INFECTION CONTROL

I. INTRODUCTION
There are important concepts regarding infection prevention and control
measures that have been clarified over the past decade. In the health care
setting infection can easily spread from person to person.
A client may be infected while receiving care.
A health worker may be infected while carrying out their duties.
People who work or interact with clients in a health care setting may be
infected.
This transmission of infection is called cross infection.
It is essential to understand the way infection is controlled in any health care
setting including hospitals, residential aged care, community services, dental
practices, mortuaries or alternative health care services.

II. DEFINITION
INFECTION:
An invasion and multiplication of micro organisms in body tissues, as in an
infectious disease. The infectious process is similar to a circular chain with
each link representing one of the factors involved in the process.
The mere presence of micro organisms without reaction is not evidence of
infection.
-MedicineNet.com
Clients in all health care settings are at risk for acquiring infections because of
lower resistance to infectious micro organisms, increased exposure to numbers
and types of disease causing micro organisms and invasive procedures. In
acute ambulatory are facilities, clients can be exposed to pathogens. Some of
which may be resistant to most antibiotics. By practicing infection prevention
and control techniques, the nurse can avoid spreading micro organisms to
clients. Client teaching should include information concerning infections,
mode of transmission and methods of prevention.
-Potter Perry

INFECTION CONTROL:
Infection control is the discipline concerned with preventing nosocomial or
healthcare-associated infection, a practical (rather than academic) subdiscipline of epidemiology. It is an essential, though often under-recognized
and under-supported, part of the infrastructure of health care. Infection control
and hospital epidemiology are akin to public health practice, practiced within
the confines of a particular health-care delivery system rather than directed at
society as a whole.
-www.enotes.com

III. PURPOSE
The purpose of infection control is to reduce the occurrence of infectious
diseases. These diseases are usually caused by bacteria or viruses and can be
spread by human to human contact, animal to human contact, human contact
with an infected surface, airborne transmission through tiny droplets of
infectious agents suspended in the air, and, finally, by such common vehicles
as food or water. Diseases that are spread from animals to humans are known
as zoonoses; animals that carry disease agents from one host to another are
known as vectors.

IV. TRANSMISSION
Micro organisms are transmitted in health care settings by several routes, and
the same micro organism may be transmitted by more than one route. There
are five main routes of transmission: contact, droplet, airborne, common
vehicle, and vector borne.
a) Contact transmission, the most important and frequent mode of
transmission of health care associated infections (HAI), is divided into direct
and indirect contact transmission. Direct contact transmission involves a direct
body surface-to-body surface contact and physical transfer of micro organisms
between an infected or colonized person, such as occurs when a health care
provider turns a client, gives a client a bath, or performs other client care
activities that require direct personal contact.

b) Droplet transmission, theoretically, is a form of contact transmission.

However, the mechanism of transfer of the pathogen to the host is quite
distinct from either direct or indirect contact transmission. Droplets are
generated from the source person primarily during coughing, sneezing, and
talking, and during the performance of certain procedures such as suctioning
and administering nebulized medications.
c) Airborne transmission occurs by dissemination of either airborne droplet
nuclei (small particle residue [five mm or smaller in size] of evaporated
droplets containing micro organisms or dust particles containing the infectious
agent.
d) Common vehicle transmission applies to micro organisms transmitted by
contaminated items such as food, water and medications to multiple hosts and
can cause explosive outbreaks. Control is through using appropriate standards
for handling food and water and preparing medications.
e) Vector borne transmission occurs when vectors such as mosquitoes, flies,
rats, and other vermin transmit micro organisms; this route of transmission is
of less significance in health care facilities in Canada than in other settings.

V. INFECTION CONTROL TEAM

i) The Infection Control Team are
1. Senior Nurses, Infection Control Nurses, Nurse Consultant and
Infection Control Specialist Advisor
2. Infection Control Doctors (Medical Microbiologists)/Infection
control officer
3. Biomedical scientists
4. Administrative staff

ii) Responsibilities of the Infection Control Team:

Advise staff on all aspects of infection control and maintain a safe
environment for patients and staff
Advise management of at risk patients
Carry out targeted surveillance of hospital acquired infections and act
upon data obtained e.g. investigates clusters of infection above
expected levels.

 Provide a manual of policies and procedures for aseptic, isolation and

antiseptic techniques.
Investigate outbreaks of infection and take corrective measures.
Provide relevant information on infection problems to management.
Assist in training of all new employees as to the importance of
infection control and the relevant policies and procedures
Have written procedures for maintenance of cleanliness
Surveillance of infection, data analyses, and implementation of
corrective steps. This is based on reviews of lab reports ,reports from
nursing in charge etc.,
Waste management
Supervision of isolation procedures.
Monitors employee health program.
Addresses all requirements of infection control and employee health
as specified by NABH, state and local laws.
iii) INFECTION CONTROL OFFICER (ICO)
The Infection Control Officer is usually a medical microbiologist or any other
physician with an interest in hospital associated infections. The Pathologists
serves as Infection Control Officer. The ICO supervises the surveillance of
hospital acquired infection as well as preventive and corrective programmes
Functions
Secretary of Infection Control Committee and responsible for
recording minutes and arranging meetings;
Consultant member of ICC and leader of ICT;
Identification and reporting of pathogens and their antibiotic
sensitivity;
Regular analysis and dissemination of antibiotic resistance data,
emerging pathogens and unusual laboratory findings;
Initiating surveillance of hospital infections and detection of
outbreaks;
Investigation of outbreaks, and
Training and education in infection control procedures and practice.

iv) INFECTION CONTROL DOCTOR (ICD)

The ICD must be a registered medical practitioner. In the majority of countries,
the role is performed either by a medical microbiologist or hospital
epidemiologist. Hospital consultants in other disciplines (e.g. infectious
diseases) may be appointed. Irrespective of their professional background, the
ICD should have knowledge and experience in asepsis, hospital epidemiology,
infectious disease, microbiology, sterilization and disinfection, and
surveillance. It is recommended that one ICD is required for every 1,000 beds.
The role and responsibilities of the ICD are summarized as follows:
Serves as a specialist advisor and takes a leading role in the effective
functioning of the ICT.
Should be an active member of the hospital Infection Control
Committee (ICC) and may act as its Chairman.
v) INFECTION CONTROL NURSE (ICN)
Duties of Infection Control Nurse: The duties of the ICN are primarily
associated with ensuring the practice of infection control measures by nursing
and house keeping staff.
Functions
Serves as a specialist advisor and takes a leading role in the effective
functioning of the ICT.
Should be an active member of the hospital ICC.
Assists the hospital ICC in drawing up annual plans and policies for
infection control.
Provides specialist nursing input in the identification, prevention,
monitoring, and control of infection within the hospital.
Participate in surveillance, investigation, and control of infection in the
hospital.
Identify, investigate and monitor infections, hazardous practice and
procedures.
Advice to the contracting departments, participating in the preparation
of documents relating to service specifications and quality standards.

 Ongoing contribution to the development and implementation of

infection control policy and procedure, participating in audit, and
monitoring tools related to infection control and infectious diseases.
Presentation of educational programmes and membership of relevant
committees where infection control input is required.

VI. HOSPITAL INFECTION CONTROL PROGRAMME

Hospital infection control program is dedicated to assisting the Public Health
Services, State and Local Health Departments, Hospitals and other
professional organizations in the prevention and control of nosocomial
infections.
To be effective the infections control programme should include the
following.
1. Organised surveillance and control activities
2. One infection control practitioner for every major Health Facility.
3. A Trained Hospital Epidemiologist
4. A system for reporting surgical wound infection rates and other
infection back to the practicing surgeons and physicians.

VII. GUIDELINES AND RECOMMENDATIONS

* Hand washing and Hospital Environmental Control
* Immunization
* Infectious Diseases Control
* Intravascular Device-Related Infections and its control
* Isolation Precautions
* Long-Term Care Facilities
* Guidelines for Infection Control in Health Care Personnel
* Surgical Site Infections Control

* Urinary Tract and Respiratory Tract Infections Control

* Ordering and Preparing Guidelines appropriately
* Home care
* Hospital Construction
* Sterilization / Disinfection

VIII. Tips for prevent infection in Hospitals

The following are 5 tips that a hospital can keep in mind when preventing
infection:
1. Wash your hands
The most effective was to protect a hospital from spreading infection is to
enforce strict hand-washing protocol. All physicians should clean their hands
before treating any patient so it doesnt hurt to ask them to do it in front of
you. Hospitals should consider placing alcohol-based hand cleaners in each
room, or in close proximity of rooms to keep harmful bacteria off the hands
that will be touching sick, weakened patients.
2. Keep equipment clean
Stethoscopes are commonly contaminated with Staphylococcus aureus and
other bacteria. A central line catheter that is antibiotic-impregnated or silverchlorhexidine coated can reduce chance of infection. It is also important to
keep bodily fluids intact by covering the mouth and nose when sneezing or
coughing.
3. Keep the sick away from the healthy
If a patients sickness is infectious, it is important to keep them quarantined or
separate from other patients and employees, especially those whose immune
system is weakened. Consider investing in single-patient rooms or better airventilation systems.
4. Constantly change IVs

Patient IVs should be changed constantly, at a pace of every 3 to 4 days. Make

sure that the IV is inserted and removed under clean conditions, and that the
attending nurse or physician is wearing clean gloves.
5. Encourage patients to prevent infection
Patients are as much in control of their infection as the hospitals that treat
them. Help the patient to understand the importance of washing their hands,
covering the mouth and nose, avoiding close contact with others, and possibly
getting vaccinated.

IX. Precautions for infection control

There is a two-tier approach to management of cross infection:
Standard precautions and Additional precautions.

i) Standard precautions
Standard precautions include the following five procedures:
Hand washing,
Use of personal protective equipment,
Correct handling and disposal of waste,
Appropriate cleaning of client care equipment, and
Hygienic environmental control.
Standard precautions apply whenever you may come in contact with
the following four bodily substances
Blood (including dried blood),
All body substances, secretions and excretions (excluding
sweat), regardless of whether or not they contain visible blood,

 Non-intact skin, and

Mucous membranes.

a) Hand washing
Hand washing is the single most effective way to reduce the number of microorganisms on the surface of the skin. It should always be performed:

Before and after contact with a client,

Before and after eating,
After using the toilet,
Before and after using gloves,
After contact with used equipment, and
Immediately following contact with bodily fluids.
Standard hand washing procedure:
Remove jewellery.
Wet hands thoroughly all over.
Use pH neutral soap.
Lather soap all over hands.
Rub hands together vigorously for 15-20 seconds. Pay particular
attention to the fingertips, thumbs, wrists, finger webs and the backs of
the hands.
Rinse under running water.
Pat hands dry with paper towels.
Barrier creams
The best protection against bacteria is intact skin, so each time you wash
your hands you should apply barrier cream. Take care when cutting your
finger nails and pay attention to maintaining intact cuticles. Any wound
or abrasion should be covered using a waterproof dressing.
Waterless hand washing
There are waterless alcohol based hand wash solutions that are as
effective as soap and water hand washing. These preparations should
only be used when there is no visible soiling of the hands. If there is
visible soiling, then soap and water hand washing should be used. These
waterless preparations contain an emollient and aid in reducing damage
to the hands.

 Gloves do not replace hand washing; it is an additional protective

measure to hand washing. Hands should be washed before and after
using gloves.

Hand washing should be carried out before and after glove use as gloves may
have pinholes or other defects.
Type of protective
equipment
1. Sterile gloves

2. Non sterile gloves

3. General-purpose
utility gloves

Type of use

Correct usage

Wear when likely to have contact

with sterile body cavity or tissue of a
client.

Always check for

holes. Only wear
once. Discard after
use.

Wear to reduce contact with blood,

bodily secretions, excretions,
disinfectants, chemicals.

Always check for

holes. Only wear
once. Discard after
use.

Always check for

holes. Clean and
Wear for cleaning and during manual
store dry between
decontamination of used instruments
uses. Replace when
and equipment
showing signs of
deterioration.

Wear to reduce the risk of cuts,

4. Heavy duty gloves punctures or lacerations.
Wear to reduce the risk of injury
from chemical or thermal burns.

Always check for

holes. Clean and
store dry between
uses. Replace when
showing signs of
deterioration.

b) Respiratory Protection
Masks are worn to protect you from the environment in which you are
working, and infection from clients. They are also worn to protect the client
from you if you are infectious. The correct mask must be worn depending on
the situation at hand.

Type of
protective
equipment
1. Paper Mask

2. Surgical mask

3. Specialised
particulate
respiratory filter
mask

4. Respiration
mask

Type of use

Correct usage

Wear in areas where droplet

infection of the client is a concern.
Wear when the worker has a cold.
Cannot be worn for extended
periods.

Cover the nose and

mouth. Secure
correctly behind
your ears with
elastic fastenings.

Wear in areas where droplet

infection of the client is a concern.
Can be worn for extended periods.

Cover the nose and

mouth. Secure
correctly behind
the ears with tape
fastenings.

Wear to protect from droplet

infection from active pulmonary
tuberculosis clients.

Cover the nose and

mouth. Secure
correctly behind
the ears with elastic
fastenings.

Wear when there are noxious fumes,

harmful dusts, sprays, vapours and
mists.

Has an inbuilt
filtration system.
Cover the nose and
mouth. Secured
correctly behind
the ears by straps.

c) Foot Protection
Appropriate footwear should be worn at all times for your own safety and to
prevent the spread of infection.
Type of protective
equipment

1. Shoe covers

Type of use

Correct usage

Wear to protect from

contamination when
entering an area of
infection.
Wear to prevent
contamination from
spreading.

Cover shoe completely

and tie securely. Made
from polypropylene.
Discard after use.

2. Enclosed,
Wear at all times to reduce
waterproof footwear contact with blood, bodily
with non-slip soles
secretions, excretions,
disinfectants, chemicals.

3. Protective
footwear

Upper section of
footwear should cover all
of the upper foot and be
made of waterproof
material. Soles should be
made of a substance that
reduces the chance of
slipping. Shoes should be
flat, with a heel of not
more than 2.5 cm.

Wear to protect from

Footwear with a steel
splashes, drips, and the
toecap, a heavy duty
dropping or rolling of heavy
upper and rubber soles.
objects.

d) Body Protection
Gowns and clothes such as overalls will reduce the possibility of contact with
hazardous or contaminated substances. They also protect from contact with
micro organisms.
Type of protective
equipment

1. Fabric or paper
gown

2. Plastic Apron

3. Overalls

Type of use

Correct usage

Wear to protect self from

infectious client.
Wear to protect client from
possible exposure to micro
organisms.

Has ties at the neck and

at the waist. Both sets of
ties need to be tied
securely. Discard paper
gown after use. Wash
fabric gown. If
infectious, place in
correct linen bag and
secure. Change between
clients.

Wear to reduce contact with

blood, bodily secretions,
excretions, disinfectants,
chemicals.

Has ties at the neck and

at the waist. Both sets of
ties need to be tied up.
Clean and store dry
between uses. Change
between clients.

Change if overalls
become contaminated.
Wear when there is a risk of
Wash after use.
splashing from corrosive
Disposable overalls
materials.
should be correctly
discarded after use.

e) Eye Protection
Eyewear provides the worker or client with protection from splashes. Splashes
may be from bodily fluids, chemicals spray or splash, dust or particles.
Type of protective
equipment

1. Safety spectacles

2. Goggles

Type of use

Correct usage

Wear when there is the risk of

eye injury from splashing.

May look like normal

glasses or may have
side shields. Cannot
wear glasses
underneath. Clean
after use.

Wear if required when using

potentially dangerous equipment.
Wear when handling dangerous
substances such as chemicals
Wear instead of safety spectacles
if you wear glasses

Have a larger area of

coverage. May wear
glasses underneath.
Clean after use.

f) Head Protection
Protection of the head is important in many areas. It is also important as a
means of preventing contamination.
Type of protective
equipment

Type of use

Correct usage

1. Hairnet/Cover

Wear to prevent contamination

from falling hair.

Hair should be tied

up and completely
tucked into cover.

2. Hard Hat

Wear when there is a danger of

falling objects

Should be correct
type of hat for
different work areas

g) Ear Protection
Ear protection is necessary when there is a risk of auditory damage.
Type of protective
equipment

1. Ear Plugs

2. Ear Muffs

Type of use

Correct usage

Wear to reduce harm from

noise.

Roll the ear plugs

until they are thin
and then place them
into your ear canal
where they will
reexpand to the
shape of the canal

Wear when operating loud

machinery.

Place them firmly

over your ears so that
your entire ear is
covered. The strap
sits across the centre
of your head joining
the 2 ear pads

h) Sharps Management
Sharps are any item that has the possibility to puncture or penetrate. They
include:
Needles, scissors, scalpels, razors, or anything that could constitute a danger of
penetration such as a sharp piece of metal, broken glass or a sharp piece of
plastic. Contaminated sharps have a high risk of transmitting blood-borne
diseases.
Methods to reduce the incidence of needle stick injuries and contamination
include:
Safe work practices and on going training,
The development and use of retractable needles and syringes and needlefree IV delivery systems,

 Rigid sharps disposal containers placed strategically in all work and

clean up areas, and
The correct use of personal protective equipment where possible to
reduce injury, eg; heavy-duty leather gloves for maintenance personnel.

ii) Additional precautions

Additional precautions are put into place when there is a higher level of
protection required to prevent the transmission of infectious diseases. They are
used in addition to standard precautions.
Additional precautions may include the following five procedures:
Client isolation,
The use of gloves and gowns, where the protective equipment is
removed and discarded into the waste bin in the room prior to
exiting,
Hands are washed before and after glove use,
Equipment stays in the room rather than going back into general
population use, and
There is specialised equipment cleaning and disinfection of both
the equipment and the environment.

X. WASTE MANAGEMENT
Waste management practices must meet national and local requirements; the
following principles are recommended as a general guide.

Principles of Waste management of hospital waste include:

Generation,
Segregation/separation,
Collection,
Transportation,
Storage,
Treatment,
Final disposal.
Develop a waste management plan that is based on an assessment of the
current situation and minimizes the amount of waste generated.
Waste is divided into three categories; general, biomedical and pathological.
Legislation requires that biomedical waste be handled and disposed of in such
a way as to avoid transmission of potential infections.

XI. BIO MEDICAL WASTE MANAGEMENT

The most obvious biomedical waste generated in a long term care facility,
health office or community health agency is sharps. Use puncture resistant
sharps containers to remove, store and dispose of used sharps such as needles,
blades, razors and other items capable of causing punctures.
If your practice generates large quantities of bio-hazardous waste, you may
have to partner with a medical waste management company in order to dispose
of the waste safely. Bio-hazardous waste includes both anatomical and non
anatomical waste. Hazardous anatomical waste includes human tissues, blood,
and body fluids but excludes teeth, hair, nails, urine and feces. You may throw
out a diaper in the regular waste, for example. This means that bio-hazardous
waste must be transported and disposed of properly.

XII. Protection from Bio-medical Waste

Wash your hands with soap and warm water after handling biomedical waste.
Also, wash all areas of your body with soap and water that you think may have

come into contact with biomedical waste, even if you are not sure your body
actually touched the biomedical waste.
Keep all sores and cuts covered.
Immediately replace wet bandages with clean, dry bandages.
Wear disposable latex gloves when handling biomedical waste.
Discard the gloves immediately after use.
Wear an apron or another type of cover to protect your clothes from
contact with the waste. If your clothes become soiled, put on fresh
clothes, and take a shower, if possible.
Launder or throw away clothes soiled with biomedical waste.
Promptly clean and disinfect soiled, hard-surfaced floors by using a
germicidal or bleach solution and mopping up with paper towels.
Clean soiled carpets. First blot up as much of the spill as possible
with paper towels and put the soiled paper towels in a plastic lined,
leak-proof container. Then try one of the following:
Steam cleans the carpet with an extraction method.
Scrub the carpet with germicidal rug shampoo and a brush. Soak the
brush used for scrubbing in a disinfectant solution and rinse the
brush. Let the carpet dry, and then vacuum it.
Never handle syringes, needles, or lancets with your hands. Use a
towel, shovel, and/or broom and a dustpan to pick up these sharp
objects. Dispose of them in a plastic soda pop bottle with a cap. Tape
down the bottle cap. Then throw the bottle in the trash.

XIII. JOURNALS

1. Borg MA, Benbachir M, Cookson BD, et al. Health care worker

perceptions of hand hygiene practices and obstacles in a developing
region. American Journal of Infection Control 2009; 37: 855-857.
2. Jumaa PA. Hand hygiene: Simple and complex. International Journal of
Infectious Diseases 2005; 9:3-14.
3. Yuan CT, Dembry LM, Higa B, Fu M, Wang H, Bradley EH.
Perceptions of hand hygiene practices in China. Journal of Hospital
Infection 2009; 71: 157-162
4. Cookson B, French G, Gould D, et al. Hand washing: A modest measure
- with big effects. British Medical Journal 1999; 318: 686
5. Rutala, WA. APIC guideline for selection and use of disinfectants. 1994,
1995, and 1996 APIC Guide lines Committee. Association for
Professionals in Infection Control and Epidemiology, Inc. American
Journal of Infection Control 1996 Aug: 24(4): 313-342.

XIV. THEORY OF APPLICATION

No single intervention has been successful in improving and sustaining such

infection control practices as universal precautions and hand washing by health
care professionals.
Nationally, 9-10% of hospital in-patients acquire an infection during their
admission. These infections are a major source of avoidable morbidity,
mortality and additional resource use. Many could be prevented by use of
effective infection control practices.

XV. SUMMERY
This updated guideline responds to changes in healthcare delivery and
addresses new concerns about transmission of infectious agents to patients and
healthcare workers in the health care setting and infection control. The primary
objective of the guideline is to improve the safety of the healthcare delivery
system by reducing the transmission.
The recommendations on standard principles provide guidance on infection
control precautions that should be applied by all healthcare personnel to the
care of patients in community and primary care settings.
The recommendations are divided into four distinct interventions:

hand hygiene
the use of personal protective equipment

the safe use and disposal of sharps

education of patients, their carers and healthcare personnel.

XVI. CONCLUSION

It is the responsibility of all health care providers to enact principles of care to

prevent health careassociated infections, though not all infections can be
prevented. Nurses can reduce the risk for infection. Proper use of personal
protective barriers and proper hand hygiene is paramount to reducing the risk
of exogenous transmission to a susceptible patient. For example, micro
organisms have been found in the environment surrounding a patient and on
portable medical equipment used in the room..
Health care workers should be aware that they can pick up environmental
contamination of micro organisms on hands or gloves, even without
performing direct patient care.
Nursing has many complicated scopes of practice, which challenge time
management, priority setting, and efficiency of practice. Although system and
administrative support is beneficial to supporting aspects of nursing care,
direct care is performed by individuals.

XVII. BIBILOGRAPHY

1. Medhat A, et al, 2002. Hepatitis C in a community in Upper Egypt: Risk

factors for infection. Am J Trop Med Hyg 66:633-8.
2. Mehtar S, 1992. Hospital Infection Control: Setting up a Cost -Effective
Programme.
3. Damani NN, 1997. Manual of Infection Control Procedures.
4. Huskins WC, et al, 1998. Hospital infection prevention and control: a
model for improving the quality of hospital care in low- and middleincome countries. Infect Control Hosp Epidemiol 19(2): 125-135.
5. Jarvis WR, 2001. Infection Control and Changing Health-Care Delivery
Systems. Emerg Infect Dis 7.
6. Chin J, editor. Control of communicable diseases manual. 17th ed.
Washington DC, American Public Health Association, 2000.
7. Andreoli, T. E., J. C. Bennet, C. C. Carpenter, and F. Plum. Cecil
Essentials of Medicine. Philadelphia: W.B. Saunders Co., 1997.

Seminar on
Infection Control

Submitted To:-

Submitted By:-

Mrs. Sharadha

Mrs. Udaya

M.Sc (N)

MAMATHA COLLEGE OF NURSING

KHAMMAM

Sree.G
M.Sc., Nursing Ist Year

MAMATHA COLLEGE OF NURSING

KHAMMAM