Infection Prevention Control
Infection Prevention Control
Infection Prevention Control
CONTROL
١
Infection Control Overview
admission.
HEALTHCARE ASSOCIATED
INFECTIONS
Remember
►Infection in a hospitalized
patient
►Not present or incubating on
admission
►Hospital acquired infection
٤
Why now the urgent need for
Infection Control Program
► HAIs are becoming more prevalent, especially
with the advent of more invasive procedures &
increase in use of immunosuppresive therapy.
► HAIs are preventable( can kill )
► HAIs are associated with prolonged morbidity.
► HAIs are associated with increased length
of stay & increased cost of care.
٥
TYPES OF HAIs
Procedure Associated
Infections ٦
17
UT
%
44 I
% SSI
18 BSI
% Pneum
10 11
% o
%
Others
٧
Source Healthcare Associated
Infections
Patient’s Medical
Own Flora
HAIs
Equipment
Staff Member
٨
The GOAL
The goal of Infection Control Program is
to provide a safe healthy environment
through identification and reduction the
risks of acquiring and transmission of
HAIs among patients, medical staff,
administration staff, volunteers, students
and visitors.
١٠
Importance
of Infection Control Program
١٣
HOSPITAL ENVIRONMENT
HIV
CHIKENPOX
TB
١٤
Chain of infection
• Model of infectious disease transmission
• Six elements must be present for an
infection to develop
1. The infectious agent
2. Reservoir host
3. Portal of exit from
the host
4. Route of transmission
5. Port of entry
6. Susceptible host
Chain of infection
Infectious
agent
Susceptible Reservoir
host Host
Portal of
entry Portal of
exit
Route of
transmission
Chain of infection
1. Infectious agent: a pathogen must be
present
2. Reservoir host: the pathogen must
have a place to live and grow – the human
body, contaminated water or food,
animals, insects, birds, dead or decaying
organic material.
• Humans who can transmit infection but how
no signs of the disease are called carriers.
Person may be unaware they are a carrier.
Chain of infection
3. Portal of exit: the pathogen must be able
to escape from the reservoir host where
it has been growing.
• Examples of portals of exit are blood,
urine, feces, breaks in the skin, wound
drainage, and body secretions like saliva,
mucus and reproductive fluids
Chain of infection
4. Route of transmission: When the pathogen
leaves the reservoir host through the
portal of exit, it must have a way of being
transmitted to a new host.
• Examples of routes of transmission are air,
food, insects, and direct contact with an
infected person
Chain of infection
5. Portal of entry: The pathogen must
have a way of entering the new host.
Common ports of entry are the mouth,
nostrils, and breaks in the skin
6. Susceptible host: An individual who has
a large number of pathogens invading the
body or does not have adequate resistance
to the invading pathogen will get the
infectious disease
Breaking the chain of infection
• Breaking at least one link stops the spread of
infectious disease
1. The infectious agent
– early recognition of signs of infection
– Rapid, accurate identification of organisms
2. Reservoir host
• Medical asepsis
• Standard precautions
• Good employee health
• Environmental sanitation
• Disinfectant/sterilization
Breaking the chain of infection
3. Portal of exit from the host
– Medical asepsis
– Personal protective equipment
– handwashing
– Control of excretions and secretions
– Trash and waste disposal
– Standard precautions
Breaking the chain of infection
4. Route of transmission
– Standard precautions
– Handwashing
– Sterilization
– Medical asepsis
– Air flow control
– Food handling
– Transmission-based precautions
Breaking the chain of infection
5. Portal of entry
– Wound care
– Catheter care
– Medical asepsis
– Standard precautions
6. Susceptible Host
– Treating underlying diseases
– Recognizing high-risk patients
factors that render individuals
more susceptible to infection:
Extremes of age
Presence of an underlying disease, such as
diabetes mellitus, or human immunodeficiency
virus (HIV) infection
Use of certain medications, such as
antimicrobials, corticosteroids, chemotherapeutic
agents, or other immunosuppressive drugs
Irradiation
Breaks in the first line of defense mechanisms
caused by invasive procedures such as surgical
operations, anaesthesia, indwelling catheters, and
other procedures
Routes of Transmission
The five (5) main modes of transmission—contact,
droplet, air, common vehicle, and
1. Contact Transmission: the most important and
most frequent mode of HAI transmission.
It is divided into two subgroups:
Direct-contact transmission involves a direct body-
surface-to-body-surface contact and physical
transfer of microorganisms between a susceptible
host and an infected or colonized person. It can
occur when a HCW turns a patient, gives a patient
a bath, or performs other activities that involve
direct personal contact.
Direct-contact transmission can also occur
between two patients, with one serving as the
source of the infectious microorganisms and
the other as a susceptible host. Indirect-
contact transmission involves contact
between a susceptible host and a
contaminated intermediate object, usually
inanimate, such as contaminated instruments,
needles, dressings, contaminated and
unwashed hands, or gloves that are not
changed between patients.
Droplet Transmission
Droplet transmissions occur when droplets are
propelled a short distance through the air and
deposited on the hosts conjunctivae, nasal
mucosa, or mouth.
The droplets are generated from the source
person primarily through coughing, sneezing,
and talking and during certain procedures
such as suctioning and bronchoscopy.
For transmission to occur, the source and the
susceptible host must be within one meter
(approximately three feet) of one another.
Airborne Transmission
occurs by dissemination of either airborne droplet
nuclei (small-particle residue) of evaporated
droplets that contain microorganisms and remain
suspended in the air for long periods of time, or
dust particles that contain the infectious agent.
Airborne microorganisms can be dispersed widely
by air currents and can be inhaled by a
susceptible host within the same room or some
distance from the source patient, depending on
environmental factors.
Microorganisms transmitted by airborne
transmission include Mycobacterium
tuberculosis, rubella, and varicella viruses.
Control of airborne transmission is the most
difficult, because it requires control of airflow
through special ventilation systems
Common-Vehicle Transmission
Common-vehicle transmission refers to the
transmission of infection to multiple hosts by
contaminated items (vehicles).
This mode can result in explosive outbreaks.
Vehicles for transmission include the following:
Foods, which can transmit salmonellosis
Water, which can transmit shigellosis,
Medications and intravenous solutions
Blood, which can transmit hepatitis B (HBV) and
hepatitis C (HCV) and HIV, for example
Equipment and devices
Vector-Borne Transmission
Infections acquired in
healthcare
Spread of antimicrobial ٢٠
resistance
All health care works
involve the hands
٢١
Hands are contaminated
Hands
spread
germs
٢٢
The health care environment
is contaminated
٢٣
Colonized or Infected:
What is the Difference?
► People who carry bacteria without evidence
of infection (fever, increased white blood
cell count) are colonized
► Ifan infection develops, it is usually from
bacteria that colonize patients
► Bacteriathat colonize patients can be
transmitted from one patient to another by
the hands of healthcare workers
~ Bacteria can be transmitted even if the
patient is not infected ~ ٢٤
The Iceberg Effect
Infected
Colonized
٢٥
The inanimate environment is
a reservoir of pathogens
X represents a positive Enterococcus culture
٢٨
Hand Hygiene is the simplest, most
effective measure for preventing
Hospital-Acquired Infections.
٢٩
30%-40% of all HAIs are
Attributed to Cross Transmission:
Importance of Hand Hygiene?
٣٠
Types of Hand Hygiene
► Normal hand washing
► Antiseptic hand washing
►Alcohol-based hand rub
Can be used instead of hand
washing , if hands are not visibly
soiled with blood or any other
patient body fluids
► Surgical hand wash
٣١
Routine Hand Washing
٣٢
Antiseptic Hand Washing
٣٣
Samples taken before and after
antiseptic handwashing
٣٤
Waterless Hand Rub
“alcohol-based hand rub
٣٥
Efficacy of Hand Hygiene
Preparations in Killing Bacteria
Good Better Best
Guideline for Hand Hygiene in Health-Care Settings MMWR,2009. vol. 51, no. RR-16.
٣٦
Hand Hygiene Options
Wet hands, apply
soap and rub for
>10 seconds.
Rinse, dry & turn
off faucet with
paper towel.
٣٨
٤١
HAHS © 1999
When must I hand wash?
upon arriving at and before leaving the health
care facility,
Before and after performing any procedure
between patients or on the same patient
Before and after examining (coming in direct
contact with) a client or patient
Before putting on gloves
After removing gloves
After any situation in which hands might
become contaminated, such as: Handling
contaminated objects, including used instruments
Diapering or toileting children Using the toilet,
wiping or blowing one‟s nose, or performing
other personal functions
Touching mucous membranes, blood, body
fluids, secretions, or excretions Coming in
contact with a source of microorganisms
Before preparing medication
Before preparing, handling, serving, or
eating food
Before feeding a patient
Personal Protective Equipment
(PPE)
٤٤
Personal Protective Equipment
PPE provides a physical barrier between
microorganisms and the wearer, thereby
preventing microorganisms from contaminating
hands, eyes, clothing, hair, and shoes. PPE also
prevents microorganisms from being transmitted
to other patients and staff.
PPE reduces, but does not completely eliminate,
the risk of acquiring an infection.
PPE must be used effectively, correctly, and
whenever there is a risk of contact with blood and
body fluids. Making PPE available and training
HCWs to use it properly are essential. Note: Use
of PPE does not replace the need to follow basic
IPC measures such as hand hygiene.
Principles for Using PPE
Health care workers should follow these guidelines for
using PPE:
Assess the risk of exposure to blood, body fluids,
excretions, or secretions and choose items of PPE
accordingly.
Use the right PPE for the right purpose.
Avoid any contact between contaminated (used) PPE
and surfaces, clothing, or people outside the patient care
area.
Discard used PPE in designated disposal bags.
Do not share PPE.
Change PPE completely and thoroughly your wash
hands each time you leave a patient to attend to another
patient or another duty.
Types of PPE used in Healthcare
Gloves
Masks Gowns
٤٣
٤٥
Who should wear PPE?
1- Standard Precautions
Standard precaution (SP) is the primary
strategy for preventing transmission of
microorganisms to patients, They are
applied to all patients .
٤٩
Practical Issues and Considerations
► Hand Hygiene.
► Personnel Protective Equipment (PPE).
► Safe Use of Sharps.
► Monitoring Staff Health.
► Cleaning and Disinfecting Patient Care
Equipment.
► Disposing of Waste Safely.
► Cleaning the Environment.
► Removing Spills of and
Fluids
Blood Body ٥٠
Expanded Precautions
Pulmonary TB
Meseals
Meningitis MDR
Chickenpox Influenza A
H1N1
Mumps
٥٢
٥٤
٥
٥٦
٥٧
CONTACT PRECAUTIONS
► The patient is placed into a private room
whenever possible. Cohorting patients
with the same organism may be done if
needed.
► A GOWN AND GLOVES MUST BE WORN BY
ALL ENTERING THE ROOM! THIS
INCLUDES VISITORS. Dietary staff that
are delivering trays are required to wear
gloves, not gowns.
٥٩
Employee Health Program
PRE-EMPLOYMENT
SCREENING
IMMUNIZA
TION
WORK RESTRICTION
MANGEMENT OF
OCCUPATIONAL
EXPOSURE
T
٦١
OBJECTIVES
►What the risk of exposure?
►How we can prevent the
exposure?
►If the exposure is already
done, what is the exposure
management plan?
٦٢
Bloodborne Pathogen Exposures
TYPES OF EXPOSURE
Percutaneous Mucous
Exposure . Cutaneous
Membrane
Standard
Precautions
Treat all human blood and other potentially
infectious materials like they are
infectiousfor Hepatitis B&C and HIV ٦٤
Safer Sharps
٦٥
Safe Handling of Sharps
Sharps (needles, scalpels, etc.)
Do not pick up a handful of sharp instruments
simultaneously. Position the sharp end of
instruments away from self and others.
Exercise caution when rotating instruments are in
use. Wear heavy-duty or strong utility gloves
while decontaminating, cleaning, and disinfecting
instruments. Dispose of used sharps
immediately in designated puncture- and leak-
proof containers labelled with a biohazard symbol.
Prevent access to used needles and syringes,
and other sharps while awaiting transport for final
disposal. If injured by sharps, contact the
supervisor immediately.
SHARP INJURIES PREVENTION
► Avoid rushing when handling needles and sharps.
is securely locked.
To safely recap needles use “the
one-hand” technique
Step 1
► Place the cap on a flat surface, then remove
your hand from the cap.
Step 2
► With one hand, hold the syringe and use the
needle to “scoop up” the cap.
Step 3
► When the cap covers the needle
completely, use the other hand to secure the
cap on the needle hub. Be careful to handle
the cap at the bottom only (near the hub).
٦٩
VACCINATION
٧٠
IMMEDIATE CARE
OF INJURY
MANGEMENTOF
EXPOSED RISK ASSESMENT
HCWs ٧١
► The employee concerned should immediately
wash away the contaminating fluid. If blood
or body fluids get in the mouth, spit out
and then rinse mouth with water several
times.
► If there is a puncture wound, wash with soap
and water and disinfected by Alcohol or
Betadine.
► If the eyes are contaminated (may be more
dangerous than an NSI) rinse well with
tap water or saline.
٧٢
► Should be in detail with
completion of the appropriate form.
► Report should include details of the incident
,date & time of incident , people involved
,any witnesses to the incident.
► All occupational exposures must be fully
documented to meet relevant legal
requirement.
٧٣
Exposed
Source Injury
HCWs
Percutaneous exposure
CHECK ( High Risk
CHECK Exposure )
Mucous membrane
HBsAg ( Moderate Risk
Exposure )
Anti-HCV
Cutaneous-
Anti- to non-intact
exposure skin
٧٤
(Low Risk Exposure)
HIV
٧٥
►Source is –ve for HBV,HCV,HIV
Anti-HBs Ab titre
POST-EXPORUE PROPHYLAXIS
Source is +ve or likely to be +ve
forHBV
Anti-HBs Ab
+Ve - Ve
IMMUNE NON IMMUNE
POST EXPOSURE PROPHYLAXIS ٧٧
Post Exposure
Prophylaxis
No plasma,bl,body tissue
donation.
Seek for clinical advise Protect sexual partner.
Highest risk
percuteneous ٧٩
exporure,modify WP.
Source is +ve or
likely to be +ve for HCV
Screening Confirmatory
HCV-IgG HCV-RNA by
real-time PCR
No plasma,bl,body tissue
Seek for clinical advise donation
Protect the sexual partner .
Hihgest risk percutaneous ٨١
exposure,modify WP.
Source is +ve or likely to be
+ve for HIV
► Postexporue Prophylactic treatment is
indicated.
► It must be commenced as soon as
possible
.preferably within hours rather than
days .
► It should be administrated for 4
weeks.
► If PEP is offered & taken &the source is
later determined to be HIV -ve ,PEP should ٨٢
be discontinued.
Repeated HIV screening
at 1 & 3 & 6 months
٨٤
Waste segregation
Waste generation refers to the quantity of
materials or products that enter a waste stream
before compositing, incinerating, or recycling.
Waste is generated during patient management
and care and in other areas of the health care
setting.
Segregate contaminated and noncontaminated
wastes at the point of generation. Separating
wastes minimizes costs by reducing the volume
of contaminated waste that must be treated
with the expensive procedures that are required
for managing and disposing of contaminated
waste properly.
Use appropriate colour-coded separate
containers for noninfectious, infectious, and
highly infectious waste. Fill the waste
containers not more than three-quarters full.
Use colour-coded bins and bin liners or
label the waste containers (see Figure 14).
Never sort through contaminated wastes. Do
not try to separate noncontaminated waste
from contaminated waste, or combustible
from noncombustible waste, after they have
been combined.
Decontamination of Used
Instruments and Equipment
The recommended decontamination agent is a
0.5 percent chlorine solution.
Make a fresh solution every morning, or after 8
hours, or more often if the solution becomes
visibly dirty. A 0.5 percent chlorine solution can
be made from readily available liquid chlorine or
chlorine tablets (NaDCC).
The formula for making a dilute solution from
concentrated solutions is as follows: Total Parts
(TP) water = (percentage chlorine in
manufacturers concentration ÷ % desired
chlorine concentration) - 1 Mix 1 part
concentrated bleach solution with the total parts
water required. Example: To make a 0.5 percent
chlorine solution from 5 percent concentrated
chlorine solution: TP water: (5.0% ÷ 0.5%) - 1=
10 - 1 = 9 Add 1 part concentrated solution to 9
parts water. Cover containers containing 0.5
percent chlorine solution and protect them from
light
Decontaminate large surfaces that might
have come in contact with blood and body
fluid, such as pelvic-examination, operating,
or delivery tables. Wipe them with a cloth
soaked in the 0.5 percent chlorine solution.
Decontaminating Used
Instruments and Other Items
Keep surgical or examination gloves on after
completing the procedure. Decontaminate the
instruments while wearing the gloves:
Immediately after use, place all instruments in
an approved disinfectant, such as 0.5 percent
chlorine solution, for 10 minutes to inactivate
most organisms, including HBV and HIV. Use
plastic, noncorrosive containers for
decontamination to prevent sharp instruments
from getting dull (due to contact with metal
containers) and to prevent instruments from
getting rusted (due to electrolysis between two
different metals when placed in water).
Remove instruments from 0.5 percent
chlorine solution after 10 minutes and
immediately rinse them with cool water to
remove residual chlorine before thoroughly
cleaning them. Remove gloves and dispose
of them appropriately. Note: To prevent
rusting, do not soak metal instruments in
water for more than one hour, even if they are
electroplated. Once instruments and other
items have been decontaminated, they can
safely be cleaned and sterilized or high-level
disinfected.
Cleaning
After decontamination and prior to disinfecting
or sterilizing, all instruments and equipment
MUST be cleaned to remove organic materials or
chemical residue. If instruments and equipment
are not cleaned properly, organic matter could
prevent the disinfectant or sterilizing agent
from making contact with the instrument or
piece of equipment and might also bind and
inactivate the chemical activity of the
disinfectant. Ensure that all surfaces of
instruments and equipment, including channels
and bores, are cleaned.