INFECTION CONTROL

HAIs
 Healthcare-associated infections (HAIs) are
infections that develop, usually after 48 h, in
a patient and are related to receiving
healthcare

 Are a serious problem in hospitals.

 Therefore each hospital should have an Infection
Control (IC) program designed to prevent
acquisition of infections.
 IC program

 It is an IC plan that should be designed by

specialized IC persons.

 The plan should give a continuously updated

guide to identify, assess and reduce
different risks of infections (HAIs) among
patients, employees, students, and visitors in
the hospitals.
 Infection Control Program
Focuses ON
 Patients:
 Urinary catheter.
 Surgery.
 Mechanical ventilator.
 Inserted vascular catheter.
 Haemodialysis.
 Neonates.
 Burn patients.
 Attending dental clinics.
 Undergoing endoscopy.
 Immunocompromised: neutropenia, organ
transplantation, cancers…….
 Infection Control Program
Focuses ON
 Significant organisms:

 Multi-resistant (MRSA, VRSA).

 Mycobacterium tuberculosis.

 Blood-borne pathogens (HIV, HBV, HCV).

 N. meningitides.

 Avian influenza (H5N1), pandamic swine strain

(H1N1).
 Infection Control Program
Focuses ON
 Certain health-care settings:
 ICUs
 NICUs
 PICUs
 Burn units.
 Delivery room.
 Dialysis unit.
 ER
 Dental clinic.
 OR
 CSSD
 TPN.
 Recommended Infection
Control Practices to Prevent
Transmission of Infections
Recommended Infection Control Practices to
Prevent Transmission of Infections (1)

 Hand hygiene should be practiced by all

HCWs since it is the most effective way to
prevent co-transmission of HAIs.
 Recommended Infection Control Practices to
Prevent Transmission of Infections (2)

 Isolation Precautions, include:

1. Standard Precautions must be applied all the time of care
irrespective of the infectious status of the patient

2. Transmission-based Precautions must be applied in addition

to the Standard Precautions when a patient has a diagnosed
infection:
1. Airborne Precautions in patients infected with agents transmitted
by airborne: pulmonary TB, chicken pox and measles.
2. Droplet Precautions in patients infected with agents transmitted by
droplets: meningococcal meningitis, influenza, mumps, rubella.
3. Contact Precautions in patients infected with agents transmitted by
contact: MRSA, diarrhea, hepatitis A virus.
 Recommended Infection Control Practices to
Prevent Transmission of Infections (3)
 Education and training of HCWs, patients, family and
visitors, regarding hand hygiene and isolation precautions

 Use surveillance data to monitor performance of IC

practices

 Use surveillance cultures when indicated

 Management of infection outbreaks and epidemics

 Preparation of IC policies based on sound evidences

Hand Hygiene
 Importance of Hand Hygiene

 Many infections are transmitted

on the hands of healthcare
personnel.

 It can reduce the transmission of

infections – to your patients and
to you.
 Types of Hand Hygiene

 Hand washing with soap and water (social hand wash).

 Alcohol hand rub by alcohol gel (hygienic hand wash).

 Surgical hand scrub.

 Indications for Hand Hygiene
 Before & after contact with patients.
 Before and after touching wounds.
 Before aseptic techniques (e.g., before insertion
of intravascular catheter, preparing a medication).
 After contact with blood, body fluids or items
potentially contaminated with them.
 After removing gloves.
 When to use Gloves?
 Before touching non-intact skin, mucosa,
blood or body fluids of patients.

 Before touching contaminated equipment.

 Remove immediately after use & before

leaving point of care in order not to
contaminate other places
Standard Precautions
 Standard Precautions
 The Standard Precautions are a group of IC practices
which when implemented by HCWs should reduce
risk of transmission of blood borne pathogens (HBV,
HCV and HIV) as well as other microorganisms
among HCWs and patients.

 Principle: The Standard Precautions assume that

every patient is potentially infected with an
organism that could be transmitted. Thus precautions
should be automatically applied to all patients, all the
time, regardless of their infection status.
 Standard Precautions practices (1)
 Hand hygiene

 Personal protective equipment

(PPE): use of gloves, gown,
mask ..etc.
 Standard Precautions practices (2)
 Respiratory Hygiene & acute respiratory illness e.g.,
flu, are instructed to:
 cover mouth & nose when sneezing/coughing with tissues or
mask;
 wash hands or rub with alcohol;
 Cough Etiquette: to contain respiratory secretions and prevent
transmission of respiratory pathogens.
 Standard Precautions practices (3)
 Cleaning, disinfection and sterilization of patient care
equipment, instruments and devices.
 Care of the environment:
 Clean and maintain routinely environmental and clinical surfaces
 Use of disinfectants
 Safe injection practices.
 Workers’ safety and employee health.
 Proper handling of soiled linen.
 Safe disposal of infectious waste:
 Solid waste e.g., used gloves, pathological tissue & placenta
 Blood and body fluids
 Used needles and syringes
 Airborne Precautions
 Indications: Patients with Pulmonary TB,
chickenpox and measles
 Measures:
 Patient should be isolated in negative pressure
room: so that microorganisms carried by air
from the patient will not spread to other
hospital areas.
 Caring staff must use N95 mask before
entering the room.
 Droplet Precautions
 Indications: patients with meningitis
(meningococcal), mumps, rubella, influenza.

 Measures:
 Patient placed in single room
 Caring staff must use surgical mask upon room
entry.
 Contact Precautions
 Indications: patients infected with MRSA or
other multidrug resistant organisms
(MDROs), or diarrhea.

 Measures:
 Patient placed in single room.
 Caring staff must use gown & gloves upon
room entry.
Prevention of Occupational Exposures
 Occupational exposures of the healthcare workers
(HCWs) to infections should be prevented by
following IC guidelines.

 When accidental exposures occur the exposed

person should receive post-exposure prophylaxis,
especially for serious infections (HBV & HIV).

 Hepatitis B vaccine & seasonal influenza vaccine

should be given to HCWs.
 HCWs should follow the best practice to
avoid exposure to patient’s blood
 Using gloves, masks, eye goggles, .
 Avoiding unnecessary use of needles and other
sharps.
 Not recapping needles.
 Discarding needles and sharps in puncture
resistant container.
 Not holding patient tissue with fingers when
suturing or cutting.
 Prompt cleaning blood spills by using household
bleach (1000 ppm chlorine).
 What to do if you are exposed?

 Immediately and vigorously wash the site of

needle sticks with soap & water.

 Immediately flush with water if splashes to

the nose, mouth, or skin.

 If splashes to the eyes, irrigate with clean

water, saline or sterile irrigates.
 What care provided to the exposed
person?

 Identification of the source person if possible.

 Baseline lab testing done at once, then follow-
up testing for 6 months
 Checking for risk of HBV, HCV and HIV
infection.
 Post-exposure prophylaxis (PEP) on time, if
indicated.
Post-exposure prophylaxis
 Person exposed to HBsAg positive
source

 give PEP according to vaccination status.

 Person exposed to HBsAg positive
source
 Unvaccinated:

 start Hepatitis B vaccine series

 Single dose of Hepatitis B immune globulin

(HBIG) within 24 hours.
 Person exposed to HBsAg positive
source
 Incomplete vaccination:

 Give one dose of HBIG immediately

 Complete vaccination
 Person exposed to HBsAg positive
source
 Vaccinated responder
 No treatment

 Vaccinated non-responder
 Give 2 doses of HBIG; one
within 24 hours and the 2nd a
month later
 Person exposed to HIV positive
source

 give anti-HIV drugs.

 Two or three drugs according to risk of

infection.
 Drugs should be given for 28 days
 Anti-HIV drugs are given according to the
risk of infection
 Source is HIV +ve has no AIDS  Source is HIV +ve has no AIDS
symptoms. symptoms.
AND
AND  Minimal percutaneous injuries or
mucosal exposure to LARGE
 Minimal percutaneous injuries or blood volume.
mucosal exposure to small
blood volume. OR
 AIDS patient with ANY degree of
percutaneous injury or mucosal
exposure.

Basic 2 drug regimen

Expanded 3 drug regimen

Microbiologic Investigations Related to
Infection Control in Hospitals 1

Routine monitoring:
 Spore test for monitoring the sterilization
processes in the hospital.

 Cultures of haemodialysis water.

Microbiologic Investigations Related to
Infection Control in Hospitals 2

Occurrence of outbreaks:
 Outbreaks of surgical site infections.
 MRSA outbreaks in ICU.

 Microbiologic sampling & cultures from

patients, HCWs or hospital environment.

 Otherwise useless & recommended to be stopped.

Microbiologic Investigations Related to
Infection Control in Hospitals 3
Strain typing:
in the epidemiologic studies of outbreaks
by:
 Colony morphology
 Biotype profiles
 Phage typing
 Plasmid analysis
 Ribotyping
 Chromosomal analysis and PCR.
Thank
You