Microbiology and Immunology

Department Public Health

(PHM561/PM501/PM412n)
Fall 2024

Lecture 2:
 Healthcare-associated infections
and
Infection control
References

1. K. Park - Park’s Text Book of Preventive & Social Medicine. 1-Bhanot Publishers (2016), ISBN

9789382219057.

2. James F. McKenzie, Robert R. Pinger, Denise M. Seabert - An Introduction to Community &

Public Health- Jones & Bartlett Learning (2016) ISBN 9781284108415

3. Bernard J. Turnock - Public Health_ What It Is and How It Works (2015, Jones & Bartlett Learning)

ISBN 978- 0763754440

4. Mary-Jane Schneider - Introduction to Public Health-Jones & Bartlett Learning ISBN 978-
0763730000

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 Lecture Learning Outcomes

 By the end of the lecture, students should be able to demonstrate knowledge of:
1. Healthcare associated infections.
2. Aspects of infection prevention and control.
3. Prevention plans of specific healthcare associated infections.

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4
Healthcare-associated infection
(HAI)
 Definition: “An infection that occurs in a patient as a result of
care at a health care facility and was not present or
incubating at the time of arrival at the facility”.
 The term “health care-associated infection” replaces
the formerly used “nosocomial” or “hospital” infection
 because these infections can affect patients in any
setting where they receive health care.

• Onse On or after Day 3 of hospitalization

“Day 1 = the day of hospital
t admission”
On the day of discharge

One day after discharge

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• The major types of HAIs 2

1 3

4
5

*HCAI (Health care associated infection)

HAI Example
During the hospital stay
Tonsillitis Critical septic shock
Burden and impact of
HAIs

Why?
The true global burden is unknown Because of the difficulty in gathering reliable
data.
 It is estimated that each year, hundreds of millions of patients around the world are
affected by HAIs.

Prolonged hospital
Impact of HAIs
stays Increased resistance
of microorganisms to
antimicrobials
Long-term disability
Unnecessary deaths

Massive additional costs for

health systems and patients'
families

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 Microbiology of
HAIs
1. Characteristics of Organisms That Commonly Associated with HAIs
(may have one or more of the following characteristics):

Small and
Colonize patients can be
and staff transmitted
Thrive in short
allowing the distances Very small in
Survive Live in blood damp microorganisms through the size and
Survive on the dryness, heat, and body areas EX; to survive in the air in able to float
hands, and fluids Gram- health care respiratory long Resistant to
environmental disinfectants EX: negative environment and droplets, distances on antimicrobial
surfaces, and EX: C. difficile, hepatitis B bacteria pass from person particularly air currents. s EX;
medical some molds virus, such as to person. when EX: MRSA*.
equipment that survive by hepatitis C Acinetobacter
Ex: include propelled by varicella,
EX: S. aureus. forming virus, and and
coughing or measles,
spores HIV. Pseudomona S. aureus,
sneezing and SARS.
s spp. Enterobacteriaceae
, and EX: influenza
Enterococcus spp. and
*MRSA (Methicillin-resistant Staphylococcus aureus) N.meningitidis.

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Microbiology of
HAIs
2. Sources of Microorganisms that can cause HAIs

Endogenous Source Exogenous Sources

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Microbiology of
HAIs
2. Sources of Microorganisms that can cause HAIs
A. Endogenous source (The patient’s own body (normal flora or colonization).

Endogenous infections occur in the following conditions:

When the immune system Body defenses are

is compromised interrupted (via a wound or
medical device)

Overgrowth of some
microorganisms due to antibiotic
therapy
(such as yeast in the genital tract). 12
Microbiology of
HAIs
3. Sources of Microorganisms that can cause HAIs
B. Exogenous source “External reservoirs”

Cross infection Environmental infection

• Other patients (Direct contact with blood or other • Water, food, dust/soil, etc.
body’s fluids, respiratory droplets or unwashed
hands)
• Staff members (Contaminated or colonized hands,
clothing and skin)
• Objects (Contaminated by an infected person)

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Endogenous or Exogenous source ?
 High risk patient
groups
 Anyone can acquire an HAI while receiving care; but certain patient groups are at higher
risk than others.
 They include:

1. Newborns 2. Elderly patients 3. Immune-compromised

patients (Ex: AIDs and Cancer
patients)

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Contributing Factors for Health Care-Associated
Infections
Bed space less than 1 Low compliance with hand
High patient-to-nurse ratio
meter (3 feet) apart hygiene practices

Increasing use of invasive

Lack of resources medical and surgical
Lack of trained IPC
including rooms for procedures (e.g.,
(Infection Prevention
isolation or cohosting mechanical ventilators,
Control) practitioners and
(grouping together urinary catheters, central
limited opportunities for
patients with the same intravenous lines) without
staff training
infection). proper IPC training or
laboratory support.

Contamination of
Suboptimal cleaning (Less
prepared supplies / Antibiotic resistance due
than the higher standard),
pharmaceuticals (e.g., IV to overuse of broad-
disinfection, and
fluid, infant formula, spectrum antibiotics
sterilization practices.
general medications)
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Infection prevention and control
(IPC)
• Definition: It is a scientific approach and practical solution designed to
prevent harm caused by infection to patients and health workers.
• It encompasses evidence-based practices and procedures that, when applied
consistently in health care settings, can prevent or reduce the risk of transmission of
microorganisms to health care providers, patients, and visitors.

Infection Prevention and Control Program (IPC)

IPC Committee IPC Team IPC Manual

A multidisciplinary The team is responsible A manual
committee responsible for for the day-to-day containing
the planning, and functions of infection recommended
implementation, resource control. instructions and
allocation of all issues practices for 15
relating to IPC.
Interventions to Prevent Health Care-Associated
Infections
1. Tracking HAIs in a health care facility and sharing data with the staff and
program manager
2. Follow the general IPC practices, including:
a. Standard Precautions
b. Transmission-Based Precautions
3. Implementing interventions targeting specific HAIs

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A. Standard
Precautions
Definition:

 Standard Precautions are a set of practices that should be used in the care and
treatment of all patients, regardless of whether they are known or suspected to be
infected with a transmissible organism.

Purpose: Break the chain of infection 

Reduce the risk of transmitting
microorganisms from known or unknown
sources of infection (e.g., respiratory
droplets, contaminated objects, used
needles and syringes, and multi-dose vials)
within health care settings.
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A. Standard
Precautions
Key Components of Standard precautions:
1. Hand hygiene:
 Hand hygiene must be performed consistently as
recommended during patient care using soap
and water or alcohol-based handrub and
with a technique that effectively removes
Your 5 moments for HAND
HYGIENE
2. microorganisms from hands.
Use of Personal Protective Equipment (PPEs)
 PPE should be chosen by the health care worker
(HCW) according to the assessed risk of contact
with potentially infectious materials.

 PPE may include: Gloves, Eye protection such as

goggles, Surgical masks, Face shields, and Fluid-
resistant gowns and/or aprons.
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A. Standard
Precautions
Key Components of Standard precautions:
3. Respiratory hygiene and cough etiquette
 This prevents the spread of respiratory
secretions via droplets expelled from the
respiratory tract onto the hands and surfaces.

4. Safe injection practices:

 These practices include:
 Use aseptic technique when
preparing and
delivering injections.
 Use single-dose vials whenever possible.
 If multi-dose vials must be used, both
the needle or cannula and syringe used to
access the multi- dose vial must be sterile.
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A. Standard
Precautions
Key Components of Standard precautions:
5. Cleaning and disinfection

 Patient care equipment, instruments, devices, and environmental surfaces should be

cleaned and disinfected.

 Reusable textile items should be cleaned in a manner that removes pathogens from
the textiles and protects cleaned textiles from reintroduction of pathogens to reduce
risk for transfer of pathogens to HCWs, other patients, and the environment.
6. Waste disposal

 Dispose sharps into leak-proof, puncture-resistant

containers.
 Segregate infectious waste (contaminated with blood,
body fluids, secretions, and excretions) at the place where
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waste is generated.
B. Transmission-based
Precautions
 “Transmission-Based Precautions" are practices used for patients who are known or
suspected to be infected or colonized with those infectious agents that require additional
control measures to effectively prevent transmission of infection in health care facilities”.
 They are applied in addition to Standard Precautions when the disease transmission
cycle is not completely interrupted using Standard Precautions alone.
Empiric/Syndromic Use of Transmission-Based Precautions
 Since the infecting agent is often not known at the time of admission to a health care
facility, in addition to Standard Precautions for all patients at each encounter,
Transmission-Based Precautions are used empirically for selected patients presenting with a
relevant clinical syndrome indicating a likely infectious agent (e.g., acute onset
respiratory symptoms, diarrhea).
 Transmission-Based Precautions are then modified as needed if/when the pathogen
was identified or a transmissible infection is ruled out.

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B. Transmission-based
Precautions
 The three main modes of infection transmission are:
1. Contact
2. Droplet
3. Airborne
 There are three main types of Transmission-Based Precautions:
1. Contact Precautions
2. Droplet Precautions
3. Airborne Precautions
 An infectious microorganism can be transmitted by more than one route.
For example, the varicella virus (chicken pox) can be transmitted both by the airborne and
contact routes while the influenza virus can be transmitted by both the droplet and contact
routes.
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Important note: Diseases that have multiple routes of transmission may require
B. Transmission-based
Precautions
A. Contact Precautions
Infections that require Contact Precautions
 Varicella-zoster (Chickenpox and Shingles); Herpes simplex virus infections;
Influenza, and
C. difficile infections.
• Patient placement: Patients should be isolated in a single room.
• PPE: Gown and gloves
• Cleaning:
1. Frequent (focusing on toilets, frequently touched surfaces, and equipment in the
immediate patient area).
2. Organisms that form spores (such as C. difficile) require cleaning products, such as
bleach, that inactivate spores, which are more difficult to destroy than vegetative
microorganisms. 25
B. Transmission-based
Precautions
B. Droplet Precautions

Infections that require droplet precautions

 Seasonal influenza virus, and Neisseria meningitidis infections
• Patient placement:
 Ideally  single room.
 In multi-patient rooms, waiting rooms, or similar areas, separation between patients
(chairs or beds at least 1 meter [3 feet]) and use of a physical barrier, such as a
curtain or divider.
• PPE: Eye protection and a face mask or face shield.
• Cleaning:
 As in contact precautions.
 Use gloves, gown and face/eye protection during cleaning.
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B. Transmission-based
Precautions
C. Airborne Precautions
Infections that require Airborne Precautions
 Mycobacterium tuberculosis, measles, and varicella viruses.
• Patient placement:
 Ideally, patients should be placed in an airborne infection isolation rooms (AIIRs) that
includes:
1. Negative pressure compared to the corridor.
2. Closed door
3. Air exhausted directly to the outside and not recirculated in the room
• PPE: Wear a particulate respirator, such as N95, and conduct a seal check before entering the
patient’s room.
• Cleaning:
 Use a respirator when cleaning patient care equipment and the environment of the patient.
 After cleaning, wait for aerosols to clear the room before entering rooms without a respirator.
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Airborne Infection Isolation Room
(AIIR)
N95 respirator
 Is a type of respirator which removes particles
from the air that are breathed through it.
These respirators filter out at least 95% of very
small (0.3 micron) particles.
 They can filter out all types of particles,
including bacteria and viruses.

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Key interventions for
prevention of
specific HAIs

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Prevention of specific
HAIs
1. Prevention of catheter-associated urinary tract
infection
1. Consider alternatives to indwelling urinary catheterization.
2. Remove catheter as soon as possible.
3. Ensure that only properly trained persons aseptically insert
and maintain catheters.
4. Maintain a closed drainage system and unobstructed urine
flow.
2. Prevention of central line-associated bloodstream infection
(CLABSI)
1. Choose proper central line insertion
sites.
2. Follow and monitor proper insertion
practices.
3. Use appropriate agents for skin
Learn more about
antisepsis. central line usage
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and importance
Prevention of specific
HAIs
3.Prevention of Surgical site infection

A. Before surgery:

4. Use antimicrobial prophylaxis in accordance with guidelines.

5. Treat remote infections whenever possible before elective
operations.
6. Avoid removing hair at the operative site unless it will interfere with
Surgical site infection
the operation; do not use razors.
7. Ensure patients bathe or shower.
8. Use appropriate antiseptic agent and technique for skin
preparation.
1.
B.Keep operating-rooms
During surgery: doors closed during surgery.
2. Ensure all surgical equipment is sterile and maintain asepsis throughout surgery.
3. Maintain normothermia. 32
Prevention of specific
HAIs
3. Prevention of Surgical site
infection
C. After surgery:
1. Protect primary closure
of incision with a
sterile dressing.
2. Control blood glucose levels during
the immediate postoperative period
(for cardiac surgery).
3. Discontinue antibiotics after surgery
according to guidelines.

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Prevention of specific
HAIs
4. Prevention of
Pneumonia
General prevention measure
1. Exclude staff with respiratory illness from contact with patients.
2. Avoid crowding patients in wards and waiting areas.
3. Provide or recommend appropriate vaccinations for staff and patients.

Prevention measure are designed to avoid the three commonest mechanisms

by which pneumonia develops:
1. Aspiration  E.g; elevate patients head, non-sedative pain therapy, encourage
mobilization,…
2. Contamination of the aerodigestive tract  E.g; regular oral cavity care, avoid
gastric overdistention, avoid H2 blocking agents and proton pump inhibitors
(to avoid bacterial colonization),
3. Contaminated equipment  E.g; minimize ventilation duration, avoid
extubation and reintubation,…
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Preventing infections of Healthcare workers
(HCWs)
 At recruitment of healthcare workers, their health should be
reviewed by checking:
 Immunization history
 Previous exposures to communicable diseases (e.g. tuberculosis)
 Immune status.

Immunizations recommended for staff include:

1. Hepatitis A and B,
2. Annually influenza vaccination
3. MMR: Measles, Mumps, Rubella
4. dT  diphtheria and tetanus vaccine

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