Infection Prevention and Control
Video Transcript
Healthcare-Associated Infections: Modes of Transmission, Types, and Prevention
Introduction to Healthcare-Associated Infections: Modes of Transmission, Types, and Prevention
Modes of Transmission of HAI
Infections may be transmitted to patients and staff via various modes.
The modes of transmission of infection can be broadly classified as follows:
• Contact transmission: Transmission of disease when direct contact between the infected
and uninfected individual is called contact transmission. Examples of diseases transmitted
via direct contact include diarrheal disease and impetigo.
• Droplet transmission: Droplet transmission is another form of person-to-person
transmission via the respiratory route. Coughing or sneezing releases the droplets of infected
material, which are carried over a certain distance, and they cause infections in other
individuals who come into contact with the droplets. An example of infection transmitted by
droplet nuclei is influenza.
• Airborne Transmission: Airborne transmission occurs when infected particles of less than
five microns are released into the environment. These can remain suspended in the
atmosphere for a longer duration and cause infection in persons who inhale them. An
example of an infection transmitted by airborne transmission is tuberculosis.
• Vehicle-borne: Some diseases may be transmitted by inanimate objects that carry the
infective agent. These are called vehicles of disease transmission. For example, if a person
is pricked by a needle infected with HIV-positive blood, he can acquire the infection.
• Vector-borne: Some diseases are transmitted by living beings or insects that act as vectors.
For example, flies can transmit diarrheal illness.
Agents Causing Healthcare- Associated Infections
Infection Prevention and Control
The following flowchart explains the various agents causing healthcare-associated infections:
bacteria, fungi, viruses, and parasites.
•Bacteria include commensal bacteria like E.coli, Klebsiella, and Enterococcus. Pathogenic bacteria
include Staphylococcus aureus, pseudomonas, clostridium, and legionella.
•Blood borne viruses like HIV, Hepatitis B, Hepatitis C, Cytomegalovirus. Other modes of
transmission rotavirus, respiratory syncytial virus, influenza, and varicella-zoster virus.
•Examples of fungi include cryptococcus, candida, and aspergillus.
Types of HAI
• According to WHO, 30% of the patients under intensive care develop HAI. Pooled data from
several studies showed that 17 episodes of HAI occur per 1000 patient days among adults
under intensive care in industrialized countries. In low- and middle-income countries, a grim
figure of 42.7 episodes per 1000 patient days was noted.
• The most important healthcare-associated infections occur among patients with a central
line, a urinary catheter, or ventilators. Infections that occur among them include catheter-
associated urinary tract infections (CAUTI), central line-associated bloodstream infections
(CLABSI), and ventilator-associated events (VAE), and surgical site infections (SSI). CAUTI is
the most commonly reported HAI in developed countries, whereas SSI is the most widely
reported one in low and middle-income countries.
The following table describes the various types of HAI and their incidence in high-income countries
and low-income countries.
Prevention of HAI
• Prevention and management of healthcare-associated infections must occur in conjunction
with clinical care of the patients. It requires the coordinated effort of all personnel involved in
the patient care and the patients themselves.
Infection Prevention and Control
• An effective infection prevention and control program is the primary determinant of the
quality of healthcare delivery. Therefore, the requirements of IPC must be integrated at every
level of healthcare delivery. Prevention strategies may be categorized as vertical or
horizontal.
• Vertical approach (pathogen-specific): Vertical prevention targets a specific organism and
the infections caused by it. These strategies include active surveillance, isolation, and
decolonization.
• Horizontal approach (non-pathogen specific): The horizontal strategy of prevention targets
the transmission mode and aims to prevent infections caused by all organisms that share
the standard transmission mode.
• The methods include hand hygiene, standard precautions, universal or selective
decolonization, environmental cleaning and disinfection, and antimicrobial stewardship.
• Vertical and horizontal approaches are not mutually exclusive. However, the horizontal
approach may be cost-effective and widely appealing.
The following table explains the examples of vertical and horizontal approaches for infection
control.
The vertical approaches include
• Identification of asymptomatic carriers by active surveillance
• Isolation of colonized individuals and implementation of transmission-based or contact
precautions
• Decolonization of carriers
The horizontal approaches include
• Standard precautions
• Personal protective equipment
• Universal or selective decolonization
Infection Prevention and Control
• Antimicrobial policy
• Cleaning and disinfection of hospital environment
CDC has laid down standard definitions and diagnostic criteria for each HAI. Most guidelines for the
prevention of these infections employ ‘care bundles.’ These are a collection of practices that ensure
uniform delivery of infection control practices. Improvements in infection control strategies and
implementation of best practices in infection control require team-led performance initiatives. Each
area of care or unit requires a designated physician and nurse to champion infection control
practices and implementation of intervention bundles. A practitioner of infection prevention and
control must implement preventive measures against healthcare-associated infections and reduce
its burden.
Summary
• HAI are a serious health hazard that leads to increased morbidity and mortality, length of
hospital stay, and the costs associated with a hospital stay.
• Preventive measures, surveillance, and training are the three components of HAI.
• The various types of HAI include catheter-associated urinary tract infections (CAUTI), central
line-associated bloodstream infections (CLABSI), and ventilator-associated events (VAE),
and surgical site infections (SSI).
• CAUTI is the most commonly reported HAI in developed countries, whereas SSI is the most
widely reported one in low and middle-income countries.
