body is working hard behind the scenes to fight the
pathogen.
Convalescence Period
During this stage, the infection is in its decline. The
person’s body has successfully fought the pathogen, either
on its own or with the help of medications. Symptoms will
improve as the infection dwindles within the body.
However, the patient needs to protect their body during
this time. Stress on the immune system can increase the
chances of catching another illness.
 HEALTHY LIFE

HEALTHY LIFE

FACTORS INCREASING
SUSCEPTIBILITY TO
INFECTION
 Age - The very young or very old are usually more susceptible.

 Health status - Malnourished, dehydrated, or otherwise

unhealthy persons are more at risk

 Medication usage - Immune suppressing drugs allow pathogens

to take hold more freely

 General resistance factors - Intact mucous membranes and skin,

and robust cough and sneeze reflexes help defend against
invading pathogens.
BODY DEFENSES AGAINST INFECTION
INFLAMMATORY RESPONSE
Inflammation is a local and nonspecific defensive
response of the tissue to an injurious or infectious
agent; it is an adaptive mechanism that destroys or
dilutes the injurious agent, prevents further spread
of the injury, and promotes the repair of damaged
tissue.
 First stage: Vascular and cellular responses. There is constriction of blood
vessels, dilatation of small vessels, increased vessel permeability,
increased leukocytes, swelling, and pain; leukocytes begin to engulf the
infection.

 Second stage: Exudate production. This stage is characterized by

exudation with fluids and dead cells; serous (clear, part of the blood),
purulent (thick, pus with leukocytes), and sanguineous (bloody).

 Third stage: Reparative phase. The repair of tissues; examples are

regeneration (same tissues), stroma (connective tissues), parenchyma
(functional part), and fibrous (scar).
IMMUNE RESPONSE
 Active immunity-In active immunity, the host produces
antibodies in response to natural antigens (e.g., infectious
agents) or artificial antigens (e.g., vaccines); B cells are
activated when they recognize the antigen; they the
differentiate into plasma cells; the B cell may produce
antibody molecules of five classes of immunoglobulins: IgM,
IgG, IgA, IgD, and IgE.

 Passive immunity-With passive (or acquired) immunity, the

host receives natural (e.g., from a nursing mother) or
artificial (e.g., from an injection of immune serum)
antibodies produced by another source.
HEALTH-CARE ASSOCIATED
INFECTION
(NOSOCOMIAL INFECTION)
 Urinary tract-The most common microorganisms in the urinary tract include Escherichia
coli (improper catheterization technique), Enterococcus species (contamination of closed drainage system),
and Pseudomonas aeruginosa (inadequate hand hygiene).

 Surgical sites-The most common microorganisms in surgical sites include Staphylococcus

aureus including MRSA (inadequate hand hygiene), Enterococcus species including vancomycin-resistant
strains (improper dressing change technique), and Pseudomonas aeruginosa.

 Bloodstream-The most common bloodstream microorganisms include coagulase-negative staphylococci

(inadequate hand hygiene), Staphylococcus aureus and Enterococcus species (improper intravenous fluid,
tubing, and site care technique).

 Pneumonia-The most common causative microorganisms for pneumonia include Staphylococcus

aureus (inadequate hand hygiene), Pseudomonas aeruginosa and Enterobacter species (improper suctioning
technique).
SEPSIS

ASEPSIS
SEPSIS - Sepsis is the condition in which acute organ dysfunction occurs secondary to infection.

ASEPSIS - Asepsis is the freedom from disease causing microorganism; aseptic technique is used to
decrease the possibility of transferring microorganisms from one place to another. Asepsis is a condition in
which no living disease-causing microorganisms are present. Asepsis covers all those procedures designed
to reduce the risk of bacterial, fungal or viral contamination, using sterile instruments, sterile draping and
the gloved 'no touch' technique.

MEDICAL ASEPSIS - Medical asepsis includes all practices intended to confine a specific
microorganism to a specific area, limiting the number, growth, and transmission of microorganisms.

SURGICAL ASEPSIS - Surgical asepsis, or sterile technique, refers to those practices that keep an area
or an object free of all microorganisms; it includes practices that destroys microorganisms and spores.
HAND HYGIENE
 Hand Hygiene-It is a general term that applies to handwashing,
antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis

 Hand Washing-It is defined as the washing of hands with plain (i.e.,

non-antimicrobial) soap and water.

 Antiseptic Handwash-A term that applies to handwashing with an

antimicrobial soap and water.

 Surgical Hand Antisepsis-Commonly called as a surgical hand scrub.

This is to remove as many microorganisms from the hands as possible
before the sterile procedure
PURPOSES OF HAND HYGIENE
• It reduces the transmission of microorganisms.

• It increases patient safety.

• It decreases health care-associated infection.

Moments for Hand Hygiene
STEPS OF HAND HYGIENE
PERSONAL PROTECTIVE EQUIPMENTS
Personal Protective Equipment (PPE) is specialized
clothing or equipment worn by an employee for
protection against infectious materials.
PPE prevents contact with an infectious agent or
body fluid that may contain an infectious agent, by
creating a barrier between the potential infectious
material and the health care worker.
Gloves
 Gloves are worn for three reasons: first they protect the hands when the nurse is likely to handle any body
substances; second, gloves reduce the likelihood of nurses transmitting their own endogenous microorganisms
to individuals receiving care; and third, gloves reduce the chance that the nurses’ hands will transmit
microorganism to from one client or object to another client.
 In all situations, gloves are changed between client contacts.
 The hands are cleansed each time the gloves are removed for two primary reasons: (1) the gloves may have
imperfections or be damaged during wearing so that they could allow microorganism entry; and (2) the hands
may become contaminated during glove removal.
Gowns
 Clean or disposable impervious (water-resistant) gowns or plastic aprons are worn during procedures when
the nurse’s uniform is likely to become soiled.
 Sterile gowns may be indicated when the nurse changes the dressings of a client with extensive wounds.
 Single-use gown technique (using a gown only once before it is discarded or laundered) is the usual practice
at hospitals.
Face Masks
 Masks are worn to reduce the risk for transmission of microorganisms by the droplet contact or
airborne routes and by splatters of body substances.
 The CDC recommends that masks be worn:
 By those close to the client if the infection is transmitted by large-particle aerosols (droplet); large
particle aerosols are transmitted by close contact and generally travel short distances (about 1 m or 3
ft).
 By all individuals entering the room if the infection is transmitted by small particle aerosols (droplet
nuclei); small-particle aerosols remain suspended in the air and thus travel great distances in the air.
Eye Wear
 Protective eye wear (goggles, glasses, face shields) and masks are indicated in situations where body
substances may splatter the face.
 If the nurse wear prescription eyeglasses, goggles must still be worn over the glasses because the
protection must extend around the sides of the glasses.
PPE Donning and Doffing Sequence
Donning means to put on and use PPE properly to achieve the
intended protection and minimize the risk of exposure.
Doffing means removing PPE in a way that avoids self-
contamination.
STANDARD PRECAUTIONS
Standard precautions are used in the care of all hospitalized individuals regardless of their diagnosis possible infection status.
 Designed for all clients in the hospital.
 These precautions apply to (a) blood; (b) all body fluids, excretions, and secretions except sweat; (c) nonintact broken skin;
and (d) mucous membranes.
 Designed to reduce risk of transmission of microorganisms from recognized and unrecognized sources.
 Perform hand hygiene after contact with blood, body fluids, excretions, secretions, and contaminated objects whether or not
gloves are worn.
 Wear clean gloves when touching blood, body fluids, secretions, excretions, and contaminated items.
 Wear a mask, eye protection, or face shield if splashes or sprays of blood, body fluids, secretions, or excretions can be
expected.
 Wear a clean, non-sterile, water-resistant gown if client care is likely to result in splashes or sprays of blood, body fluids,
secretions, or excretions; the gown is intended to protect clothing.
 Handle client care equipment that is soiled with blood, body fluids, secretions, or excretions carefully to prevent transfer of
microorganisms to others and to the environment.
 Handle all soiled linen as little as possible.
 Place used needles and other “sharps” directly into puncture-resistant containers as soon as their use is completed.
BIOMEDICAL WASTE MANAGEMENT
Biomedical Waste Management is the process of
collecting, segregating, disposing or recycling, and
monitoring of waste materials. Waste materials or
chemicals are often a result of human activity and are
inherent to civilization. These materials can be of solid,
liquid, gaseous or radioactive nature that can pose as a
threat to both the environment and those living in the
environment.
SOURCES OF BIOMEDICAL WASTE MANAGEMENT - The major
sources of health care waste are:
 Hospitals, nursing homes and health care facilities
 Diagnostic research and laboratory centres
 Autopsy and mortuary centres
 Animal research centres
 Pain, palliative and rehabilitative centres
 Blood bank and pathology centres
HEALTH IMPACTS
There has been an alarming increase in the amount
of health care waste with the increase in the number
of hospitals and dispensaries that the local
government is unable to deal with or clear. With the
exception of a few large hospitals, many health care
institutions are facing the problem of disposal of
waste generated.
The health risks associated with the waste include:
 Exposure to toxic chemicals like mercury, xylene and formalin can result in chemical injuries among health
personnel and patients in contact.
 Microorganisms can come into contact with health care personnel and patient bystanders due to exposure to
surfaces that are soiled with infected body fluids. In 2010 it was found that unsafe injection use was
responsible for 1.7 million Hepatitis B infections, 315000 Hepatitis C infections and 33800 Human
immunodeficiency virus infections.
 Improper disposal and lack of properly designed landfills result in contamination of water and exposure to
toxic wastes.
 Inadequate incineration can result in toxic air pollution; the failure to use proper filters adds to the release of
such pollutants into the air. Incineration of chlorine containing waste produces dioxins that are carcinogens.
 Lack of segregation of the biomedical wastes can risk an exposure to sharps among the workers of waste
disposal and treatment. Even one needle stick injury from an infected source patient can result in 30% risk of
Hepatitis B virus, 1.8% risk of Hepatitis C virus and 0.3% risk of Human immunodeficiency virus.
 Open waste dumping results in piling up of the waste which attracts insects; these dumps during the rains
become breeding areas for the insects and as sources for vectors which spread infectious disease.
 Pouring of the antibiotics into the drain results in the killing of required microbes and altering the environment
that helps in the breakdown of biological matter in septic tanks.
ERRORS WHILE HANDLING
BIOMEDICAL WASTE - Management of
waste requires diligent knowledge and practice.
Though there are laws available and
implemented, there still exists a failure in
proper waste disposal.
Some of the concerns that require to be addressed are:

 Lack of awareness of health hazards related to health care waste

 Lack of training on proper waste disposal practices
 Absence of available constructed waste disposal systems
 A low priority level even after knowing the harmful effects of improper waste
disposal
 A lack of funds and resources towards constructing waste disposal systems
 Occupational risks to health care waste exist but have not been efficiently
addressed
THANK YOU