Healthcare

Epidemiolo
gy

KATE TRIXIE E. MANZO

2 levels of safety precautions:

Standard Precautions
 Combination of major the major features of universal precautions and body substance Isolation
Precautions and are intended to be applied to the care of all patients in all healthcare settings,
regardless of the suspected or confirmed presence of an infectious agent.
 Based on the principle that all blood, body fluids, secretions, excretions except sweat, nonintact
skin, and mucous membranes may contain transmissible infectious agents.
 Provides infection prevention guidelines regarding hand hygiene, wearing gloves, gowns, masks,
eye protection, respiratory hygiene or cough etiquette; safe injection practices, lumbar
puncture, cleaning of patient-care equipment, environmental control (cleaning and
disinfection), handling of soiled linens, handling and disposal of used needles and other sharps,
resuscitation devices, and patient placement.
 Protects both healthcare personnel and their patients from becoming infected with HIV, HBV,
HCV
 Vaccinations
o Hepatitis B recombinant vaccine
o Influenza vaccine
o Measles live-virus vaccine
o Mumps live-virus vaccine
o Rubella live-virus vaccine
o Varicella-zoster live-virus vaccine
 Personnel Protective Equipment
 Gloves
 Protects both patient and healthcare personnel from exposure to infectious
materials that may be carried on hands
 Used when direct contact with blood or body fluids, mucous membranes,
nonintact skin, and other potentially infectious material,
 Used when having direct contact with patients who are colonized or infected
with pathogens transmitted by the contact route
 Used when handling or touching visibly and environmental surfaces
 Must be changed between tasks and procedures on the same patient whenever
there is risk of transferring microorganisms from one body site to another.
 Remove promptly after use
 Wash hands after removing the gloves
 Isolation Gowns
 Worn in conjunction with gloves and with other PPE
 Protects the healthcare worker’s arms and exposed body areas and prevent
contamination of clothing with blood, body fluids, and other potentially
infectious material
 Worn only if contact with blood or body fluid is anticipated.
 Should be removed before leaving the patient-care area to prevent possible
contamination of the environment outside the patient’s room
 Prevents contamination of clothing or skin
  The outer contaminated side of the gown is turn inward and rolled into a bundle
and then, discarded into a designated container for waste or linen to contain
contamination.
 Masks
 Protects a person from contact with infectious material from patients.
 Worn when engaged in procedures requiring sterile technique to protect
patients from exposure to pathogens that may be present in a healthcare
worker’s mouth or nose.
 Placed on coughing patients to limit potential dissemination of infectious
respiratory secretions from the patient to others.
 Eye protection
 Googles and disposable or nondisposable face shields
 It is necessary especially when it is likely that there will be a splash or spray of
any respiratory secretions or other body fluids.
 Must be removed after gloves are removed.
 Respiratory Protection
 Requires the use of a respirator with N95 or higher filtration to prevent
inhalation of infectious particles
 Respirators are recommended when working with patients with TB, severe
acute respiratory syndrome (SARS), smallpox and during performing of aerosol-
generating procedures on patients with avian or pandemic influenza.
 Patient-Care Equipment
o Organic materials must be removed from medical equipment, instruments, and devices
prior to high-level disinfection and sterilization
o Cleaning and disinfection must include computer keyboards and personal digital
assistants (PDAs)
o Devices used must be thoroughly cleaned and disinfected before use by or on another
patient.
 Environmental Control
o Routine care, cleaning and disinfection of environmental surfaces
 Linens
o Textiles must be handled, transported, and laundered in a safe manner.
o Soiled textiles must not be shaken, must not come in contact with the healthcare
worker’s body or clothing, and must be contained in a laundry bag or designated bin.
 Disposal of Sharps
o Needles and other sharp devices must be handled in a manner that prevents injury
o Contaminated needles and other contaminated sharps must not be bent, recapped, or
removed, and shearing or breaking of needles is prohibited. Must be disposed
immediately after use, by placing them in special containers known as sharp containers.

Transmission-Based Precautions
Enforced only for certain specific types of infections
 Contact Precautions
o Most important and frequent mode of transmission of HAIs.
o Used for patients known or suspected to be infected or colonized with epidemiologically
important pathogens that can be transmitted by direct or indirect contact.
 Droplet Precautions
 o A form of contact transmission
o Produced primarily as a result of coughing, sneezing, and talking, as well as during
hospital procedures such as suctioning and bronchoscopy
o Transmission occurs when droplets containing microbes are propelled a short distance
trough the air and become deposited on another person’s conjunctiva, nasal mucosa, or
mouth.
 Airborne Precautions
o Involves either Airborne droplet nuclei or dust particles containing pathogen.
 Airborne droplet nuclei are small particle residues of evaporated droplets containing microbes.
They remain suspended in air for long periods.

 Patient Placement
o Single-patient rooms are used for patients who might contaminate the hospital
environment or who do not assist in maintaining appropriate hygiene or environmental
control
o Single rooms are always indicated for patients placed on Airborne Precautions and are
preferred for patients requiring Contact or Droplet Precautions
o Airborne Infection Isolation Rooms
 AIIR is a single-patient room that is equipped with special air handling and
ventilation systems.
 Under negative pressure to prevent room air from entering the corridor when
the door is opened, and air that is evacuated from such rooms passes through
high efficiency particulate air (HEPA) filters to remove pathogens
o Protective Environments
 Protective Isolation or Positive Pressure Isolation
 Rooms that are under positive pressure, and vented air that enters these rooms
passes through HEPA filters
 Handling food and eating utensils
o Using high-quality, fresh food
o Properly refrigerating and storing food
o Properly washing, preparing, and cooking food
o Properly disposing of uneaten food
o Thoroughly washing hands and fingernails before handling
o food and after visiting a restroom
o Properly disposing of nasal and oral secretions in tissues and then thoroughly washing
hands and fingernails
o Covering hair and wearing clean clothes and aprons
o Providing periodic health examinations for kitchen
o workers
o Prohibiting anyone with a respiratory or gastrointestinal
o disease from handling food or eating utensils
o Keeping all cutting boards and other surfaces scrupulously
o clean
o Rinsing and then washing cooking and eating utensils in a dishwasher in which the
water temperature is greater than 80°C
 Handling Fomites
o Fomites are any nonliving or inanimate objects other than food that may harbor and
transmit microbes.
  Use disposable equipment and supplies wherever possible
 Disinfect or sterilize equipment as soon as possible after use
 Use individual equipment for each patient
 Use electronic or glass thermometers fitted with onetime use, disposable covers
or use disposable, single-use
 Thermometers; electronic and glass thermometers must be cleaned or sterilized
on a regular basis, following manufacturer’s instructions
 Empty bedpans and urinals, wash them in hot water, and store them in a clean
cabinet between uses
 Place bed linen and soiled clothing in bags to be sent to the laundry
 Medical Waste Disposal
o Biohazards (Biologic Hazards) are materials or substances that are harmful to health
 Any receptacle used for decomposable solid or liquid waste or refuse must be
constructed so that it does not leak and must be maintained in a sanitary
condition. This receptacle must be equipped with a solid, tightfitting cover,
unless it can be maintained in a sanitary condition without a cover.
 All sweepings, solid or liquid wastes, refuse, and garbage shall be removed to
avoid creating a menace to health and shall be removed as often as necessary to
maintain the place of employment in a sanitary condition.
 The medical facility’s infection control program must address the handling and
disposal of potentially contaminated items.
 Infection Control in Dental Healthcare Settings
o Development of a written infection control program that includes policies, procedures,
and guidelines for education and training of dental healthcare personnel,
immunizations, exposure prevention and postexposure management, work restriction
caused by medical conditions, and maintenance of records, data management, and
confidentiality
o Preventing transmission of bloodborne pathogens, including HBV vaccination and
preventing exposures to blood and other potentially infectious materials
o Hand hygiene and PPE; Figure 12-13 illustrates the protection afforded by PPE
o Contact dermatitis and latex hypersensitivity
o Sterilization and disinfection of patient-care items
o Environmental infection control, including use of disinfectants, housekeeping services,
spills of blood or body substances, and medical waste
o Special considerations, such as dental handpieces, dental radiology, aseptic technique
for parenteral medications, oral-surgical procedures, handling of biopsy specimens and
extracted teeth, dental laboratory, and patients with tuberculosis
 Infection Control Committees and Infection Control Professionals
o In a hospital setting, the infection control program is usually under the jurisdiction of
the hospital’s Infection Control Committee (ICC) or Epidemiology Service.
o ICC is composed of representatives from most of the hospital’s departments, including
medical and surgical services, pathology, nursing, hospital administration, risk
management, pharmacy, housekeeping, food services, and central supply.
o The chairperson is usually an Infection Control Professional (ICP), such as a physician
(e.g., an epidemiologist or infectious disease specialist), an infection control nurse, a
microbiologist, or some other person knowledgeable about infection control.
The primary responsibilities of an ICP are as follows:
• Possess knowledge of infectious diseases processes, reservoirs, incubation periods,
 periods of communicability, and susceptibility of patients
• Conduct surveillance and epidemiologic investigations
• Prevent/control the transmission of pathogens to include strategies for hand hygiene,
antisepsis, cleaning, disinfection, sterilization, patient care settings, patient
placement, medical waste disposal, and implementation of outbreak control
measures
• Manage the facility’s infection control program
• Communicate with the public, facility staff, and state and local health departments
concerning infection control-related issues
• Evaluate new medical products that could be associated with increased infection risk
o Other ICC responsibilities include patient surveillance, environmental surveillance,
investigation of outbreaks and epidemics, and education of the hospital staff regarding
infection control.

 Role of the Microbiology Laboratory in Healthcare Epidemiology

o By monitoring the types and numbers of pathogens isolated from hospitalized patients.
o By performing antimicrobial susceptibility testing, detecting emerging resistance
patterns, and preparing and distributing periodic cumulative antimicrobial susceptibility
summary reports
o By processing samples including samples from hospital employees that have been
collected from within the affected ward(s), with the goal of pinpointing the exact source
of the pathogen that is causing the outbreak. Examples of environmental samples
include air samples, nasal swabs from healthcare personnel, and swabs of sink drains,
whirlpool tubs, respiratory therapy equipment, bed rails, and ventilation grates and
ducts.
o By performing biochemical, immunological, and molecular identification and typing
procedures to compare various isolates of the same species
Conclusions
 An HAI can add several weeks to a patient’s hospital stay and may lead to serious
complications and even death.
 From an economic viewpoint, insurance companies rarely reimburse hospitals and other
healthcare facilities for the costs associated with HAIs.
 Insurance companies take the position that HAIs are the fault of the healthcare facility
and, therefore, that the facility should bear any additional patient costs related to such
infections.
 Sadly, cross-infections transmitted by hospital personnel, including physicians, are all too
common; this is particularly true when hospitals and clinics are overcrowded and the staff
is overworked.
 However, HAIs can be avoided through proper education and disciplined compliance with
infection control practices.
 All healthcare workers must fully comprehend the problem of HAIs, must be completely
knowledgeable about infection control practices, and must personally do everything in
their power to prevent HAIs from occurring.