Epidemiology and

infection prevention
Presented by-
Mrs. Khushnasib
Associate Professor
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.
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
 Directly:
◦ From person to person
◦ Through respiratory droplets (for example, coughing or
sneezing)
◦ Through body fluids
◦ Direct exposure to infectious agent in environment
◦ During childbirth from mother to foetus
(transplacental/perinatal)
 Indirectly:
◦ Biological - Vector or Intermediate host (for
example; Zika Virus)
◦ Mechanical - Vector or Vehicle (for example;
Plague - transmission of Yersinia Pestis by fleas)
◦ 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)
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 yet effective
infection prevention and control reduces
healthcare-associated infections by at least
30%. In a healthcare setting, the three
components required for infection spread are
the following:
 Source - places where infectious agents
survive (e.g. sinks, hospital equipment,
countertops, medical devices).
◦ Environment - patient care areas, sinks, hospital
equipment, countertops, medical devices.
◦ 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].
◦ 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
◦ Touch, including via medical equipment or a
susceptible person (for example, MRSA or VRE)
◦ Sprays or splashes (for example, Pertussis)
◦ Inhalation of aerosolised particles (for example, TB
or Measles)
◦ 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. 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:
 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.
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. 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.
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].
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
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
 Improving the communication between health care workers
especially when referring potentially contagious patients
 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
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
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
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
 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.
 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.
 The "
Executive Summary of the Minimum Requirem
ents 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
 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.
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:
 Education - There is a strong link between health
and education.
 Social Protection - Access to affordable healthcare
and some form of social security system can also
determine the health and behaviours in a community[
 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