Infection ControlThe What, Why, Who, How and When

Sejojo Phaaroe

ABOUT 80% OF INFECTIONS RUMAGING THE DEVELOPING WORLD ARE PREVENTABLE

THE PREVENTION OF INFECTIONS IS CRITICAL

Brief History of Infection Control

History of Infection Control• Despite great achievements in medical

treatments and procedures, infections have emerged that are still of great challenge to mankind e.g. HIV

• There has been a paradigm shift from treatment to prevention of diseases worldwide

Presentation Outline

• What : Definitions• Why practice IPC• How to do IPC• Who is responsible and what are the

roles? Team effort• When to practice IPC

The WhatDefinitions

• Microorganisms are part of the normal environment. No human, animal or object are without them.

• We normally live in symbiosis with them but sometimes – We lose resistance– They become more virulent

Infection vs Communicable DiseaseAn Infection is an infestation of a host (e.g. a person) by a

disease-causing organism. This infestation brings about an Infectious disease.

The organism can be:• Bacteria• Viruses• Parasites• FungiA Communicable Disease is an infectious disease that

can be transmitted from one person to another.A Nosocomical Infection is an infection acquired from a

health facility

The chain of Infection

Airborne Lifestyle

Patient Contact NutritionStaff AgeEquipment DiseaseVisitors

Susceptible Host

Source of infection

Transmission Route

• The aim of Infection Control is to establish and maintain a safe environment of the highest possible level for staff and patients with available resources by Breaking the chain of infection.

• This is achieved by breaking the chain of infection at any stage (preferably at the source)

Why The need to practice Infection

Prevention and Control

Why do we need IPC? (2)1. Hospital –acquired infections are a common

problem and increase the cost of health care– World Bank: 2/3 of developing countries spend

50% of the health budgets on diseases that are preventable

2. In a health facility there is a high population of staff, patients and /or visitors

– Immune suppressed, infected or with other vulnerabilities

Why do we need IPC? (1)3. There is a high level of activity in HCFs: – Flow of people, equipment and provision in

and out of wards4. Technological developments e.g people

hardly leave a hospital without blood sampling

5. Unwise use of Antibiotics and antiseptics:– May lead to the emergence of new strains of

microbes which may be resistant to current treatment regimes

The HowMeasures for IPC

PRECAUTIONS• There are four forms of precaution :1.Standard: The most basic precautions for the

safety of staff and patients regardless of the diagnosis or infection status of the patient

2.Airborne: For specific cases like TB3.Droplet; precautions for illnesses caused by

large droplet particles4.Contact: For prevention of infections caused by

direct or indirect contact

STANDARD PRECAUTIONS (1)

1. Hand washing: with warm running water and soap after handling body fluids and secretions regardless of wearing gloves.– One of the basic elements for hygiene– One of the cheapest of the precautions

STANDARD PRECAUTIONS (2)

2. Wearing clean gloves when handling body fluids, intact skin, contaminated items etc

3. Wearing masks and eye protection when appropriate e.g. Envisaged body fluid splashes and inhalation of hazardous materials

4. Proper handling and storage of clean and soiled equipment to avoid cross contamination.

5. Practicing the safe management of Healthcare waste

2. Airborne Precautions

1. Wearing of masks2. Isolation of relevant patients3. Appropriate ventilation of isolation

rooms/wards and patient waiting rooms4. Minimal movement of infected patients

3. Droplet Precautions

1. Wearing of masks2. Isolation of relevant patients3. Appropriate ventilation of isolation

rooms/wards and patient waiting rooms4. Minimal movement of infected patients

4. Contact Precautions

• Wearing a mask where appropriate• Wearing Personal Protective Clothing to

ensure contact with body fluids and secretions is eliminated

• Practise safe management of Healthcare waste

In summary• Hand hygiene• Personal protective Clothing• Isolation of patients• Provision of safe food and water• Proper HCW management• Ensuring a clean environment (including

surfaces)• Cleaning and disinfection of equipment• Employee health and training programme

Barriers to adhering to Precautions

• Lack of role models or role model facilities

• Lack of reward for compliers• Lack of institutional priority• Inadequate involvement of staff

Factors of poor adherence

• Lack of knowledge• Lack or inadequacy of requirements e.g.

Soap and paper towels for hand washing• Forgetfulness• Low staffing • Overcrowding• Lack of evidence based knowledge

The WhoResponsibilities for IPC

• IPC is not delegated to any person in particular in the HCF. It is a team effort and it is the responsibility of both medical and non-medical staff.

Functions of the IPC Committee

• Surveillance of IPC in the facility• Supervision of the execution of the IPC policy and

guidelines• Conduction of formal and informal training in IPC• Research• Review of facility policies, guidelines and procedures• Liaison with departments on IPC• Records and reporting• Representation of facility in relevant forums• Evaluation of interventions

Personnel Responsibilities

Infection Control Officer -Knowledge of IPC national & facility policies-Assessment of infection risk and advise on patient isolation-Monitoring of procedures execution-Speedy investigation of potential outbreaksContinues personal study and empowerment-Act as resource person

Healthcare facility manager -Ensure availability of resources-Ensure availability of written commitment-Knowledge of policies

Clinical staff -Prevention of contamination of samples-Prevention of infecting patients and staff-Knowledge of policies and procedures-Prompt reporting of disparities to supervisors

Non-clinical staff -Knowledge and practice of procedures e.g. Ventilation of rooms, hand washing--Supporting clinical IPC campaigns

In conclusion

• The practice of IPC strategies is good for the health of the patients and staff but with IPC implementation there are other positive spin-offs e.g.– Team building– Better communication– Improved monitoring– More supporting supervision

When should we practice IPC?