Infection

Prevention & Control

Note for the Exam
•This lecture was given Dec 2. It differs in some
areas from the version in the notes.
•The source for the exam questions is the posted
notes version, although the same area may have
been covered in this lecture.
•These notes are provided for you to have a
complete set from the course and as a source of
information for the future. They also complement
the previously posted notes on Infection Control
and may be useful to augment your understanding
of important issues in Infection Control.
 Learning Objectives

The learner will:

•Define healthcare acquired infection (nosocomial)

•List 5 types of healthcare acquired infections
•Differentiate between infection & colonization
•Identify sources of healthcare acquired infection
•List 7 host risk factors
•Name 4 main routes of transmission
 Learning Objectives
The learner will:

•Describe methods to prevent transmission

•Define antibiotic resistant bacteria
•Discuss control measures for communicable
diseases
•Identify the single most effective tool to prevent
healthcare acquired infection.
The Theme
 Infection

Entry into & multiplication of an infectious

agent (pathogen) in the tissues of the host
resulting in tissue damage/injurious effects.

Subclinical – unapparent
Clinical – apparent
 Colonization

The presence of microorganisms in or

on a host with growth & multiplication
but without tissue invasion or
damage.
 Nosocomial Infection

•A result of hospitalization
•Not present or incubating at time of
admission
 Nosocomial Infection

•May be exogenous
– acquired from the environment, other
patients or caregivers

•May be endogenous
– from patients’ own organisms
 Nosocomial Infections

•UTI – urinary tract infection

•SSI – surgical site infection
•Pneumonia
•Bacteremia
•Infectious diarrhea - CDAD
 Exogenous Risk Factors
UTI

•Urinary catheterization
– Indwelling
– In/out catheterization
•Contaminated drainage systems
•Hands of care givers
 Exogenous Risk Factors
SSI
•Shave prep
•Length of procedure
•Contaminated surgical instruments
•Nares & oropharynx of OR personnel
•Contaminated solutions, antiseptics,
dressings
•Hands of personnel
 Exogenous Risk Factors
Pneumonia

•Intubation
•Respiratory therapy equipment
•Respiratory tract instrumentation
•Hands of caregivers
 Exogenous Risk Factors
Bacteremia

•Intravascular access devices

•Contaminated IV solutions
•Contaminated multi-dose vials
•Hands of caregivers
 Exogenous Risk Factors
CDAD
•Spore former
•Contaminated environment
•Antibiotic use
•Hands of care givers
 Endogenous Risk Factors
•Prolonged hospitalization •Poor nutritional status
•Immunosuppression •Altered GI flora
•Co-morbidities •Obesity
– Diabetes •Immobility
– Malignancy •Extensive burns or wounds
– Renal insufficiency •Trauma
– Aspiration •Age
Chain of Infection
 Chain of Infection - Links
Infectious Agent
– Agent capable of causing disease
– Bacteria, viruses, fungi, & parasites

Reservoir
– Place in which the infectious agent can survive but
may or may not multiply.
– Humans, animals, & the environment.
• Patients
• Healthcare personnel & healthcare equipment &
environment
 Chain of Infection - Links

Portal of Exit
– Path by which the infectious agent leaves the reservoir

Mode of Transmission
– Method by which the organism reaches a susceptible
host
 Chain of Infection - Links

Portal of Entry
– Means by which the an infectious agent enters the
susceptible host
– Similar to portal of exit

Susceptible Host
 Modes of Transmission
1. Contact
– Direct
– Indirect
– Droplet
2. Airborne
3. Vehicle
4. Vectors
 Infection Prevention

•Modifiable risk factors (exogenous)

•Routine practices
•Barrier precautions
•Hand hygiene
 Routine Practices
(Health Canada,1999)
•Hand washing/ hand antisepsis
•Gloves
•Gowns
•Masks & eye protection/face shields
•Accommodation
•Patient care equipment
•Environmental control
 Additional Precautions
Respiratory Isolation

Airborne spread
•Single room
•Special ventilation
•Particulate respirator (N-95)
•Varicella (chicken pox),TB

Droplet spread
•Surgical mask within 3 feet
•Influenza, mumps, pertussis (whooping cough)
 Additional Precautions

Contact Spread
•Low infective dose
•May be transmitted from intact skin
•Potential for widespread environmental
contamination

✓Strict Isolation
✓Contact Measures
✓Enteric Measures
 Hand Hygiene

The single most important measure to prevent

the transmission of infection.

Improved hand hygiene practices have been

associated with reduced healthcare-associated
infection rates.

•Frequency
•Technique
 Hand Hygiene – Resident Flora
•Survive and multiply on skin
•Inhabit deeper layers
– Coagulase negative staphylococci
– Diphtheroids
– Staphylococcus aureus
– Streptococci sp.
– Candida sp.
 Hand Hygiene – Transient Flora

•Colonize the superficial layers of the skin

•Unable to multiply on skin
•Usually have a short life span
•May include highly pathogenic organisms
•Frequently associated with infection
•Easily removed
•High incidence in HCW
•Hands without healthy skin are more susceptible
to becoming colonized with transient bacteria.
 Hand Hygiene

Before:
– beginning your work day
– every patient contact
– donning sterile gloves
– inserting invasive devices
– handling/preparing medications
– feeding a patient
– leaving the workplace/eating
 Hand Hygiene

After:

•Patient contact (even with patient’s intact skin)

•Removing gloves
•Contact with contaminated objects and equipment
•Blowing nose/coughing/trips to the washroom

Hands that are visibly soiled need to be

washed with soap & water.
 Antibiotic Resistant Bacteria
•Not new – first documented in the 50’s
•An outcome of evolution
•Bacteria devised mechanisms to survive
•Overuse & misuse of antibiotics contributed to the problem

Results
•Multiply resistant strains
•Lack of effective antibiotics
•Transmissions from patient to patient (via hands of HCW &
equipment)
•Endemic in our institutions
 Antibiotic Resistant Bacteria

Control Measures

•Prevent patient to patient transmissions

•Prevent hospital environmental reservoirs
•Judicious antibiotic use
•Research & future drug development