PREVENTION OF INFECTION

Introduction

According to the World Health Organization (WHO), infection

prevention and control (IPC) is a scientific approach and practical solution
designed to prevent harm caused by infection to patients and health
workers. It is a subset of epidemiology, but also serves an essential
function in infectious diseases, social sciences and global health.
The Spread of Infectious Disease

An infection is defined as the successful transmission of pathogenic

microorganisms, such as bacteria, viruses, parasites or fungi that are
spread:
• Directly:
• From person to person.
• Through respiratory droplets (i.e. coughing or sneezing) or
body fluids.
• Direct exposure to infectious agent in environment
• During childbirth from mother to foetus
(transplacental/perinatal)
• Indirectly:
• Biological - Vector or Intermediate host (eg. Zika Virus)
• Mechanical - Vector or Vehicle (eg. Plague - transmission
of Yersinia pestis by fleas)
• Airborne (eg. Tuberculosis)

Epidemiological Triad

In humans, infections occur when an infectious microorganism enters the

body, multiplies, and leads to a reaction in the body and potential
infectious disease. The spread of infectious disease requires three
variables, known as the epidemiological triad:

• The agent - this microorganism that causes the infection and can be
in the form of bacteria, viruses, parasites or fungi.
• The host - the target of the disease.
 • The environment - surroundings and conditions (these are external to
the host).

Infection Spread in Health care

Health care facilities, whether hospitals or primary care clinics are an
area with an elevated risk of disease transmission due to the presence and
relative ratio of susceptible individuals. One in ten patients get an infection
whilst receiving care yet effective infection prevention and control reduces
health care-associated infections by at least 30%. In a healthcare setting,
the three components required for infection spread are the following:
• Source - places where infectious agents survive (e.g. sinks, hospital
equipment, countertops, medical devices).
• Environment - patient care areas, sinks, hospital equipment,
countertops, medical devices.
• People - patients, healthcare workers, or visitors.

• Susceptible person - someone (patient, healthcare worker, or visitor)

who is not vaccinated or immune to a particular infectious disease, or
an individual with a compromised immune system (ie.
immunodeficient).
• In addition, susceptibility can be heightened in individuals due
to underlying medical conditions, medications, and necessary
treatments and procedures that increase the risk of infection
(e.g. surgery).

• Transmission -
• Touch, including via medical equipment or a susceptible person
(e.g. MRSA or VRE).
 • Sprays or splashes (e.g. pertussis).
• Inhalation of aerosolised particles (e.g. TB or measles).
• Sharps injuries introducing blood-borne pathogens (e.g. HIV,
HBV, HCV).

Controlling Infectious Diseases Within Communities

Infection control and prevention is a global issue and there are many
protocols and guidelines that can be followed to minimize the spread of
infection between people, within a population and globally. Identifying at-
risk groups such as children, older people and those with chronic
conditions can also help guide relevant strategies to protect these
vulnerable groups. The first step when looking at infection control can
start at the community level by changing behaviour, including:

• Regular hand washing.

• Usage of appropriate face-masks if suffering from respiratory
infections to prevent spread (also indicated for protection from
respiratory infections)
• Using insect repellents.
• Ensuring up-to-date routine vaccinations and participating in
immunization programmes.
• Taking prescribed medications, such as antibiotics, as directed by
health professionals.
• Social distancing - avoiding contact with others.
• Using condoms when having sex, especially with a new partner.
Other steps that can be taken to control the spread within communities
include environmental measures such as:

• Modifying environments.
• Surveillance of diseases.
• Food safety. Sudisdbcscajjqeiqusdanci c h
• Air quality.

Medical Interventions

As well as simple steps to prevent and control infections, there are

biochemical interventions that can be implemented to speed up the
recovery process and in some cases prevent viral infections completely.
The development of antibiotics, antivirals and vaccinations have been
shown to speed up recovery, slow down the progression and in some cases
eradicate infectious diseases from entire populations.

Antibiotics
Antibiotics are prescribed for bacterial infections and support the
body's natural defense system to eliminate the disease-causing bacterial
agent. They are designed to either kill bacteria or stop them from
reproducing, however poor use of antibiotics, over-prescribing and the
mutation of bacteria has led the development of resistant bacteria. In these
cases, either stronger doses are required or the combination of one or more
antibiotics.
Vaccinations
Vaccinations are designed to improve immunity to a particular
disease. Vaccines work by introducing small amounts of the disease-
causing virus or bacteria into the host, allowing them to build up natural
immunity. The introduction of regular vaccines have slowed down and in
some cases eradicated certain diseases such as polio, measles, mumps,
whooping cough and rubella (measles). There are also vaccinations for
chickenpox but this is not given routinely and is reserved for those at risk
of spreading the disease to those with a weakened immune system. This is
due to the fact that it is prevalent in children under 10 years of age and
symptoms are usually mild; this method allows them to build up natural
immunity and contributes to improving the immunisation of a community.
This type of protection is known as herd immunity.

Antivirals
For infectious diseases that are caused by viral agents such as
influenza, HIV, herpes, and hepatitis B, antibiotics provide no defence and
in these cases, antiviral medications are the most effective at slowing down
the progression of the disease and boosting the immune system.
Unfortunately, as with antibiotics, viruses can mutate over time and
become resistant to these antiviral drugs.
Infection Control in Healthcare Facilities

Another important factor in controlling and preventing the control of

infection is by improving practices in healthcare facilities. It is the duty of
health care professionals worldwide to ensure they develop strategies and
implement policies that protect those who may be immuno compromised
in order to keep susceptible patients safe from health care-associated
infections (HAIs). Globally, up to 7% of patients in developed and 10% in
developing countries will acquire at least one HAI.

HAIs are one of the most common detrimental effects in care

delivery and both the endemic burden and the occurrence of epidemics are
a major public health concern. HAIs have a significant impact on
morbidity, mortality and quality of life and present an economic burden at
the societal level. However, a large proportion of HAI are preventable and
there is a growing body of evidence to help raise awareness of the global
burden of harm caused by these infections, including strategies to reduce
their spread.
Steps to Improve Infection Control
There are two tiers of recommended precautions by the Center of
Disease Control and Prevention (CDC)to prevent the spread of infections
in healthcare settings:

(1) Standard Precautions and

(2) Transmission-Based Precautions.

Standard Precautions for All Patient Care:

• Perform hand hygiene.

• Use personal protective equipment (PPE) to prevent exposure to
infection
• Follow respiratory hygiene/cough etiquette principles
• Ensure appropriate patient placement and isolation precautions.
• Properly handle, clean, and disinfect patient care equipment and
medical instruments
• Handle and sterilize textiles and laundry carefully
• Follow safe injection practices and proper handling of sharps/needles
• Ensure health care worker safety via IPC and post-exposure
prophylaxis
• Prevention of intervention-related infections (catheter-associated
urinary tract infections, intra vascular catheter-related infections,
surgical site infections)
• The implementation of the specific isolation precaution when
diagnosing some syndromes.
• Improving the communication between health care workers
especially when referring potentially contagious patients.
 • In pediatric departments or ambulatory settings, efforts to decrease
infection from contaminated toys and encouraging families to bring
their own toys.

Transmission-Based Precautions used in addition to Standard

Precautions for patients with infectious disease to prevent transmission:
• Contact Precautions
• Droplet Precautions
• Airborne Precautions

Infection Control Programmes in Acute Care

The CDC suggest that the assessment and management of infection
control programs and practices in acute care hospital can be divided into 4
sections:

• Section 1: Facility Demographics

• Section 2: Infection Control Programme and Infrastructure
• Section 3: Direct Observation of Facility Practices (optional)
• Section 4: Infection Control Guidelines and Other Resources
They have produced a "Infection Prevention and Control Assessment
Tool for Acute Care Hospitals" that is intended to assist in the assessment
of infection control programs and practices in acute care hospitals.

Environmental Cleaning/Disinfection

The evidence suggests the important role of environmental cleaning in

controlling the transmission of organisms (e.g.Staphylococcus aureus,
vancomycin-resistant enterococci, norovirus, Clostridium
difficile and acinetobacter) especially in hospitals and health- care settings.
If an individual with a suspected or confirmed case of infectious disease
has attended your clinic, all surfaces that the person has come into contact
with must be cleaned.

• The room where they were placed/isolated should not be cleaned or

used for one hour and the door to the room should remain shut.

• The person assigned to clean the room should wear gloves

(disposable single-use nitrile or household gloves) and a disposable
apron (if one is available) then physically clean the environment and
furniture using a household detergent solution followed by a
disinfectant or combined household detergent and disinfectant, for
example, one that contains a hypochlorite (bleach solution)[30].
Products with these specifications are available in different formats
including wipes.

• No special cleaning of walls or floors is required.

• Pay special attention to frequently touched flat surfaces, backs of

chairs, couches, door handles or any surfaces that the affected person
has touched.

• Discard waste (including used tissues, disposable cleaning cloths)

into a healthcare risk waste bag.

• Remove the disposable plastic apron (if worn) and gloves and discard
into a healthcare risk waste bag.

• If a healthcare risk waste bag (yellow) is not available, place the

waste in a small household waste bag and tie securely. Do not
overfill. Then place the bag in a second household waste bag and tie
securely. Store in a safe location.If the case is not confirmed the
 waste can be disposed of as per usual. If a case is confirmed public
health will then advise you what to do with the waste.

• Once this process has been completed and all surfaces are dry the
room can be put back into use.

Infection Control Programmes Globally

The WHO guidelines on the core components of IPC programmes at

the national and facility level aim to enhance the capacity of countries to
develop and implement effective technical and behavior modifying
interventions. They form a key part of WHO strategies to prevent current
and future threats from infectious diseases such as Ebola, strengthen health
service resilience, help combat antimicrobial resistance (AMR) and
improve the overall quality of health care delivery. They are also intended
to support countries in the development of their own national protocols for
IPC and AMR action plans and to support health care facilities as they
develop or strengthen their own approaches to IPC.

Improving Social Determinants

Another important factor to consider in the control of infectious

diseases is to address and improve social determinants of health within
societies. There is a direct link between a person's health and their
environment. WHO has identified three "common interventions" for
improving health conditions worldwide:

• Education - there is a strong link between health and education.

 • Social Protection - access to affordable health care and some form of
social security system can also determine the health and behaviors in
a community.

• Urban Development - how our villages, towns and cities are designed
can have a big impact on health and the spread of diseases. Living in
overcrowded environments or in housing that is damp and/or that
doesn't have adequate facilities and sanitation can increase the spread
of infectious diseases.

Conclusion

There is no one solution to controlling the spread of infectious

diseases, and effective IPC indeed requires government intervention and
collaboration between health care agencies, individuals and communities.
Until certain risk factors are addressed and behaviors modified, the war
against infectious diseases will continue to be a predominant and costly
health issue around the world.