Infection Prevention and

Principles

Addisu B.(BSc, MSc in EMCCN)

 Learning Objectives:
• At the end of this chapter the students will be
able to:
 Define infection
 Define infection prevention
 List chain of infection
 Describe principles of infection prevention
 Apply principles of infection prevention
 Demonstrate different infection prevention
method
 Terminology Definitions
• Nosocomial infections are infections acquired in the
hospital or other health care facilities that were not
present or incubating at the time of the client’s
admission.
• Infectious disease refers to the pathologic event that
result from the invasion and multiplication of
microorganisms in a host.
• Sepsis a term that means poisoning of tissues, often is
used to describe the presence of infection.
• Transport of an infection or the product of infection
throughout the body by the blood is known as
septicemia.
 Terminology…
• Asepsis means to make free from disease
producing organisms.
• Microorganisms are simple forms of life
commonly made up of a single cell only seen with
a microscope.
• Infection control – the set of methods used to
control and prevent the spread of disease
• Contaminated – means dirty, soiled, unclean
• Disinfection – cleaning or destroying disease
causing germs (pathogens).
 Chain of infection
There are six links in the chain of infection:
1. The etiologic agent, or micro organism:
2. The reservoir, the place
3. Portal of exist from reservoir
4. Method of Transmission
5. Portal of entry in to the host
6. Susceptibility of the host
 Chain of infection…
• Infectious agent can be bacteria, virus,
fungus, or parasite.
• Source of organisms also called reservoirs,
are Inanimate objects, human beings, and
animals.
• Portal of exit provides a means for
microorganism to leave the source. Sputum,
emesis, stool, urine, blood, wound drainage, or
secretion from genitals.
 Chain of infection…
• Mode of transmission: refers the way in which
the organism moves or carried from the sources
through portal of exit. It includes:-
Contact transmission
Vehicle transmission
Droplet transmission
Airborne transmission
Vector borne transmission
 Chain of infection…
 Portal of entry is an entrance into the host.
 Pathogen can enter to susceptible host through body
orifices .
 Mucus membrane
 Non-intact skin
 GIT
 GUT
 Respiratory tract
 Concept of Asepsis

The HCP’s effort to minimize the onset &

spread of infection are based on the principles
of aseptic technique.
 Infection Prevention
• Infection Prevention: is largely depends on
placing barriers between a susceptible host
(person lacking effective natural or acquired
protection) and the microorganism.
• Infection prevention is an important part of
every component of health care system.
• Common sites of hospital acquired infection
are :- respiratory tract, gastrointestinal
tract, bloodstream, skin, and urinary tract.
Principles of Infection Prevention
 Consider every person as potentially infectious
 Hand hygiene
 Use aseptic technique
 Avoid contamination
 Gowning and gloving
 Proper waste management
 Principles…
 Instruments and equipment safe handling
 Care of Health Care Workers
 Routinely clean the hospital environment
 Proper placement of clients in hospital to
prevent spread of microorganisms to others or
to the client,
 Standard Precautions
• Standard Precautions are the minimum infection
prevention practices that apply to all patient
care, regardless of suspected or confirmed
infection status of the patient, in any setting
where healthcare is delivered.
• Standard precaution is also called universal
precautions.
• Are designed to reduce the risk of transmission
of microorganisms from both recognized and
unrecognized sources of infection in hospitals.
 Cont…
• Standard Precautions include:
1. hand hygiene,
2. use of personal protective equipment (e.g.,
gloves, gowns, masks),
3. safe injection practices,
4. safe handling of potentially contaminated
equipment or surfaces in the patient environment,
and (safety boxes, color coded bins: black,yellow
& Red
5. respiratory hygiene/cough etiquette.
 Types of hand hygiene practice
 Hand washing
 Hand Antisepsis
 Antiseptic hand-rub
 Surgical hand scrub
• Wash your hands in the following situations;
At the beginning and end of your shift
Before contact with client
Between contacts with a clients
 Cont…
Before and after contact with wounds, dressings,
specimens, or bedclothes
Before performing any invasive procedure
Before administering medications
After contact with any client secretion or
excretion.
Before and after using bathroom
After removing gloves
Before eating
Hand washing
Personal protective equipment(PPE)
 Refers to wearable equipment that is intended to protect
HCP from exposure to or contact with infectious agents.
 Techniques or equipments that prevents the transfer of
pathogens from one person to another are referred to as
“barriers” or personal protective equipment(PPE).
 Its aim is to contain pathogens by establishing aseptic
barriers around the client and personnel.
 Cont…
• The most commonly used barriers
and/ or PPE are gloves, gowns, shoe
covers, head covers, masks,
respirators, eye protection, face
shields, and goggles.
 Types of Asepsis Technique
• There are two types of asepsis:

1. Medical asepsis &

2. Surgical asepsis

Medical Asepsis
• Medical or Clean Asepsis is defined as the practice of
techniques and procedures designed to reduce the number of MOs
in an area or on an object and to decrease the likelihood of their
transfer.
 Cont…
• Medical asepsis includes all measures aimed at reducing the
number or spread of microorganisms.
• During daily routine care, the HCP uses basic medical aseptic
techniques to break the infection chain.
• Example of medical asepsis are: changing client’s bed linen
daily, hand washing, barrier techniques, & routine
environmental cleaning.
• But the most important of all is hand hygiene.
 Surgical or Sterile Asepsis or Sterile
Technique

• Includes procedures used to eliminate micro-

organisms from an area & is practiced by HCP
in ORs, labour & delivery area, major
diagnostic areas & Rx areas.
 Cont…

• It is a practice, which will maintain area free

from microorganisms, as by surgical scrub, or
sterile technique.
• The purpose of sterile technique is to prevent
the introduction of microorganisms from the
environment into the client.
 Cont…

• Surgical asepsis is used in the following

circumstances;
Surgical procedures
All procedures that invade bloodstream
Procedures that cause a break in the skin or mucus
membrane( IM injection)
 Cont..

Selected dressing changes and wound care

Procedures involving insertion of catheters or

devices into sterile body cavities( e.g bladder )

Surgical asepsis demands the highest level of
aseptic technique & requires that all areas be kept
as free as possible of infectious micro-organisms.
 Principles of surgical asepsis
• Although surgical asepsis is carried out in many
setting , the operating room is the area where
surgical asepsis is used most extensively.
• General principles of surgical asepsis include;
 Moisture cause contamination
– Handle liquids carefully near sterile field to
prevent splashing.
– Place wet objects on sterile, water impermeable
surfaces such as sterile basins.
 Cont..
 Never assume that an object is sterile.
– check to see that it is labeled as sterile.
– Always check the integrity of the packaging.
– If there is any doubt about the sterility of an object,
it should be considered as unsterile.
 Always face the sterile field.
 Sterile articles may touch only sterile articles or
surfaces.
 Cont…
 Prevent unnecessary traffic and air currents around the
sterile area.
– Close doors
– Unfold drapes
– Don’t sneeze, cough, or talk excessively over the sterile field.
– Don’t reach across the sterile fields.
 Open, unused sterile articles are no longer sterile after the
procedure.
 Surgical technique is a team effort.
– A collective and individual is the best method of enhancing
sterile technique.
 Cont…

• Sterile field is an area free from microorganisms

on which sterile items can be placed.
• The HCP working with a sterile field or with
sterile equipment must understand that the slightest
break in technique results in contamination.
Aseptic Practices
Aseptic Practices
 Instrument Processing

• Every item, whether a soiled metal

instruments or pair of surgical gloves,
requires special handling and processing in
order to:
o Minimize the risk of accidental injury or blood or
body fluid exposure to cleaning and housekeeping
staff; and
o Provide a high quality end product .
 Key steps in instrument Processing

Decontaminate

Clean High-Level
Disinfect
Sterilize Boil
Chemical
High-pressure steam Steam
Dry heat Chemical

Dry/Cool and Store

 Chemical Disinfectant

• Disinfectants are chemicals that destroy or

inactivate microorganisms on inanimate
objects
• They are not meant to be used on the skin or
mucus membranes
 Chlorine and chlorine releasing compounds

Sodium Hyporchlorite (chlorine bleach)

Advantages
• It is the least expensive and most readily available
• Easy to prepare and use.

• Quickly inactivates all viruses as well as killing

tubercle bacillus.
• Very useful for decontaminating soiled surgical
instruments, gloves and other items and large
surface areas
 Cont…
Limitation
• Inactivated by organic matter.

• Loses potency on standing if left in open container

(replace at least daily).

• May corrode metal instruments with prolonged

exposure (>10 minutes) to concentrations greater
than 0.5%.
 Formaldehyde

• It can be used as a chemical sterilant, as well as a

high-level disinfectant.
• However have the following limitations
o Causes skin irritation.
o Potential carcinogen
o Irritates the skin, eyes and respiratory tract, even at low
concentrations.
o Produces a dangerous gas when mixed with chlorine.
• There fore, should not be used for HLD or
sterilization if other high-level disinfectants are
readily available.
 Glutaraldehydes

 An alkaline-stabilized 2% glutaraldehyde available commercially

 Advantages
 Not readily inactivated by organic materials.
 Generally can be used for up to 14–28 days.
 Noncorrosive and can safely be used on surgical endoscopes
(laparoscopes)
 Limitation
 Can cause skin irritation or dermatitis with chronic exposure.
 Vapors are irritating to mucous membranes and respiratory
tract.
 Work best at room temperature (20–25oC).
 Expensive.
 Preventing Contamination of Disinfectants

• Pour solutions into smaller container for use

during service delivery to avoid contaminating
the stock container.
• Label reusable containers with the date each
time they are washed, dried and refilled.
• Always use clean water for decontamination,
boiled water for HLD and sterile water for
sterilization to dilute disinfectants.
 Decontamination

• Decontamination is the process of making

inanimate objects safer to handled by staff
before cleaning.
o Inactivates HBV and HIV
o Must be done before cleaning
o It is done by soaking the equipment in 0.5%
chlorine solution
 Instructions for Preparing Dilute
Chlorine Solutions

Total parts (TP) (H2O) =

[ % Concentrate
% Dilute ] -1

Total parts (TP) (H2O) = [ 5% Concentrate

.5% Dilute ] -1 = 9 Total parts (TP) (H2O)

To make a 0.5% chlorine solution from 5% bleach,

mix 1 part bleach to 9 parts water.
 Decontamination practices
 Place instruments and reusable gloves in 0.5%
chlorine solution after use
 Soak for 10 minutes and rinse immediately.
 Do not soak instruments in decontaminating solution
for more than 10 minutes, because it results corrosion
 Use plastic container with cover for decontamination
 Wipe surfaces (exam tables) with chlorine solution
 Flush syringe and needles with 0.5% chlorine
solution
 Cleaning
• Physically removing infectious agents and
other organic matters
• Method of mechanically reducing the number
of microorganisms, especially endospores
• Doesn’t necessarily destroying infectious
agents
• Is an essential pre- requisite to ensure effective
disinfection or sterilization
• Use liquid soap for effective cleaning
 Cleaning practices

• Use PPE during cleaning

• Disassemble instruments
• Wash with detergent,
water, and a soft brush.
• Scrub instruments under
the water surface until
visibly clean.
• Thoroughly rinse with
clean water.
 Sterilization
•Destroys all microorganisms, including
endospores
•Used for instruments and other items that
come in direct contact with the blood stream
or tissue under the skin
Common Methods of Sterilization
High-Pressure Steam Chemical
(Autoclave)

Dry-heat
(Oven)
High-Pressure Steam Sterilization (Autoclave)

The temperature, pressure and time

combination for steam sterilization is:
• 121°C (250ºF); 106 kPa pressure:
o 20 minutes for unwrapped items
o 30 minutes for wrapped items
• 1320C (2700F), under pressure for 15 minutes for
wrapped items.
• Allow all items to be cooled and dried before
removing.
 Dry Heat Sterilization (Oven)
• Dry heat sterilization is accomplished by thermal
(heat) conduction/ transfer.
• Initially, heat is absorbed by the exterior surface of an
item and then passed to the next layer.
• Microorganisms die as their proteins are slowly
destroyed.
• Dry heat sterilization takes longer than steam
sterilization because the steam speeds up the
penetration of the heat.
Requirements: Adequate temperature
Correct time
 Cont…
• Recommended temperature/time ratios
170°C (340°F) 60 minutes
160°C (320°F) 120 minutes
150°C (300°F) 150 minutes
140°C (285°F) 180 minutes
121°C (250°F) overnight

Remember: Depending on the temperature selected,

the total cycle time (preheating, sterilization time, and
cool down) will range from about 1 hours at 170°C to
more than 8 hours at 121°C.
 Chemical Sterilization
• It is an alternative for items that would be damaged if
subjected to steam or dry heat sterilization.
• Glutaraldehyde and formaldehyde are sterilants if
used for the appropriate time.
• When handling these products:
o Wear gloves to avoid skin contact.
o Wear protective eyewear to protect from splashes.
o Limit exposure time.
o Be in a well-ventilated area.
 Chemical Sterilization…continued
• Sterilization takes place
by soaking
o For 10 hours in 2–4%
glutaraldehyde solution
or
o For 24 hours in 8%
formaldehyde.
• Rinse with sterile water
 High Level Disinfection
Principles:
•Destroys all microorganisms including HBV,
HCV, and HIV; does not reliably kill all
bacterial endospores
•Only acceptable alternative when
sterilization equipment is not available
 Common Methods of HLD
Boiling Steaming

Chemical
 HLD…
Chemicals for HLD
• Chlorine solution 0.1%
o Safe for stainless and plated instruments
o Concentrated solutions >0.5% can corrode metals
• Formaldehyde 8%
o Vapors are irritating (staff should wear appropriate
PPE)
o A potential carcinogen
o Do not mix with chlorine (can produce dangerous gas)
 Cont…
• Glutaraldehyde 2-4%
o Less irritating but still needs to in well ventilated area
• Hydrogen peroxide 6%
o Highly corrosive and should not be used to disinfect
copper, aluminum and zinc
o Loses potency rapidly when exposed to heat and light,
Note
o Chemical disinfectants should be stored in a cool, dark area,
o Never store chemicals in direct sunlight or in excessive heat