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Infection Prevention and Control

Introduction
According to the World Health Organization (WHO), infection prevention and
control (IPC) is a scientific approach and practical solution designed to
prevent harm caused by infection to patients and health workers. It is a subset
of epidemiology, but also serves an essential function in infectious diseases ,
social sciences and global health [1].

Effective IPC is a public health issue that is fundamental in patient safety and
health system strengthening. The prevention of healthcare-associated
infections (HAI), epidemics (including the 2013-2016 Ebola virus disease
outbreak), and pandemics of international concern (For Example; 2009 flu
pandemic and the coronavirus disease 2019 ) are rooted in effective IPC
measures[2]. A guiding principle on WHO's Core Components of IPC is that
"access to health care services designed and managed to minimise the risks of
avoidable HAI for patients and health care workers is a basic human right" [2].

Strengthening global IPC is essential to combat HAI, antimicrobial resistance,

and to respond to disease outbreaks. A study published in 2021 looked at the
WHO's Core Components of IPC and found that most participating countries
have IPC programmes and guidelines in place, however few have set aside the
necessary resources to support the programmes. There is a need to move from
the planning stage into the implementation and monitoring stages,
particularly in low-income countries [3].
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Infection Prevention and Control

The Spread of Infectious Disease

An infection is defined as the successful transmission of pathogenic
microorganisms, such as bacteria, viruses, parasites or fungi that are spread: [4]
[5] [6] [7]

 Directly:
o From person to person
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Infection Prevention and Control

o Through respiratory droplets (for example, coughing or sneezing)
o Through body fluids
o Direct exposure to infectious agent in environment
o During childbirth from mother to foetus
(transplacental/perinatal)

 Indirectly:
o Biological - Vector or Intermediate host (for example; Zika Virus)
o Mechanical - Vector or Vehicle (for example; Plague -
transmission of Yersinia Pestis by fleas)
o Airborne (for example, Tuberculosis)

Epidemiological Triad

In humans, infections occur when an infectious microorganism enters the

body, multiplies, and leads to a reaction in the body and potential infectious
disease. The spread of infectious disease requires three variables, known as
the epidemiological triad [8]:

 The Agent - The microorganism that causes the infection and can be in
the form of bacteria, viruses, parasites or fungi
 The Host - The target of the disease
 The Environment - The surroundings and conditions (these are external
to the host)

[9]

Infection Spread in Healthcare

Healthcare facilities, whether hospitals or primary care clinics are an area

with an elevated risk of disease transmission due to the presence and relative
ratio of susceptible individuals. One in ten patients get an infection whilst
receiving care [10] yet effective infection prevention and control reduces
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Infection Prevention and Control

healthcare-associated infections by at least 30% [10]. In a healthcare setting, the
three components required for infection spread are the following [11]:

 Source - places where infectious agents survive (e.g. sinks, hospital

equipment, countertops, medical devices).
o Environment - patient care areas, sinks, hospital equipment,
countertops, medical devices.
o People - patients, healthcare workers, or visitors.

 Susceptible Person - Someone (Patient, Healthcare Worker, or

Visitor) who is not vaccinated or immune to a particular infectious
disease, or an individual with a compromised immune system /
immunodeficient [11].
o In addition, susceptibility can be heightened in individuals due to
underlying medical conditions, medications, and necessary
treatments and procedures that increase the risk of infection (for
example, surgery).

 Transmission - The way germs are moved to the susceptible person

o Touch, including via medical equipment or a susceptible person
(for example, MRSA or VRE)
o Sprays or splashes (for example, Pertussis)
o Inhalation of aerosolised particles (for example, TB or Measles)
o Sharps injuries introducing blood-borne pathogens (for
example, HIV, HBV, HCV)

Controlling Infectious Diseases Within Communities

Infection control and prevention is a global issue and there are many
protocols and guidelines that can be followed to minimise the spread
of infection between people, within a population and globally [2]. Identifying at-
risk groups such as children, older people and those with chronic conditions
can also help guide relevant strategies to protect these vulnerable groups. The
first step when looking at infection control can start at the community level by
changing behaviour, including:
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Infection Prevention and Control

 Regular hand washing
 Appropriate use of Face-masks (protect from and prevent spread of
respiratory infections)
 Using insect repellents
 Ensuring up-to-date routine vaccinations and participating in
immunisation programmes
 Taking prescribed medications, such as antibiotics, as directed by health
professionals
 Social distancing - avoiding contact with others
 Using condoms when having sex, especially with a new partner

Other steps that can be taken to control the spread within communities
include environmental measures such as:

 Modifying environments
 Surveillance of diseases
 Food safety
 Air quality

Medical Interventions
As well as simple steps to prevent and control infections, there are
biochemical interventions that can be implemented to speed up the recovery
process and in some cases prevent viral infections completely. [12] The
development of antibiotics, antivirals and vaccinations have been shown to
speed up recovery, slow down the progression and in some cases eradicate
infectious diseases from entire populations.

Antibiotics

Antibiotics are prescribed for bacterial infections and support the body's
natural defence system to eliminate the disease-causing bacterial agent. They
are designed to either kill bacteria or stop them from reproducing. However,
poor use of antibiotics, over-prescribing and the mutation of bacteria has led
the development of resistant bacteria [13]. In these cases, either stronger doses
are required or the combination of one or more antibiotics.
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Vaccinations

Vaccinations are designed to improve immunity to a particular disease.

Vaccines work by introducing small amounts of the disease-causing virus or
bacteria into the host, allowing them to build up natural immunity. The
introduction of regular vaccines have slowed down and in some cases
eradicated certain diseases such as polio, measles, mumps, whooping cough
and rubeola (measles). There are also vaccinations for chickenpox, but this is
not given routinely and is reserved for those at risk of spreading the disease to
those with a weakened immune system [14]. This is due to the fact that it is
prevalent in children under 10 years of age and symptoms are usually mild;
this method allows them to build up natural immunity and contributes to
improving the immunisation of a community [15]. This type of protection is
known as herd immunity[16].

Antivirals

Antibiotics provide no defence for infectious diseases that are caused by viral
agents such as influenza, HIV, herpes, and hepatitis B. In these cases,
antiviral medications are the most effective at slowing down the progression
of the disease and boosting the immune system. Unfortunately, as with
antibiotics, viruses can mutate over time and become resistant to these
antiviral drugs [13].

Infection Control in Healthcare Facilities

Another important factor in controlling and preventing infection is by

improving practices in healthcare facilities. It is the duty of healthcare
professionals worldwide to ensure they develop strategies and implement
policies that protect those who may be immunocompromised in order to keep
susceptible patients safe from healthcare-associated infections (HAIs).
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Globally, up to 7% of patients in developed and 10% in developing countries
will acquire at least one HAI [2][17].

HAIs are one of the most common detrimental effects in care delivery and
both the endemic burden and the occurrence of epidemics are a major public
health concern. HAIs have a significant impact on morbidity, mortality [18] and
quality of life and present an economic burden at the societal level. However,
a large proportion of HAI are preventable and there is a growing body of
evidence to help raise awareness of the global burden of harm caused by these
infections, including strategies to reduce their spread [11].

[19]

Steps to Improve Infection Control

There are two tiers of recommended precautions by the Center of Disease

Control and Prevention (CDC) [20] to prevent the spread of infections in
healthcare settings: (1) Standard Precautions and (2) Transmission-
Based Precautions [21][6].

Standard Precautions for All Patient Care:

 Perform hand hygiene [22][23][24]

 Use personal protective equipment (PPE) to prevent exposure to
infection
 Follow respiratory hygiene/cough etiquette principles
 Ensure appropriate patient placement and isolation precautions [25]
 Properly handle, clean, and disinfect patient care equipment and
medical instruments
 Handle and sterilise textiles and laundry carefully
 Follow safe injection practices and proper handling of sharps/needles
 Ensure healthcare worker safety via IPC and post-exposure prophylaxis
 Prevention of intervention-related infections (catheter-associated
urinary tract infections, intravascular catheter-related infections,
surgical site infections)
 The implementation of the specific isolation precaution when
diagnosing some syndromes [25]
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Infection Prevention and Control

 Improving the communication between health care workers especially
when referring potentially contagious patients [26]
 In paediatric departments or ambulatory settings, there should be
efforts to decrease infection from contaminated toys. Families can be
encouraged to bring their own toys [26]

Transmission-Based Precautions

Transmission-Based Precautions [27] used in addition to Standard Precautions

for patients with infectious disease to prevent transmission:

 Contact precautions
 Droplet precautions
 Airborne precautions

[28]

Further details and guidelines for transmission-based and isolation

precautions are provided by the Centers for Disease Control and Prevention
(CDC):

 Transmission-Based Precautions: Centers for Disease Control and

Prevention

Infection Control Programmes in Acute Care

The CDC[29] suggest that the assessment and management of infection control
programmes and practices in acute care hospital can be divided into 4
sections:

 Section 1: Facility Demographics

 Section 2: Infection Control Programme and Infrastructure
 Section 3: Direct Observation of Facility Practices (optional)
 Section 4: Infection Control Guidelines and Other Resources
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They have produced a "Infection Prevention and Control Assessment Tool for
Acute Care Hospitals " that is intended to assist in the assessment of infection
control programmes and practices in acute care hospitals.

Environmental Cleaning and Disinfection

Evidence supports the important role of environmental cleaning in controlling

the transmission of organisms (e.g.Staphylococcus Aureus, Vancomycin-
resistant Enterococci, Norovirus, Clostridium Difficile and Acinetobacter),
especially in hospitals and healthcare settings. [30]

If an individual with a suspected or confirmed case of infectious disease has

attended your clinic, all surfaces that the person has come into contact with
must be cleaned.

 The room where they were placed/isolated should not be cleaned or

used for one hour and the door to the room should remain shut.
 The person assigned to clean the room should wear gloves (disposable
single-use nitrile or household gloves) and a disposable apron (if one is
available) then physically clean the environment and furniture using a
household detergent solution followed by a disinfectant or combined
household detergent and disinfectant, for example, one that contains a
hypochlorite (bleach solution) [31]. Products with these specifications are
available in different formats including wipes.
 No special cleaning of walls or floors is required.
 Pay special attention to frequently touched flat surfaces, backs of chairs,
couches, door handles or any surfaces that the affected person has
touched.
 Discard waste (including used tissues, disposable cleaning cloths) into a
healthcare risk waste bag (yellow).
 Remove the disposable plastic apron (if worn) and gloves and discard
into a healthcare risk waste bag.
 If a healthcare risk waste bag is not available, place the waste in a small
household waste bag and tie securely. Do not overfill. Then place the
bag in a second household waste bag and tie securely. Store in a safe
location. If the case is not confirmed the waste can be disposed of as per
usual. If a case is confirmed public health will then advise you what to
do with the waste.
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Infection Prevention and Control

 Once this process has been completed and all surfaces are dry the room
can be put back into use.

Infection Control Programmes Globally

The WHO Guidelines [2] on the Core Components of IPC Programmes at the
national and facility level aim to enhance the capacity of countries to develop
and implement effective technical and behaviour modifying interventions.
They form a key part of WHO strategies to prevent current and future threats
from infectious diseases such as Ebola, strengthen health service resilience,
help combat antimicrobial resistance (AMR) and improve the overall quality
of health care delivery. They are also intended to support countries in the
development of their own national protocols for IPC and AMR action plans
and to support health care facilities as they develop or strengthen their own
approaches to IPC.

[32]

The "Executive Summary of the Minimum Requirements by Core Component "

provides a good summary to present and promote the minimum requirements
for IPC programmes at the national and health care facility level, identified by
expert consensus according to available evidence and in the context of the
WHO core components.

Infection Control in Disaster and Conflict Settings

The principles of IPC remain of paramount importance in emergency settings
in order to protect yourself and your patients. This is especially important
given the unsanitary conditions post-disaster and conflict in camps, which can
create a perfect storm for infection, both for infectious diseases and wound
infection. With a high incidence of complex, open traumatic injuries requiring
surgery performed in sub-optimal surgical environments, there comes an
increased risk of wound infection, which is further exacerbated by limited
access to resources including clear (potable) water and medical consumables,
creating significant challenges for rehabilitation professionals in many
disaster and conflict settings. [33]
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Infection Prevention and Control

When working in an area where infectious diseases (e.g. cholera,
diphtheria, Ebola, Middle East Respiratory Syndrome (MERS)) are an
identified risk, additional IPC precautions will be in place. Make sure that you
have had specific training and have been provided with additional PPE as
required.[33]

Improving Social Determinants

Another important factor to consider in the control of infectious diseases is to
address and improve social determinants of health within societies. There is a
direct link between a person's health and their environment. WHO has
identified three "common interventions" for improving health conditions
worldwide[34]:

 Education - There is a strong link between health and education [35].

 Social Protection - Access to affordable healthcare and some form of
social security system can also determine the health and behaviours in a
community[36].
 Urban Development - How our villages, towns and cities are designed
can have a big impact on health and the spread of diseases. Living in
overcrowded environments or in housing that is damp and/or that does
not have adequate facilities and sanitation can increase the spread of
infectious diseases [37].

Conclusion
There is no one solution to controlling the spread of infectious diseases, and
effective IPC indeed requires government intervention and collaboration
between healthcare agencies, individuals and communities. Until certain risk
factors are addressed and behaviours modified, the war against infectious
diseases will continue to be a predominant and costly health issue around the
world.

Resources
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Infection Prevention and Control

The following resources expand further on the four sections mentioned above:

 Infection Control Assessment Tools (2019) - CDC

 IPAC Checklist for Clinical Office Practice: Core Elements (2019) -
Public Health Ontario
 National infection prevention and control (2022) - NHS