Infection prevention and control

Dr. Nessren Farouk

Lecturer of public health and
community medicine
Infection
This refers to the entry and development or multiplication
of an infectious agent in the human (or, animal) body, with
an implied response (e.g. immunological response) on the
part of the human or animal.
It must be remembered that “infection” by itself does not
mean “infectious disease”.

Infectious disease
An infectious disease is that part of the spectrum of
“infection” which is clinically apparent.
 Infection Control

• The process by which health care facilities

develop and implement specific policies and

procedures to prevent the spread of infections

among health care staff and patients

 Why Infection Control?
• infection is the leading cause of preventable
death in hospital every year
• the CDC estimate that there are approximately 2
million preventable Infections in hospital every
year leading to 90,000 unnecessary deaths
 Hospital acquired infections are a common
problem—prevalence about 9%
 Hospital acquired infections contribute to AMR
 Overuse of antimicrobials (development)
 Poor infection control practices (spread)
 Why Infection Control?
 Hospital-acquired infections increase the cost
of health care
 World Bank studies have shown that two-
thirds of developing countries spend more
than 50% of their health care budgets on
hospitals
 Effective IC programs are beneficial
 They decrease spread of nosocomial
infections, morbidity, mortality, and health
care costs
• Knowing the chain of infection helps
identify effective points to prevent
disease transmission.
Chain of infection
 What is an infection prevention and
control program?

• IPC programs include activities, procedures and policies

designed to reduce the spread of infections, usually within
healthcare facilities.

• The primary goals of an IPC program are:

To prevent susceptible patients acquiring pathogenic

(disease-causing) micro-organisms

To limit the spread of antimicrobial resistant infections.

 infection prevention and control committee
• An IPC committee is a multi-disciplinary group of healthcare
facility staff
Goal—
 To prevent the spread of infections within the health care
facility

Functions—
 Addressing food handling, laundry handling, cleaning
procedures, visitation policies, and direct patient care
practices
 Obtaining and managing critical bacteriological data and
information, including surveillance data
infection prevention and control committee

Functions (cont.,)
 Developing and recommending policies and
procedures pertaining to infection control
 Recognizing and investigating outbreaks of
infections in the hospital and community
 Intervening directly to prevent infections
 Educating and training health care workers,
patients, and nonmedical caregivers
 Infection Control Committee
Membership
 Doctors
 General physician
 Infectious disease specialist
 Surgeon
 Clinical microbiologist
 Infection control nurse
 Representatives from other relevant departments
 Laboratory
 Housekeeping
 Pharmacy and central supply
 Administration
 infection prevention and control team

• Ideally, an IPC team is made up of an IPC

doctor and one or more IPC nurse
practitioners, however, in some countries
the IPC nurse practitioners function on
their own. Preferably, an IPC doctor should
be trained in infectious diseases, medical
microbiology, public health or related
specialties.
 Some Standards of Hospital Hygiene
• The hospital environment must be visibly clean, free from dust
and spoilage, and acceptable to patients, visitors and staff.
• Increased levels of cleaning, including the use of hypochlorite
and detergent, should be considered in outbreaks where the
pathogen survives in the environment and environmental
contamination may contribute to spread.
• Shared equipment in the clinical environment must be
decontaminated appropriately after each use.
• All healthcare workers need to be aware of their individual
responsibilities for maintaining a safe environment for patients
and staff.
• Regular cleaning will not guarantee complete elimination of
microorganisms, so hand decontamination is required.
There are 2 tiers of recommended precautions to
prevent the spread of infections in healthcare
settings:
Standard Precautions and Transmission-Based
Precautions.
 Standard Precautions
• Apply to all patients
• Integrate and expand Universal Precautions
to include organisms spread by blood and
also
–Body fluids, secretions, and excretions
–Non-intact (broken) skin
–Mucous membranes
 Standard Precautions
• Basic level of infection control to be used in the care of all
patients
• Key components
– Hand hygiene
– Use of PPE (gloves, face protection, gown)
– Safe injection practices
– Respiratory hygiene and cough etiquette
– Safe handling of contaminated equipment and surfaces in the
patient environment
– Environmental cleaning
– Handling and processing of used linens
– Proper waste management
 1.Hand Hygiene
• Wash Hands
– Immediately after arriving for work
– Always after handling healthcare waste
– After removing gloves and/or coveralls
– After using the toilet or before eating
– After cleaning up a spill
– Before leaving work
Types of hand washing :
(A) Routine Hand Washing
The aim of routine hand washing with soap and warm water is to remove dirt
and organic material, dead skin and
most transient organisms.
:(B) Antiseptic Hand Hygiene
Used During outbreaks of infection where contact with blood/body fluids or
situations where microbial contamination is likely to occur.
In “high” risk areas e.g. isolation, ICU etc.
Before/after performing an invasive procedure.
Before/after wound care, urethral or IV catheters etc.
(C) Surgical Hand Hygiene
requires the removal and killing of transient micro-organisms and reduction
of the resident flora of the surgical team for the duration of the operation, in
case a surgical glove is punctured. Ensure that fingernails are kept short and
clean. Wrist watches and jewellery MUST be removed before surgical hand
disinfection.
 Hand Hygiene
• Steps in hand washing
– Wet hands and apply soap
– Work up lather on palms, back
of hands, sides of fingers, and
under fingernails
– Scrub vigorously with soap for
at least 20 seconds
– Rinse well
– Dry with a clean towel or allow
to air dry
Hand Hygiene Technique with Soap and Water
Recommended Duration: 40-60 seconds
Hand Hygiene Technique with Alcohol-Based Formulation
Recommended Duration: 20-30 seconds
2.Personal Protective
Equipment
 Personal Protective
Equipment

• A major component of Standard Precautions

• Protects the skin and mucous membranes
from exposure to infectious materials in
spray or splash
• Should be removed when leaving treatment
areas
 Masks, Protective Eyewear, Face Shields
• Wear a surgical mask and either eye protection
with solid side shields or a face shield to protect
mucous membranes of the eyes, nose, and
mouth
• Change masks between patients
• Clean reusable face protection between
patients; if visibly soiled, clean and disinfect
 Protective Clothing
• Wear gowns, lab coats, or
uniforms that cover skin and
personal clothing likely to
become soiled with blood,
saliva, or infectious material
• Change if visibly soiled
• Remove all barriers before
leaving the work area
 Gloves
• Minimize the risk of health care personnel
acquiring infections from patients
• Prevent microbial flora from being transmitted
from health care personnel to patients
• Reduce contamination of the hands of health
care personnel by microbial flora that can be
transmitted from one patient to another
• Are not a substitute for hand washing!
 Recommendations for Gloving

• Wear gloves when contact with

blood, saliva, and mucous
membranes is possible
• Remove gloves after patient
care
• Wear a new pair of gloves for
each patient
 Recommendations for Gloving

Remove gloves that

are torn, cut or punctured

Do not wash, disinfect

or sterilize gloves for reuse
3-Prevention of needle stick injuries:
Use care when:

- Handling needles, scalpels, and other sharp

instruments or devices.
- Cleaning used instruments.
- Disposing of used needles.
4-Disinfection and sterilization policies:
 Cleaning
• The most basic measure for maintaining
hygiene in a healthcare facility
• Cleaning is the physical removal of visible
contaminants such as dirt without necessarily
destroying microorganisms
• Thorough cleaning with soaps and detergents
can remove more than 90% of microorganisms
 Sterilization and Disinfection
• Sterilization – rendering an object free from
microorganisms; shown by a 99.9999% reduction of
microorganisms
• High-level disinfection – destruction of all
microorganisms except for large numbers of bacterial
spores
• Intermediate disinfection – inactivation of
Mycobacterium tuberculosis, vegetative bacteria, most
viruses and fungi, but not bacterial spores
• Low-level disinfection – destruction of most bacteria,
some viruses and fungi, but no resistant microorganisms
such as tubercle bacilli or bacterial spores
 Methods for Sterilization and Disinfection
• Autoclaving – use of steam under pressure (moist
heat(
• Dry heat – relatively slow and requiring higher
temperature compared to moist heat
• Use of chemical Sterilizers and disinfectants
• Others: low-temperature plasma with hydrogen
peroxide gas, radiation sterilization, germicidal
ultraviolet irradiation
 Main Chemical Disinfectants
Agent Spectrum Uses Advantages Disadvantages
Alcohols Low to • Used for some semi critical and • Fast acting • Volatile, flammable, and
intermediate-level noncritical items (e.g. oral and irritant to mucous
(60–90%) including ethanol • No residue
disinfectant rectal thermometers and membranes
or isopropanol
stethoscopes) • No staining
• Inactivated by organic
• Used to disinfect small surfaces • Low cost matter
such as rubber stoppers of multi- Readily
• • May harden rubber, cause
dose vials available in all glue to deteriorate, or crack
• Alcohols with detergent are safe countries acrylate plastic
and effective for spot disinfection
of countertops, floors and other
surfaces

Chlorine and chlorine Low to high-level • Used for disinfecting tonometers • Low cost, fast • Corrosive to metals in high
compounds: the most disinfectant and for spot disinfection of acting concentrations (>500 ppm)
widely used is an aqueous countertops and floors
• Readily • Inactivated by organic
solution of sodium
• Can be used for decontaminating available in material
hypochlorite 5.25–6.15%
blood spills most settings
(house bleach) at a • Causes discoloration or
concentration of 100–5000 • Concentrated hypochlorite or • Available as bleaching of fabrics
ppm free chlorine chlorine gas is used to disinfect liquid, tablets
• Releases toxic chlorine gas
large and small water- or powders
when mixed with ammonia
distribution systems such as
dental appliances, hydrotherapy • Irritant to skin and mucous
tanks, and water-distribution membranes
systems in haemodialysis centres Unstable if left uncovered,
•
exposed to light or diluted;
store in an opaque
container

Agent
Aldehydes
glutaraldehyde: ≥2%
aqueous solutions buffered
to pH 7.5–8.5 with sodium
bicarbonate
There are novel
glutaraldehyde formulations
Peracetic acid 0.2–0.35% High-level disinfectant/
and other stabilized organic sterilant
Orthophthalaldehyde
(OPA) 0.55%
Main Chemical Disinfectants
Spectrum Uses
High-level disinfectant/ • Most widely used as high-level
sterilant disinfectant for heat-sensitive semi
critical items such as endoscopes
(for 20 minutes at 20 °C)
• Used in automated endoscope
reprocessors
• Can be used for cold sterilization of
heat-sensitive critical items (e.g.
haemodialysers)
• Also suitable for manual instrument Environment friendly by-
processing (depending on the
formulation)
High-level disinfectant/ • High-level disinfectant for
sterilant endoscopes
Advantages
• Good material
compatibility
Rapid sterilization cycle time at •
low temperature (30–45 min. at
50–55 °C)
Active in presence of organic
matter
products (oxygen, water, acetic
acid)
Excellent stability over wide pH
range, no need for activation
Superior mycobactericidal
activity compared to
glutaraldehyde
Does not require activation
Disadvantages
• Allergenic and its fumes are irritating to
skin and respiratory tract
• Causes severe injury to skin and mucous
membranes on direct contact
• Relatively slow activity against some
mycobacterial species
• Must be monitored for continuing efficacy
levels
Corrosive to some metals
• Unstable when activated
• May be irritating to skin, conjunctive and
mucous membranes
• Expensive
• Stains skin and mucous membranes
• May stain items that are not cleaned
thoroughly
• Eye irritation with contact
May cause hypersensitivity reactions in bladder
cancer patients following repeated exposure to
manually processed urological instruments
• Slow sporicidal activity
• Must be monitored for continuing efficacy
levels
 Main Chemical Disinfectants
Agent
Hydrogen peroxide 7.5%
Hydrogen peroxide 7.5% and
peracetic acid 0.23%
Glucoprotamin
Phenolics
Iodophores (30–50 ppm free iodine)
Spectrum Uses Advantages Disadvantages
High-level disinfectant/ • Can be used for cold sterilization of heat- No odour • Material compatibility
sterilant sensitive critical items concerns with brass, copper,
Environment friendly by- zinc, nickel/silver plating
• Requires 30 min at 20 °C products (oxygen, water)
High-level disinfectant/ • For disinfecting haemodialysers Fast-acting (high-level • Material compatibility
sterilant disinfection in 15 min) concerns with brass, copper,
zinc and lead
No activation required
• Potential for eye and skin
No odour damage
High-level disinfectant • Manual reprocessing of endoscopes Highly effective against • Lack of effectiveness against
mycobacteria some enteroviruses and
• Requires 15 min at 20 °C spores
High cleansing
performance
No odour
Low to intermediate- • Have been used for decontaminating Not inactived by organic • Leaves residual film on
level disinfectant environmental surfaces and non-critical matter surfaces
surfaces
• Harmful to the environment
• Should be avoided
• No activity against viruses
• Use in nurseries should be
avoided due to reports of
hyberbilirubinemia in infants
Low-level disinfectant • Have been used for disinfecting some non- Relatively free of toxicity or • Inactivated by organic matter
critical items (e.g. hydrotherapy tanks); irritancy
however, it is used mainly as an antiseptic (2– • Adversely affects silicone
3 ppm free iodine) tubing
Phenolics • May stain some fabrics
•
5-Respiratory hygiene and cough etiquette:
Persons with respiratory symptoms should
apply source control measures:
cover their nose and mouth when
coughing/sneezing with tissue or mask, dispose
of used tissues and masks, and perform hand
hygiene after contact with respiratory
secretions.
 6-Environmental cleaning:

Use adequate procedures for the routine

cleaning and disinfection of environmental and
other frequently touched surfaces
7-Linens:
Handle, transport, and process used linen in a manner which:
1- prevents skin and mucous membrane exposures and
contamination of clothing.
2- avoids transfer of pathogens to other patients and or the
environment.
8-Waste disposal:
1- Ensure safe waste management.
2- Treat waste contaminated with blood, body fluids,
secretions and excretions as clinical waste, in accordance with
local regulations.
3- Human tissues and laboratory waste that is directly associated
with specimen processing should also be treated as clinical
waste.
4- Discard single use items properly.
9-Patient care equipment:
-Handle equipment soiled with blood, body
fluids, secretions, and excretions in a manner
that prevents skin and mucous membrane
exposures, contamination of clothing, and
transfer of pathogens to other patients or the
environment.
-Clean, disinfect, and reprocess reusable
equipment appropriately before use with
another patient.
10-Isolation policies :
• place patient in a single room and if a single room is unavailable
then place the patient with other patient with the same
infection.
• Use personal protective equipment.
• Limit patient transport outside the room.
• Handle patient-care equipment and instruments according to
standard precautions.
• Ensure that rooms of patients are prioritizing for frequent
cleaning and disinfection.
• For airborne infections , susceptible healthcare personnel should
be restricted from entering the room for patients with measles if
they exposed , they should be vaccinated.
Places of isolation:
1- quarantine station: diseases under
international regulation such as cholera and
plaque.
2- fever or infectious hospitals: endemic
diseases such as hepatitis and T.B.
3- at home but under certain circumstances for
mild conditions.
 Transmission based precautions
• Transmission-Based Precautions are the second
tier of basic infection control and are to be used
in addition to Standard Precautions for patients
who may be infected or colonized with certain
infectious agents for which additional
precautions are needed to prevent infection
transmission.
 Transmission-Based Precautions
• Additional precautions used when routes of transmission are
not completely interrupted by Standard Precautions
• Three categories of transmission-based precautions
1. Contact Precautions – e.g. for E. coli O157:H7, Shigella spp. Hepatitis A
virus, C. difficile, abscess draining, head lice
2. Droplet Precautions – e.g., for 2019 Novel Coronavirus, Neisseria
meningitidis, seasonal flu, pertussis, mumps, Yersinia pestis pneumonic
plague, rubella
3. Airborne Precautions – e.g., for M. tuberculosis, rubeola virus
• Combined precautions, e.g.
– Airborne and contact precautions for varicella zoster, methicillin-
resistant S. aureus (MRSA), severe acute respiratory syndrome virus
(SARS-CoV), avian influenza
– Contact and droplet precautions for respiratory syncytial virus
 Measures for Improving Infection Control
Wasteful practices that should be eliminated:
• routine swabbing of health care environment to
monitor standard of cleanliness
• routine fumigation of isolation rooms with
formaldehyde
• routine use of disinfectants for environment cleaning,
e.g. floors and walls
• inappropriate use of PPE in intensive care units,
neonatal units and operating theatres
 Measures for Improving Infection Control
Wasteful practices that should be eliminated (cont.,)
• use of overshoes, dust attracting mats in the operating
theatres, intensive care and neonatal unit
• unnecessary intramuscular and intravenous (IV)
injections
• unnecessary insertion of invasive devices (e.g. IV lines,
urinary catheters, nasogastric tubes(
• inappropriate use of antibiotics for prophylaxis and
treatment
• improper segregation and disposal of clinical waste.
Measures for Improving Infection Control
No-cost measures: using good infection-control
practices:
• use aseptic technique for all sterile procedures
• remove invasive devices when no longer needed
• isolate patients with communicable diseases or a
multidrug-resistant organism on admission
• avoid unnecessary vaginal examination of women in
labour
• minimize the number of people in operating theatres
• place mechanically ventilated patients in a semi-
recumbent position.
Measures for Improving Infection Control
Low-cost measures: cost-effective practices:
• provide education and practical training in standard
infection control (e.g. hand hygiene, aseptic
technique, appropriate use of PPE, use and disposal
of sharps)
• provide hand-washing material throughout a health-
care facility (e.g. soap and alcoholic hand
disinfectants)
• use single-use disposable sterile needles and syringes
• use sterile items for invasive procedures
Measures for Improving Infection Control
Low-cost measures: cost-effective practices (cont.,)
• avoid sharing multi-dose vials and containers between
patients
• ensure equipment is thoroughly decontaminated
between patients
• provide hepatitis B immunization for health-care
workers
• develop a post-exposure management plan for health-
care workers
• dispose of sharps in robust containers.
 r
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THANK YOU