INFECTION

PREVENTION &
CONTROL
BY
E. CHELOGOI
 TERMINOLOGY
2
  Pathogen : microorganism that causes disease
 Anti microbial- An agent that prevents the
development of pathogenic action of microbes
 Antiseptics- an agent that is applied to the body
tissues such as skin to destroy, retard growth of
microorganisms
 Sepsis- condition resulting from the presence of
pathogenic bacteria and their products
 Asepsis- absence of disease producing
microorganisms
 Aseptic techniques- methods to eliminate
contamination by germs or infection
 Bacteriostatic- a substance that prevents the
growth or multiplication of bacteria
 Bacteriocidal- agents that kill bacteria
 Bio hazard waste- any solid or liquid waste
that may present a threat of infection
 Protective isolation- practices designed to
protect a highly susceptible person from
contagious diseases ( reverse isolation)
 Surgical asepsis- practices which will
maintain area free from microorganisms, as
by a surgical scrub, or sterile techniques
 Colonization- organism present in body
tissues but not multiplying or invading the
tissues.
 Contamination- introduction of disease ,
germs or infectious material into or on
sterile objects
 What is infection prevention and control?
5
(IPC)

 Infection control is a process where policies,

procedures and activities are designed to
control and prevent the transmission of
diseases within the health care facilities and
community.
Objective of IPC
6

 To prevent spread of infection- provision of

quality health care
 Promote patient safety through enhanced
practice of infection control by health care
workers in health facilities and at community
settings.
 To effectively prevent, identify ,monitor and
control spread of infections in all health care
facilities

01/19/2023 6
7 Hospital acquired infection (HAIs) /Nosocomial
infections

 Infections acquired during the delivery of

healthcare or while receiving treatment or
visiting a health facility.
 Not present or incubating at the time the
patient is admitted to hospital
 Appear 48 hrs or more after hospital
admission or within 30 days after discharge.
8 The most common types of
hospital-acquired infections

 urinary tract infection (UTIS)

 surgical-site infection, (SSI)
 pneumonia
 Bloodstream infection (BSI)
CONDITIONS PREDISPOSING TO NOSOCOMIAL INFECTIONS AMONG PATIENTS
9

 Crowding and population size are increasing

 Impaired immunity
 New microorganisms will develop/New
infections
 Existing microorganism develop even greater
resistance.
 Surgical wounds
 Venipuncture sites
Cont;
10
 Gastro intestinal tract Instrumentation- nasogastric
tubes etc.
 Invasive devices- IV line.
 Respiratory tract- endotracheal tubes, tracheostomy,
suction, prolonged bedrest
 Total parenteral nutrition- long-stay lines, hypertonic
solutions used supports a wide variety of organisms
 Implanted prosthetic devices- artificial heart valves,
vascular grafts etc
Common
11
organisms causing
nosocomial infections
 Clostridium difficile
 Methicillin resistant staphylococcus aureus- MRSA
 Vancomycin resistant enterococcus
 Other- bacteria, virus, fungi, protozoa
Note: HAI’s are commonly caused by :
 lack or poor hand washing practices
 dirty environment
 Failure to identify and protect susceptible patients
 12

As healthcare professionals, it is important

to understand two facts about infection.
1. Method of transmission
2. Ways of breaking the chain of infection
 BREAKING THE CHAIN OF
13
INFECTION
 To remove the source / potential source of
infection
 Block the route of transportation of
microorganism from potential sources and
reservoirs
 Enhance patients resistance to infection
 Transmission based precautions

01/19/2023 13
 Breaking the Chain of Infection
14 INFECTIOUS AGENT
Bacteria , Fungi, Viruses
Rapid accurate
&Parasites
identification of organism
Treatment of
underlying
disease
SUSCEPTIBLE HOST Employee health
Low immune status, Care
Diabetes, Surgery, Burns, RESERVOIRS
Recognition of
Neonates, foreign bodies, People Environmental
high risk
patients
length of hosp. stay, INVOLVES ALL Equipment sanitation
Environment
HEALTH Water Disinfection/
PROFESSIONALS sterilization

Aseptic
Technique Hand-hygiene
PORTAL OF
Catheter ENTRY
Mucous membrane Control of
Care PORTAL OF EXIT
GI / urinary / excretions and
Thro. The body systems-
Respiratory track Hand- MEANS OF secretions
Skin, urinary, Resp.
Broken skin hygiene TRANSMISSION system.
Wound
Direct Contact
Care Trash &
Fomites
- Injection / Ingestion waste
- Airborne Isolation disposal

Food handling
Sterilization
Air flow control
Standard
15 / universal Precautions

Because it is not always possible to tell who is

infected, these practices should be the
approach for the care of all patients all the
time

Formerly known as “universal precautions”

16 STANDARD PRECAUTIONS TAKEN TO
BREAK THE CHAIN OF INFECTIONS
Standard precautions in health care
1.Hand hygiene
2.Appropriate use of personal protective
equipment. (PPE)/ devices
-gloves
-Facial protection (eyes, nose, and mouth
-Gown
3.Safe injection practices
17 Cont. of Standard precautions
4.Respiratory hygiene and cough etiquette
5. Environmental cleaning
6. Used linen processing –(Handle, transport)
7.Health care Waste management
8.Patient care equipment processing-
Decontamination, Cleaning, Disinfection &
Sterilization
 Cont…
18

9.Isolation precaution and patient placement

10.Health education to patient and Visitors
11.Staff health
20
HAND HYGIENE

 Hand hygiene is the act of cleansing hands

with the use of water or another liquid for
the purpose of removing soil, dirt ,or
microorganisms.

20
 METHODS
21

Hand washing: use of plain soap & water

to mechanically remove bacteria/ viruses
and debris
Hand sanitizer: use of waterless hand gels,
sprays & solutions to kill bacteria & viruses
on the hands
 22 LEVELS OF HAND HYGIENE

Social hand washing

HAND HYGIENE Clinical or hygienic

hand washing

Surgical hand
washing/scrub
 PRINCIPLES OF HANDWASHING
 Wash hands thoroughly at the beginning of the
shift before providing care
 Wash hands for 10-15 seconds before and after
providing client care
 Wash hands after handling soiled linen,
equipment and supplies
 Wash hands between contact with different
clients
 Wash hands after removing gloves
 Wash hands after you have sneezed or
coughed on the hands
 Wash hands before eating
 Wash hands just before leaving the
nursing unit
Hand washing Technique

26
1 2 3

Palm to palm. Right palm over left dorsum Palm to palm

and left palm over right dorsum. fingers interlaced.

4 5 6

Backs of fingers to opposing palms with Rotational rubbing of right thumb Rotational rubbing, backwards and
fingers interlocked. clasped in left palm and vice versa. forwards with clasped fingers of right hand
in left palm and vice versa.
5.3
27 2.PERSONAL PROTECTIVE
EQUIPMENT (PPE)

 Should be guided by risk assessment and

the extent of contact anticipated with blood
and body fluids, or pathogens
GLOVES
 Wear when touching blood, body fluids,
secretions, excretions, mucous membranes,
no intact skin.
 Change between tasks and procedures on
the same patient.
 Remove after use, before touching non-
contaminated items and surfaces, and
before going to another patient.
 Perform hand hygiene immediately after
removal.
Personal
29 Protective Equipment:
Standard Precautions

Gloves:
If contact with
blood or body
fluids may occur

Face mask / eye

protection:
If contact with blood
or body fluids may
occur Gown:
If contact with blood or body
fluids may occur
Sequence
30 of Putting on PPE-donning
Sequence
31 of Taking off PPE (“Doffing”)
 RESPIRATORY HYGIENE AND COUGH
32 ETIQUETTE
 Developed during the severe acute respiratory
syndrome (SARS) outbreak, is now considered
as part of standard precautions.
 Apply source control measures
 Cover the nose and mouth when
coughing/sneezing with tissue or mask,
 Dispose off used tissues and masks
appropriately
 Hand hygiene after contact with secretions
 Place acute febrile respiratory symptomatic
patients away from others if possible- isolation.
33 HEALTH CARE WASTE
MANAGEMENT (HCWM)

 Healthcare waste is a potential

reservoir of pathogenic micro-
organisms and requires
appropriate ,safe and reliable handling.
34 KEY STEPS IN WASTE
MANAGEMENT
Minimization
 Segregation
Containment
Handling and Storage
Transport
Treatment or Destruction
Disposal
CONTAINERS & COLOUR CODES FOR EACH CATEGORY OF
WASTE
35

Highly Infectious General/ Non- Infectious

infectious Waste Sharps Waste
(Anatomical) Waste

3-BIN plus SAFETY BOX SYSTEM

 IMPORTANCE OF PROPER WASTE
36 DISPOSAL

 Minimizes the spread of infections

 reduces the risk of accidental injury to staff,
patients, visitors and the community
 Reduces the likelihood of contamination of
the soil or ground water with chemicals or
microorganisms
 Attracts fewer insects, rodents and animals;
 Reduces odors
 Helps provide an aesthetically pleasing
atmosphere
 37
Safe Injection Practices: Why

• Safe injection practices are intended to prevent

transmission of infectious diseases between
individuals AND to prevent injuries such as
needlesticks

• A safe injection- does not harm the recipient,

does not expose the care provider to any
avoidable risks, and does not result in waste
that is dangerous for the community
Safe
38 Injection Practices Include:
 Aseptic technique
 Using a single syringe, needle and
fluid infusion sets ONLY once
 Using single-dose vials when
possible
 If multi-dose vials must be used,
then use & store them according to
manufacturer's recommendation
 Only give injections when necessary
 Use needles with safety devices
 Never recap, break, or bend needles
 Never leave needles unattended
 Never reuse disposable sharps
 Dispose of all needles in a regulated, color-
coded, labeled sharps container
 Sharps containers should be changed when
1/2-3/4 full.
 Transmission-based Precautions
 For patients who are known or suspected to
be infected by certain epidemiologically
important pathogens, which require
additional control measures to effectively
prevent transmission.
Standard precautions plus:
• Contact precaution
• Droplet precaution
• Airborne precaution
MINISTRY OF HEALTH
Contact Transmission
 Direct Contact: occurs when there is
physical contact between an infected
person and a susceptible person-Contact
with blood or body fluids (touching,
kissing, sexual contact, contact with oral
secretions.
 Indirect contact: transfer of infectious
agents through contaminated objects
• Objects include: contaminated shared
patient equipment, touching wound
dressings, contaminated toilets

MINISTRY OF HEALTH
Contact Precaution
 Intended to prevent transmission of infectious agents,
which are spread by direct or indirect contact with the
patient or the patient’s environment (e.g cholera,
Avian influenza, Ebola, Shigellosis, scabies)
 Recommended Precautions
• Hand hygiene before contact
• Recommended PPE (gowns, gloves)
• Hand hygiene after contact

MINISTRY OF HEALTH
Droplet Transmission
 Droplets generated by a person with an
infectious agent can spread disease:
• by coughing, sneezing, and talking
• during procedures like bronchoscopy or
suctioning
 Portal of entry: mucous membranes (eyes,
mouth, inhalation through nose) These
pathogens do not remain infectious over
long distances eg TB, chicken pox,
measles, influenza

MINISTRY OF HEALTH
Droplet Precautions
 Taken in addition to Standard and contact Precautions
 Recommended Precautions
• Hand hygiene upon entry into patient bed area
• Wearing a surgical mask by staff and visitors when
within 1 to 2 meters from the patient
• Patient to practice cough etiquette or
• Patient to wear a surgical mask when being
transported or in open clinical areas
• Hand hygiene after contact and when exiting the
patient bed area

MINISTRY OF HEALTH
 Droplet Precautions
In Standard and contact Precautions
• Health worker: Use of PPE
• Medical-surgical/N95 mask when within 1m (3”) of
patient
• Wear face shield or goggles
Patient
• Isolate the patient in a well ventilated single room.
• If not possible, cohort patients with same
suspected etiology in same room.
• If not possible, place patient beds at least 1m
apart and arranged to keep a distance between
patients.
• Limit patient movement out of the isolation room
COVID-19 Critical Care Training

MINISTRY OF HEALTH
 Airborne Transmission
• Different from droplet transmission
• Refers to the presence of microbes within droplet nuclei
referred to as aerosols which are generally considered to
be particles <5μm in diameter,  
• The infectious agents remain infectious over long
distances when suspended in the air
• The small infectious droplets can travel on air currents
and remain suspended in the air for long periods of time
• Airborne infectious particles can spread by coughing,
sneezing, and talking
• Portal of entry: inhalation into upper airways - Nose

COVID-19 Critical Care Training

MINISTRY OF HEALTH
 Airborne Precautions
Taken in addition to Standard, Contact and Droplet
Precautions
 Airborne Precautions prevent transmission of
infectious agents that remain infectious over long
distances when suspended in the air – eg measles
 Recommended Precautions
• Hand hygiene before contact
• Recommended PPE (high-efficiency filtration
respirator) or N95
• Caution in aerosol generating procedures
• Negative pressure rooms
COVID-19 Critical Care Training

• Hand hygiene after contact

MINISTRY OF HEALTH
COVID-19 Critical Care Training

MINISTRY OF HEALTH
Cleaning
51 of the Environment
Our environment contains
microorganisms that can
cause infection.

Cleaning and disinfecting

surfaces and objects such as medical equipment
can decrease the spread of these organisms to
people.
Common
52 Terms
• Clean = remove all visible dust, soil, and any
other foreign material with soap and water.
• Decontaminate = remove disease-producing
microbes to make safe for handling using
chemicals eg jik- chlorhexidine solution.
• Disinfect= kill or destroy nearly all disease-
producing organisms, except spores using a
chemical or physical agent
 Sterilize = destroy microorganisms and spores
Cleaning
53 Process
• Environmental Services
should approach cleaning in a
orderly, regularly scheduled
method.
• Clockwise or counter-
clockwise
• Working from top to
bottom
• Cleanest to the dirtiest
 Sample
54 Cleaning Schedule

Who is
Equipment Responsible Frequency Cleaning Process
Blood pressure Between registered
Nursing
cuff patients disinfectant

Environmental Between registered

Call button
Services patients disinfectant

Environmental registered
Bed rails Daily
Services disinfectant

*Adapted from New York City Department of Mental Health and Hygiene, 2010, available at:
http://www.nyc.gov/html/doh/downloads/pdf/bhpp/ped_ltcf_conf/peds_conf_clones.pdf
Disinfecting
55 Agents
• Only use disinfectants registered
• Cleaners and disinfectants should be
reviewed for use, dilution, contact
time, and shelf life
▫ Contact time: amount of time
needed for the chemical to come in
contact with the microorganism so
that a significant number of
organisms are killed
Classification
56 Chart
Critical items Semicritical items Noncritical items

Enter sterile body

Contact with Contact with
tissues, sterile body
mucous intact skin, not
fluids, or vascular
membranes or mucous
system
non-intact skin membranes

High-level Low-level
Sterilization disinfectant disinfectant
57 STAFF HEALTH
 Observe the standard precautions
 Personal hygiene
 Vaccinations
 Periodical screening and re-deployment
 Useful exercises
 Vaccinations
58
• A vaccine is a preparation that improves immunity
to a particular disease.
▫ Examples: influenza, tetanus, or pneumonia
• The vaccine typically contains an agent that
resembles a disease-causing microorganism.
• The vaccine stimulates the body’s immune
response to recognize the foreign invader, destroy
it, and "remember" it, so that the immune system
can more easily recognize and destroy any of these
microorganisms that may be encountered later.
Why Vaccinate?
59 • Vaccines can help prevent some
diseases
▫ Save costs (resource reallocation)
 Lost time from work
 Treatment expenses
▫ Save lives
• Long-term protection in the individual
• Help prevent outbreaks from occurring
Successful
60 Vaccination Strategies

• Stress benefits of vaccination.

• Allay fears and misconceptions.
▫ Vaccines are safe!
▫ Can’t “catch” the disease from the vaccine
▫ Minimal side effects
▫ Benefits outweigh the risks
• Find creative ways to increase staff influenza
vaccination rates.
Staff Members and Illness
61
 Staff sick leave policies should allow and
encourage those who are ill to stay home
 Consistent with public health guidance
 Non-punitive and as flexible as possible
 Keep track of illness in staff via surveillance
logs
 After returning to work, remind staff to
practice good hand hygiene and respiratory
etiquette
 Education is Prevention!
• Share
62 information and strategies with staff
▫ Upon hire, Annually and As needed
• Use effective teaching tools
▫ Address the adult learning principles
▫ Engage, involve, interact
 Case studies -Group discussion
 Group exercises -Applied practice
 Role playing -Interviews
▫ Use assessments before and after training to see
if training was successful
POST EXPOSURE PROPHYLAXIS- PEP

 CDC statistics 2002 estimated that 600,000 to

800,000 needle stick injuries occurs each year with
potential risk of HIV exposure, hepatitis B & C
 Follow hospital existing protocols on PEP
 Prompt reporting
 Post exposure care and treatment
 Educate on importance of early reporting
 Risk assessment – high risk – PEP regimen
 4 week regimen
 DRESSING AND BEHAVIOUR
 Remove jewellery
 Hair should be well covered
 Avoid carrying unnecessary items to hospital
 Too long clothing that touch the floor
 When having RTI’s seek treatment and avoid seeing
patients
 Educate ISOLATED patient and relatives on IPC
 Avoid chewing in the ward- pens etc
 Control visitors
 Frequent hand washing