Infection control

Tamuna Grdzelishvili
2020
CIU
 DEFINITION

• AN INFECTION IS A DISEASE STATE THAT RESULTS

FROM THE PRESENCE OF PATHOGENS (DISEASE
PRODUCING MICROORGANISMS) IN OR ON THE BODY
 INFECTION

• Dictionary meaning: Invasion by and multiplication of

pathogenic microorganisms in a bodily part or tissue,
which may produce subsequent tissue injury and
progress to overt disease through a variety of cellular or
toxic mechanisms.
 Definitions Disease and
Infectious Disease

• Disease -Any deviation from a condition of good health

and well-being

• Infectious Disease -A disease condition caused by the

presence or growth of infectious microorganisms or
parasites
 Definitions - Pathogenicity
and Virulence

• Pathogenicity -The ability of a microbe to cause disease.

This term is often used to describe or compare species.

• Virulence-The degree of pathogenicity in a

microorganism. This term is often used to describe or
compare strains within a species 
 Infection means-

Infection is the invasion of a host organism's bodily tissues

by diseasecausing organisms, their multiplication, and the
reaction of host tissues to these organisms and the toxins
they produce.

Infections are caused by microorganisms such as viruses,

prions, bacteria, and Viroids, and larger organisms like
parasites 
STAGES OF INFECTION

• Exposure/Invasion of Host

• Incubation -- period of time between exposure and onset

of symptoms -- e.g., interval between HIV infection and
development of AIDS can be as long as 10-15 years

• Host reaction

• Disease runs course -treatment, recovery/death

 Causative Agents effecting
humans
• Bacteria

• Viruses

• Fungi

• Protozoa

• Helminths

• Prions 
 Defense mechanism of the
body:

• NORMAL FLORA OF SKIN

• INFLAMMATORY RESPONSE

• IMMUNE RESPONSE
Factors affecting the risk for
infection:
• INTEGRITY OF SKIN & MUCUS MEMBRANE

• PH LEVELS OF G.I, G.U TRACT AND SKIN

• W.B.C. LEVEL

• AGE, SEX, RACE AND HEREDITARY FACTORS

• IMMUNIZATION STATUS

• LEVEL OF FATIGUE, NUTRITIONAL AND HEALTH STATUS

• STRESS LEVEL

• USE OF INVASIVE AND INDWELLING MEDICAL DEVICES

 Acute infections VS Chronic infection

• Acute Infection - An infection characterized by sudden

onset, rapid progression, and often with severe symptoms

• Chronic Infection - An infection characterized by delayed

onset and slow progression
 Primary infection vs
secondary infection

• Primary Infection-An infection that develops in an

otherwise healthy individual.

• Secondary Infectio- An infection that develops in an

individual who is already infected with a different
pathogen 
 Localized infection vs.
systemic infection

• Localized Infection- An infection that is restricted to a

specific location or region within the body of the host

• Systemic Infection-An infection that has spread to several

regions or areas in the body of the host
 Opportunistic infection
meaning

• An infection caused by microorganisms that are

commonly found in the host’s environment .

• This term is often used to refer to infections caused by

organisms in the normal flora 
MODES OF COMMUNICABLE DISEASE TRANSMISSION
Direct infection VS Indirect infection 

Direct Transmission

• Immediate transfer of the disease agent by direct contact

between the infected and the susceptible individuals.

• Occurs through such acts as touching, biting, kissing,

sexual intercourse, or by direct projection (droplet spread)
by coughing or sneezing within a distance of one meter.

• Examples of diseases for which transmission is usually

direct are AIDS, syphilis, gonorrhea.
MODES OF COMMUNICABLE DISEASE TRANSMISSION
Direct infection VS Indirect infection (2)

INDIRECT TRANSMISSION

• May be one of three types: air-borne, vehicle-borne, or

vector-borne.

• Air-borne transmission -transmission of microbial aerosols

to a suitable port of entry, usually the respiratory tract –
Microbial aerosols are suspensions of dust or droplet
nuclei made up wholly or in part by microorganisms -may
be suspended and infective for long periods of time –
Examples of air-borne diseases include tuberculosis,
influenza.
INDIRECT TRANSMISSION
• Vehicle-borne transmission -- contaminated materials or
objects (fomites) serve as vehicles, nonliving objects by
which communicable agents are transferred to a susceptible
host – The agent may or may not have multiplied or
developed on the vehicle – Examples of vehicles include
toys, handkerchiefs, soiled clothes, bedding, food service
utensils, and surgical instruments – Also considered vehicles
are water, milk, food (e.g., common vehicles), or biological
products such as blood, serum, plasma, organs and tissues
– Almost any disease can be transmitted by vehicles,
including those for which the primary mode of transmission
is direct, such as dysentery and hepatitis.
INDIRECT TRANSMISSION (2)

• Vector-borne transmission -- disease transfer by a living organism, such as a

mosquito, fly, or tick.

• Transmission may be mechanical, via the contaminated mouth parts or feet of

the vector, or biological, involving multiplication or developmental changes of
the agent in the vector before transmission occurs. In mechanical
transmission, multiplication and development of the disease do not usually
occur -e.g., organisms that cause dysentery, polio, cholera, and typhoid fever
have been isolated from such insects as cockroaches and house flies and
could presumably be deposited on food prepared for human consumption.

• Mosquitoes are extremely important vectors of human diseases -- e.g., they

transmit the viruses that cause yellow fever and dengué fever as well as 200
other viruses -- they also transmit malaria, which infects 100 million people in
the world each year (most in tropical areas), killing at least 1 million of them
each year.
 Signs & Symptoms of
Infection

• Redness

• Swelling

• Tenderness

• Warmth Drainage

• Red streaks leading away from wound

 DISEASE AND INJURY
PREVENTION AND CONTROL

• Prevention – Includes individual, clinical, or personal

health services such as immunizations, screening for high
blood pressure and follow-up services, or the use of Pap
smears to detect the precursors to cancer of the cervix

• Protection – Includes the activities of organizations, both

public and private, to reduce exposure to hazards such as
polluted water, contaminated food, traffic accidents,
mosquitoes. 
What can I do to reduce the
spread of "germs"?
Ways you can reduce or slow the spread of infections
include:

• Get the appropriate vaccine.

• Wash your hands frequently.

• Stay home if you are sick (so you do not spread the illness to other people).

• Use a tissue, or cough and sneeze into your arm, not your hand. Turn away from
other people.

• Use single-use tissues. Dispose of the tissue immediately.

• Wash your hands after coughing, sneezing or using tissues.

• If working with children, have them play with hard surface toys that can be easily
cleaned.

• Do not touch your eyes, nose or mouth (viruses can transfer from your hands
and into the body).

• Do not share cups, glasses, dishes or cutlery.

 When cleaning, how should it be done?
Additional measures may be required to minimize the virus from transmitting by hard surfaces (sinks, door
and cupboard handles, railings, objects, counters, etc.).

The length of time a virus survives on hard surfaces depends on the type of virus.

The Centers for Disease Control and Prevention in the United States indicates that "Most studies have
shown that the flu virus can live and potentially infect a person for up to 48 hours after being deposited on
a surface.”

In most workplaces and homes, cleaning floors, walls, doorknobs, etc. with household disinfectants or
bleach solution (5 millilitres (mL) of (5%) bleach per 250 mL of water is recommended. Follow the directions
on the cleaning or disinfecting products.

Wear personal protective clothing, such as gloves or eye protection, where required.

Know the appropriate procedures for general sanitation and infection control, and how to work safely
with hazardous products, including bleach.

If using gloves when cleaning, always wear the appropriate type of glove for the product you are
using. No one glove material is resistant to all chemicals. Some chemicals will travel through or permeate
the glove in a few seconds, while other chemicals may take days or weeks.



Only in some workplaces, such as a hospital or health care facility, are specific cleaning and disinfection
steps required.
 What is meant by social distancing?
• Social distancing is a strategy where you try to avoid crowded
places, large gatherings of people or close contact with a group
of people. In these situations, viruses can easily spread from
person to person. In general, a distance of one to two metres (3
to 6 feet) will slow the spread of a disease, but more distance is
more effective.

• Should social distancing be recommended, steps to follow

include:

• Use telephone, video conferencing, or the internet to conduct as much business as possible (including within the same building).

• Allow employees to work from home, or to work flexible hours to avoid crowding the workplace.

• Increase the distance between desks or work stations.

• Increase the number of times surfaces are cleaned.

• Cancel or postpone any travel, meetings, workshops, etc. that are not absolutely necessary.

• Drive, walk, or cycle to work, but try to avoid public transit. Alternatively, workplaces can consider allowing staff to arrive early/late
so they can use public transit when it is less crowded.

• Allow staff to eat at their desks or have staggered lunch hours to avoid crowded lunch rooms.

• Spend as little time as possible in tea rooms or photocopy centres.

• When meetings are necessary, have the meeting in a larger room where people can sit with more space between them (at least
about one to two metres apart).

• Avoid shaking hands or hugging

 PREVENTION OF COMMUNICABLE DISEASES

• Primary Prevention – In the chain of infection model, primary

prevention strategies are evident at each link of the chain –
Successful application of each strategy can be seen as
weakening the link -- with the ultimate goal of interrupting
the disease transmission cycle

• Community measures -- e.g., chlorination of the water

supply, inspection of restaurants, immunization programs
that reach all citizens, maintenance of a wellfunctioning
sewer system, proper disposal of solid waste, and control of
vectors and rodents 
PREVENTION OF COMMUNICABLE DISEASES (2)

• PREVENTION OF COMMUNICABLE DISEASES

Personal/Individual actions -- hand washing, proper cooking

of foods, adequate clothing and housing, use of condoms,
obtaining all of the available immunizations against specific
diseases 
PREVENTION OF COMMUNICABLE DISEASES

• Secondary Prevention – Community effort includes

measures taken to control or limit the extend of a disease
outbreak/epidemic -- e.g., maintaining records of cases
and compliance with regulations requiring the reporting of
notifiable diseases, investigating cases and contacts,
those who may have become infected through contact
with cases – Individual effort includes either (1) self-
diagnosis and self-treatment with nonprescription
medications or home remedies, or (2) diagnosis and
treatment with an antibiotic or other physician-prescribed
medicine
PREVENTION OF COMMUNICABLE DISEASES

• Occasionally, secondary disease control measures may

include isolation or quarantine.

• Isolation = separation, for the period of communicability,

of infected persons or animals from others so as to
prevent the direct or indirect transmission of the
communicable agent to a susceptible person/host –

• Quarantine = limitation of the freedom of movement of

well persons or animals that have been exposed to a
communicable disease until the incubation period has
passed
PREVENTION OF COMMUNICABLE DISEASES

• ISOLATION -Means separation of infected people from

non-infected people during the period of communicability.
Follows the “least restrictive” principle

• IMMUNIZATION - All states have requirements for the

immunization of children against certain infectious
diseases -- most common are diphtheria, pertussis
tetanus, rubella, and polio. The controlling agency is
usually the school system, which is required to prevent
entry of any child who has not been properly immunized 
PREVENTION OF COMMUNICABLE DISEASES

• Further measures may include disinfection -- the killing of

communicable agents outside the the host, and mass
treatment with antibiotics.

• Public health education and health promotion should also

be used as both primary and secondary preventive
measures.

• Timely laboratory Diagnosis stop of many Infections

 PREVENTION OF
COMMUNICABLE DISEASES

• Tertiary Prevention – Convalescence from infection,

recovery to full or partial health, and return to normal
activity.

• Tertiary prevention may also involve the reapplication of

primary and secondary measures to prevent further cases
-- e.g., in Japan and South Korea, people with colds or flu
wear gauze masks in public to reduce the spread of the
disease 
 Nosocomial infection

• comes from Greek words “ nosus ” meaning disease and

“ komeion ” meaning to take care of

• Also called as HOSPITAL ACQUIRED INFECTION

• Infections are considered nosocomial if they first appear

48hrs or more after hospital admission or within 30 days
after discharge.
 HISTORY
• Responsible for very high mortality and morbidity since
centuries

• Semmelweiss, introduced handwashing technique

• Florence Nightingale established principles and practices of

hospital design and hygiene to reduce sepsis

• Joseph Lister introduced antiseptic surgery

• The early 20th century saw the beginning of the antibiotic era

• Antibiotic resistance to multiple agents

 Reasons:
Rise in nosocomial infection as a result of
four factor

• Crowded hospital conditions

• New microorganism

• Increasing number of people with compromised immune

system

• Increasing Bacterial resistance

 Where do the microbes
come from?

• Patient's own flora

• Cross infection from medical personnel

• Cross infection from patient to patient

• Hospital environment (inanimate objects): - Air - Water -

Dust - IV fluids & catheters - Washbowls - Bedpans -
Endoscopes - Ventilators & respiratory equipment
 Sources of Infection
• Endogenous:

• Patients own flora may invade patient’s tissue during some surgical
operations or instrumental manipulations

• Normal commensals of the skin, respiratory, GI, UG tract

• Exogenous:

• From another patient / staff member / environment in the hospital

• Environmental sources: Inanimate objects, air, water, food

• Cross infection from: other patients, hospital staff (suffering from

infections or asymptomatic carriers)
PREDISPOSING FACTORS
• Age

• Immune status

• Underlying diseases

• Contact with infectious persons

• Diagnostic and therapeutic interventions

• Duration of hospital stay

• Contaminated environmental sites Drug resistance of the endemic

organisms

• Malnutrition
Modes of Transmission

• 1. Contact: Most common route of transmission

• Hands or Clothing: - Hands of staff: important vehicle of

spread - Contact of hands & clothing of attendants Eg:
Staphylococcus aureus, Streptococcus pyrogenes

• Inanimate objects: - Improper disinfection of Instruments:

endoscope, bronchoscope, cystoscope—-Eg:
Pseudomonas aeruginosa
• 2. Airborne: Droplets: - Droplets of Respiratory infections:
transmitted by inhalation

• Dust: - Dust from bedding, floors, wound exudates & skin

Eg: Pseudomonas aeruginosa, Staphylococcus aureus

• Aerosols: - Aerosols from nebulizers, humidifiers & AC Eg:

Legionella pneumophila
• 3. Oral Route: - Hospital food may contain Antibiotic-
resistant bacteria → may colonize intestine → can cause
infections

• 4. Parenteral route: - Disposable syringes & needles -

Certain infections may be transmitted by blood
transfusion, tissue donation, contaminated blood
products Eg: Hepatitis B, HIV
 PATHOGENS OF
NOSOCOMIAL INFECTIONS
• Pathogens may be divided into three:

Conventional pathogens: cause disease in healthy

persons

Conditional pathogens: cause disease in persons with

lowered resistance to infection

Opportunistic pathogens: cause generalised disease in

patients who have a greatly diminished resistance to
infection
 MOST COMMON
NOSOCOMIAL PATHOGENS

• BACTERIA

Gram positive bacteria:- Staphylococcus aureus -

Methicillin resistant S.aureus - Clostridium difficile -
Vancomycin resistant Enterococcus

Gram negative bacteria:- Pseudomonas spp. -

Acinetobacter spp. -Enterobacteriaceae
 MOST COMMON
NOSOCOMIAL PATHOGENS (2)
• VIRUSES

Hepatitis B & C viruses

Respiratory syncytial virus

Rotavirus

Enterovirus

Human Immunodeficiency

Virus Other viruses such as – -Cytomegalovirus, -Ebola virus -

Varicella zoster virus
 MOST COMMON
NOSOCOMIAL PATHOGENS (3)

• PARASITES -

Giardia lamblia - Cryptosporidium parvum - Toxoplasma

gondii - Sarcoptes scabies

• FUNGI

Aspergillus spp. - Candida albicans - Cryptococcus

neoformans
 Common Nosocomial
Infections
• Urinary tract infection o Most common HAI (40% of
Nosocomial infections) o Usually associated with
catheterization or instrumentation of urethra, bladder or
kidneys o Eg: E. coli, Klebsiella, Proteus, Serratia,
Pseudomonas, Candida albicans

• Pneumonia (Respiratory Infections): o Leading cause of

mortality in patients suffering from HAI o During aspiration
in unconscious patients & pulmonary ventilation o Eg:
Staph. aureus, Klebsiella, Enterobacter, Serratia, Proteus,
Pseudomonas, Acinetobacter, Legionella, E. coli
 Common Nosocomial
Infections (2)
• Wound & skin sepsis:

Follow surgical procedure where causative agents are introduced into the
tissue during operations.

Higher in elderly patients

Manifest within a week of surgery

Non-surgical wounds due to burns, bed sores. o Eg: Staph aureus,

Pseudomonas aeruginosa, E. coli, Proteus, Enterococci

Gastrointestinal infections: o Food poisoning due to Salmonella, Shigella

sonnei o Enterotoxic manifestation due to Staphylococcal contamination
of cooked food o Diarrhea due to E. coli
 Common Nosocomial Infections (3)
• Bacteremia & Septicemia:

Bacterial invasion of bloodstream in various HAIs

Mostly caused by infected intravenous cannulae

Gram negative bacilli: common pathogens

• Tetanus:

Inadequate attention to aseptic precautions during surgery

Use of contaminated dressings or improperly sterilized dressings

Improper disinfection of site of intramuscular injection

Inadequate care while cutting umbilical cord of new-born

 Diagnosis
• HAIs may occur sporadically or as an outbreak

• Diagnosis by routine bacteriological methods: Direct

smear examination or Culture Sensitivity testing

• Identification & elimination requires sampling from

possible sources of infections such as hospital personnel,
inanimate objects, water, air or food

• Typing of isolate (phage, bacteriocin): may indicate a

causal connection
 Mistakes?

• Touching infected patient without gloves

• Touching subjects without washing hand

• Touching another patient without washing hand and

without gloves
 Prevention
• Administration of antibiotic therapy to the carrier staff or source patients to destroy the
pathogenic agents

• Proper sterilization & disinfection of inanimate objects. This helps to control the source
of infection

• Disinfection of excreta & infected material is necessary to control the exit point of
infection

• Transmission can be controlled by regular washing of hands, disinfection of equipments

& change of working cloths

• Use of sterile dressings, surgical gloves & face-masks further contribute in control of
nosocomial infection

• Pre-operative disinfection of patient’s skin

• Proper investigation of HAI & treatment of such cases

Hospital Infection Control
• Reduce patient exposure to pathogens

• Reduce the number & virulence of nosocomial pathogens

• Use of aseptic technique during patient care

• Hand washing

• Proper isolation of patients known or suspected of harboring infectious diseases

• Whenever possible, avoid crowding wards

• Use gloves when necessary • Wash hands immediately after glove removal and between
patients

• Masks, Eye protection, Gown: Wear during activities likely to generate splashes or sprays

• Gowns: Protect skin and soiling of clothing

Hospital Infection Control (2)
• Avoid recapping of needles

• Avoid removing needles from syringes by hand

• Place used sharps in puncture-resistant containers Ensure clean environment:

• Establish policies and procedures to prevent food and water contamination

• Establish a regular schedule of hospital cleaning with appropriate

disinfectants in, for example, wards, operating theaters, and laundry

• Dispose of medical waste safely

• Needles and syringes should be incinerated

• Other infected waste can be incinerated or autoclaved for landfill disposal

Hospital Infection Control (3)

• ISOLATION the patient-Designed to prevent transmission

of microorganisms by common routes in hospitals.
Because agent and host factors are more difficult to
control, interruption of transfer of microorganisms is
directed primarily at transmission.

• Sterilization of all reusable equipments

 WHO notes:
• -that the rate of nosocomial infections will continue to rise
as a result of:

• the increasing crowded hospital conditions

• Increasing number of people with compromised immune

status

• New micro-organisms

• Increasing bacterial resistance