Lecture two
Learning objectives
• To describe the overview of infection prevention and
control
• To describe challenges of infection prevention and
control
• To describe health related acquired infection (HAIs)
• To describe post exposure prophylaxis protocol
• To use appropriate hand hygiene techniques
• To apply proper personal protective equipments
• To apply principles of injection safety and safe handling
of sharps
• To prepare solution for decontamination and disinfection
• To demonstrate procedures of waste disposal
Introduction
- Infection is one of the leading causes of preventable
death in hospital every year
- Centre of disease control and prevention estimated
there are approximately 2 million preventable
infection in hospitals every year leading to 90,000
unnecessary deaths.
- Regardless of work area, preventing transmission of
organism is a concern of all health workers
Intro..
• Infection control addresses factor related to spread
of infections including prevention ( hand hygiene,
cleaning, disinfection, sterilization, vaccination,
surveillance), monitoring / investigation of
demonstrated or suspected spread of infection within
health care setting (surveillance and outbreak
investigation) and management (interruption of
outbreak)
Definition; infection
• Infection refers to - invasion of bodily tissue by
pathogenic microorganisms that proliferate, resulting in
tissue injury that can progress to disease
• Invasion of viruses, bacteria and parasite those are not
normally present within the body
• Infection may cause no symptoms and be subclinical, or
may cause symptoms and be clinically apparent.
• Infection may also remain localized or may spread
through the blood or lymphatic vessel to become systemic
• Microorganism that live naturally in the body are not
considered infections (Normal flora)
Infection prevention
• Refer to policies and procedures used to minimize
risk of spreading infections, especially in health care
facilities
Infectious diseases
• Infectious disease are caused by germs and kill more
people world wide than any other single cause
• Germs are tiny living things that are found every
where in air, soil and water
• Person can get infected by touching, eating,
drinking, or breathing something that contains a
germ
• Germs can also spread through animal and insect
bites, kissing and sexual contact
Kinds of germs
• There are four main kinds of germs
1. Bacteria
2. Viruses
3. Fungi
4. Protozoa
Types of infection
• Primary infection; initial infection with an organism
to host
• Secondary infection; host whose resistance is lowered
by pre-existing infection, a new organism may set up a
new infection
• Local infection; infection that is limited to a defined
area or single organ with symptoms that resemble
inflammation (redness, tenderness and swelling)
Types of infection
• Systemic infection; infection that spreads to whole
body resulting in septicemia
• Acute infection; it appears suddenly and last for
short time
• Chronic infection; occur slowly over a long period
and may last months to years
• Latrogenic infections; infections resulting due to
therapeutic and diagnostic procedures
IPC Challenges
• Global Burden of Poor IPC Practices
80% of HAIs are either:
- UTIs
- Surgical sites
- Pneumonia and
- Blood associated with IV devices
Factors affecting IPC
• Badly structured and equipped facilities
• Heavy burden of healthcare on very limited HCWs
• No IPC policy and legal framework
• Healthcare worker attitudes
• lack of training and knowledge on IPC
• Low risk perception
• resources dedicated to IPC-Health budget<15%
Cont..
• Technological gap
• inadequate direction often related to a lack of
monitored systems, leadership and policy.
• Improper handling of health care waste
• Improper antibiotics use and lack of microbiological
information – Antibiotic resistance organism
increases hospitals stay of patients(HAI)
• Understaffing and overcrowding
• Newer modern IPC technologies expensive and not
accessible.
Definition;
• Nosocomial infections also known as hospital
acquired infections (HAIs) are infections not present
and without evidence of incubation at the time of
admission to a healthcare setting.
• They become evident 48 hours after admission or 48
hours after patient is discharged.
• Infection can originate from outside env, another
infected pt, staff that may be infected or in some
cases source of infection cannot be determined
Cont..
• For a HAI , the infection must occur
i. Up to 48 hrs after hospital admission
ii. Up to 3 days after discharge
iii. Up to 30 days after an operation
iv. In a health care facility when some one was
admitted for reasons other than the infection
Sites of nosocomial infections
• The sites of nosocomial infections, in order from
most to least common, are as follows:
- urinary tract
- surgical wounds
- respiratory tract
- skin (especially burns)
- blood (bacteremia)
- gastrointestinal tract
- central nervous system
Risk factors
• Impaired natural resistance to infection
• Pre-existing disease eg. diabetes, immunodeficiency
states, etc.
• Immunosuppresive therapy: cytotoxic drugs,
radiotherapy etc.
• Bypass of defence mechanisms of body surfaces eg.
indwelling catheters, tracheostomy, etc.
• Antibiotic treatment - resistant and virulent strains
Cont..
• Age – infant have immature defence, and such
defence changes with aging
• Nutritional status – reduction in intake of important
nutrients impair wound healing
• Stress – if stress become intense, then elevated
cortisone level result reduced in resistance to
infection
• Hereditary – certain hereditary condition impair
individual’s response to infection
Prevention and Control of HAI
• Maintaining proper personal hygiene and hand
washing
• Sterilisation of hospital equipment
• Providing clean and sanitary environment
• Regular, close observation of high-risk units .e.g
intensive care
Cont..
• Development of policies on areas such as isolation,
disinfection and antibiotic usage
• Universal precautions: - refer to a set of procedures
and guidelines designed to both prevent the
infection of the health care worker and to break
chains of transmission
• Existence of infection control team
Treatment
• Remove source of microorganism -catheter , iv line
• Broad spectrum antibiotics such as penicillins are the
drugs of choice in most cases except multi - resistant
infections caused by multiresistant gram negative
bacilli
• Pseudomonas, Acinetobacter-sensitive to synergistic
action of a combination of beta lactams and
aminoglycosides.
• MRSA- sensitive to cotrimoxazole, tetracyclines,
clindamycin.
• Vancomycin-resistant enterococci
