ROLE OF A MICROBIOLOGIST IN

PREVENTION OF HEALTHCARE-
ASSOCIATED INFECTIONS

“HE WHO CURES A DISEASE MAY BE SKILLFUL BUT HE WHO PREVENTS IT

IS A BETTER PHYSICIAN”

Dr.B.Vijayasree, 2nd year Post-graduate.

Mentor: Dr.R.Lakshmi Kumari,M.D.,

Professor & H.O.D.,

Department of Microbiology,

Siddhartha Medical College,

Vijayawada.

DEFINITION:

Healthcare-associated infections (HAIs) can be defined as the infections acquired in

the hospital by a patient admitted for a reason other than the infection in context,

 The infection shouldn’t be present or incubating at the time of admission,

 The symptoms should appear at least after 48hours of admission.
 This also includes –
a. Infections acquired in the hospital, but symptoms appearing after discharge.
b. Occupational infections among the staff of the healthcare facility like needle
stick injuries.
c. Infection in a neonate resulting while passage through the birth canal
(congenital infections due to transplacental transmission are not HAIs).
  Centre for Disease Control and Prevention (CDC), Atlanta recommends using
“Healthcare-associated infections” as a more accepted terminology because it
represents all types of healthcare delivery systems such as hospitals, nursing
homes, rehabilitation facilities, outpatient clinics, day-care, and other clinical
settings.

HISTORY:

Contributions in
Pioneer Profession Infection Prevention
and Control
Joseph Lister(1827-1912) British Surgeon & Father of Antiseptic
Scientist Surgery
Ignaz Philipp Hungarian Physician Antiseptic policy & hand
Semmelweis(1818-1865) hygiene
Oliver Wendell American Physician Proposed contaminated
Holmes(1809-1894) hand as the root cause of
Puerperal fever
John Snow(1813-1858) General practitioner, Founder of Epidemiology
London
French Chemist & Confirmed Germ theory of
Louis Pasteur(1822-1895) Microbiologist disease and contributed
in Sterilization -
Pasteurization
Robert Koch(1843-1910) German Microbiologist Disinfecting properties of
steam and hot air
William Stewart American Surgeon Invented rubber gloves
Halsted(1852-1922)
Charles French Microbiologist Developed autoclave
Chamberland(1851-1908)
Earle Spaulding(1907- American Physician Spaulding’s classification
1995) of Medical Devices

 International Infection Prevention Week (IIPW) was first established in

1986 by US President Ronald Regan, which is being celebrated during the
third week of OCTOBER every year (17th – 23rd October in 2021) to focus
 on the importance of infection prevention in saving lives and decreasing
financial burden caused by health issues.
 The Theme of IIPW for 2020 (18th-24th October) – “We Love IPs” (Infection
Preventionists).

TYPES OF HAI:

There are four most common types of HAIs.

1.Catheter-associated urinary tract infections (CAUTI)

2.Central line-associated bloodstream infections (CLABSI)

3.Ventilator-associated pneumonia (VAP)

4.Surgical site infections (SSI)

The first three infections together are termed “Device Associated Infections
(DAIs).”

ETIOLOGY: Microorganisms implicated are the “ESKAPES” pathogens proposed

by the Infectious Disease Society of America (IDSA)-

 Enterococcus faecium
 Staphylococcus aureus
 Klebsiella pneumoniae
 Acinetobacter baumannii
 Pseudomonas aeruginosa
 Enterobacter species
 Stenotrophomonas maltophilia

*Escherichia coli is an important multidrug-resistant organism (MDRO) causing HAI,

especially in Indian settings.

Less common pathogens –

 Healthcare-associated M.tuberculosis
 Legionella pneumophila
 Candida albicans
 Clostridioides difficile (CLSI)
 Bloodborne viruses
Importance of HAI:

In 2011, WHO reported that:

 On average, 7% of patients in developed and 10% in developing countries
acquire at least one HAI at any given time.
 Mortality from HAI - 10% of affected patients.
 Increased length of hospital stay associated with HAI in developing countries
ranges between 5 days and 29.5 days.
 Both the endemic burden and the occurrence of HAI epidemics are major
public health problems, posing a significant impact on morbidity, mortality,
quality of life and economic burden at the societal level.

 However, a large percentage of HAIs are preventable through effective

infection prevention and control (IPC) measures, which is a universally
relevant component of all healthcare systems.
 Good quality microbiological support provided by at least one national
reference laboratory is a critical factor for an effective national Infection
Prevention and Control surveillance programme.

An effective Hospital Infection Control Programme would have the following

components:

 Hospital Infection Control Committee (HICC) with defined composition and

function
 Hospital Infection Control manual with policies, guidelines, recommendations,
and working protocols including activities and practices under the programme
 Antimicrobial stewardship programme (AMSP)
 Ongoing educational programmes for all healthcare workers in the use of
such policies and guidelines
 The annual budget for implementation of infection control measures in the
hospital.
  HICC is an integral component of the healthcare facility, responsible for
establishing and maintaining infection prevention and control, its monitoring,
surveillance, reporting, research, and education-related activities.

Composition of HICC:

1.Administrative control:

 Chairperson – Medical superintendent or Medical director

 Member secretary – HOD, Department of Microbiology or senior physician –
monitors ICO.

2.Hospital Infection Control Team (Core Committee):

It is the functional unit of HICC, which includes -

 Infection Control Officer (ICO) – Clinical Microbiologist or Infectious disease

physician or physician of any specialty trained in IPC.
 Infection Control Nurse (ICN) – Link between the HICC and the wards or ICUs
in identifying problems and
implementing solutions.
 Infection control laboratory
technician
 Data Entry Operator (DEO)

Other members-

 Heads of all clinical departments

 Officer-in-charge, Nursing section
 Officer-in-charge, Biomedical waste
management
 Supportive services - Officer-in-
charge of
 Operation theatre complex
 Central sterile supply department (CSSD)
 Linen and Laundry department
 Housekeeping or sanitary department
 Kitchen department
  Pharmacy department
 Engineering department
 Store or material department

Functions of HICC:

 Healthcare-associated infection surveillance

 Develops a system for identifying, reporting, analyzing, investigating, and
controlling healthcare-associated infections
 Antimicrobial stewardship programme
 Education
 Staff health
 Outbreak management
 Other departments
 Reviews
 Prepares the manual
 HICC meeting

HOSPITAL INFECTION CONTROL COMMITTEE MEETING:

 HICC shall meet not less than one month.

 During an emergency, the committee should be able to meet promptly.
 HICC team should take the lead in conducting the meeting.
 Circular should be sent to all the members a week prior via mail or letter with
a reminder on the meeting day.
 ICO shall present a monthly report of HICC regarding activities like
educational and training sessions conducted, HAI surveillance, needle stick
injury report, hand hygiene audit report, care bundle report, etc.
 Identifies and discusses fundamental problems.
 ICO shall also carry out a review of the last meeting and implementation of
the action plan.
 Documents minutes of meeting with clear action points.
 ICO takes responsibility to implement action points on medical, nursing, or
operational personnel.
World Health Organization had proposed 8 core components for infection
prevention and control, which include:

1.Infection prevention and control programmes

2.National & Facility level Infection prevention and control guidelines

3.Infection prevention and control education and training

4.Healthcare-associated infection surveillance

5.Multimodal strategies for implementing Infection prevention and control activities

6.Monitoring/Audit of Infection prevention and control practices & feedback and

control activities

7.Workload, staffing, and bed occupancy at the facility level

8.Built environment, materials, and equipment for Infection prevention and control at
the facility level

So, every hospital should have a well-designed, comprehensive & co-ordinated

Hospital Infection Control programme aimed at preventing HAIs.

 The hospital infection control programme is a continuous process updated at

least once a year.
 A multidisciplinary HICC co-ordinates all the IPC activities.

“Role of Microbiologist as an Infection Control Officer”

 In small hospitals, where only one microbiologist is available, he/she can act
as both member secretary and ICO.
 ICO takes the overall responsibility for the activities of HICT and reports
directly to the member secretary and chairman of HICC.
 ICO should have knowledge and experience in clinical and diagnostic
Microbiology, infectious disease, hospital epidemiology and surveillance,
disinfection, and sterilization practices.
 A designated ICO & ICN are the functional unit of an Infection Control Team.
 ICO conducts educational and training programmes for the relevant
healthcare workers on guideline recommendations to achieve successful
implementation.
 Involves in drawing up annual plans, policies, and long-term programmes.
 ICO prepares various infection control policies and procedures meticulously
and formulates them in the infection control manual.
 ICO monitors the implementation of the policies laid down in the manual
which includes-
a. Identification of high-risk areas & procedures
 b. Adherence to all standard precautions at all times, which include-
 Hand hygiene guidelines
 Care bundle
 Appropriate use of PPE
 Transmission based precautions
 Implementation of safe injection & infusion practices in all healthcare
service sectors, including laboratory
 Cleaning, disinfection & sterilization practices
 Laundry & linen management procedures
 Kitchen sanitation & food handler screening
 Environmental cleaning
 Housekeeping practices
c. Performs antimicrobial resistance (AMR) surveillance and disseminates
cumulative and stratified antibiogram.
d. ICO Designs antibiotic policy and monitors antimicrobial stewardship
programme, and he/she should actively participate in the implementation of
the antibiotic policy.
 Antimicrobial steward (Microbiologist) goes for stewardship rounds
along with the AMS team, they review the cases and discuss with the
clinical team in detail about the compliance to the antibiotic policy of
that particular institute.
 The AMS team conveys their suggestions to the clinical team either
verbally or in written format in the case sheet or both.
 ICO performs regular surveillance activities through surprise visits to monitor
and assess the extent to which infection prevention and control standards are
being met, and activities are being performed according to the programme’s
goals and objectives.

1.These are directed towards the identified high-risk areas & procedures.

Collection of surveillance data on a regular basis (hand hygiene, Biomedical waste

management)

Verification of data on a regular basis

 Track & analyze the infection risks, rates & trends

For example,

Conduct Hand Hygiene audit in different areas of the hospital

Calculate the compliance rates of the personnel

If the compliance rates are less, do the root cause analysis and take corrective &
preventive actions like conducting training sessions on hand hygiene

2.In case of notifiable diseases, the relevant information is to be shared with

appropriate authorities

3.Supervises the HAI surveillance activities – data collection and analysis.

Calculate HAI rate using data

Communicate to respective areas

If the rates are high, take necessary corrective & preventive actions

 Formulates and implements guidelines for sterilization of equipment and

instruments (CSSD policy), disinfection policy including housekeeping policy
and then updating it periodically.
 Monitors all the CSSD activities to achieve effective sterilization.
 Carries out validation tests for sterilization & documents the results.
 Plays an active role in the investigation of an outbreak with consultation from
clinical and Microbiology departments.
 Regular monitoring of Microbiology culture data helps in identifying the
outbreaks in the hospital, which are to be documented, and necessary
preventive actions are to be taken so that the outbreaks don’t recur.
 ICO should liaise with the biomedical waste management officer (member
secretary) continually, and provide advice regarding infection control,
standards of the waste treatment, and disposal system.
 Supervises the activities of the Department of Biomedical waste –
 Biomedical waste segregation audit by direct observation or CCTV
camera
 Onsite inspection of BMW segregation at the common storage area
 Conducting surveys through structured questionnaires
 Barcoding-based tracking of BMWM, starting from segregation to
disposal.
 ICO acts as the nodal officer for the management of needlestick injury and
other occupational exposures.
 Evaluate the risks of exposure and transmission.
 Makes sure post-exposure prophylaxis is available in the hospital.
 Does the follow-up of cases.
 Investigates the cause of exposure.
 Tracks Needle Stick Injuries (NSI) and analyzes the trend of NSI cases
month-wise and year-wise.
 Inspects various hospital locations to ensure the availability of NSI
posters, spill kits.
 ICO organizes induction programmes for all healthcare workers and
monitors pre-exposure and post-exposure prophylaxis.
 Ensures immunization of all Health Care Workers (Hepatitis B and influenza)
as recommended by institutional policy.
 ICO assists in the preparation of an annual budget and tender document for
other support services.
 Reviews the risks associated with new technologies, monitors infection risks
of new devices & products before their approval for use.
 ICO should be aware of bed occupancy in the hospital with the help of the
hospital data team and inform hospital authorities if it exceeds the standard
 capacity of that particular facility-because overcrowding was recognized as a
public health issue that can lead to disease transmission.
 Periodic review of infection control manual.

“AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE”

References:

1.Manuals on Infection Prevention and Control by World Health Organisation

(www.who.int)

2.Essentials of Hospital Infection Control, Apurba S Sastry, Deepashree R

3.Hospital Acquired Infections- Prevention and Control, Purva Mathur

4.www.apic.org/IIPW