BASIC INFECTION

CONTROL
HAI DEFINITION

▰ Infections acquired in hospital by a patient - admitted for a reason other

than the infection.

▰ Infection - not be present or incubating at the time of admission

▰ Symptoms should appear at least after 48 hours of admission.

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HAI DEFINITION (Cont..)
Also include:

▰ Infections acquired in the hospital but symptoms appearing after discharge

▰ Occupational infections among staff of the HCF (e.g. needle stick injury
transmitted infections)

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Factors Affecting HAIs
▰ Immune status

▰ Hospital environment

▰ Hospital organisms

▰ Diagnostic or therapeutic interventions

▰ Transfusion

▰ Poor hospital administration

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Sources of Infection
▰ Endogenous source- involves patient’s own flora

▰ Exogenous source

 Environmental sources- Inanimate objects, air, water or food

 Health care workers- e.g. Hands of HCWs harboring MRSA

 Other patients

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Microorganisms Implicated in
HAIs
▰ The ESKAPE pathogens-
 Enterococcus faecium
 Staphylococcus aureus
 Klebsiella pneumoniae
 Acinetobacter baumannii
 Pseudomonas aeruginosa
 Enterobacter species

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Modes of Transmission (discussed
later)
▰ Contact transmission

▰ Droplet transmission

▰ Airborne transmission

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MAJOR HAI TYPES- 4 common
types
▰ Catheter-associated urinary tract infection (CAUTI, 33%)

▰ Central line-associated blood stream infection (CLABSI, 13%)

▰ Ventilator-associated pneumonia (VAP, 15%)

▰ Surgical site infection (SSI, 31%).

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PREVENTION OF HAIs

▰ The preventive measures for HAIs can be broadly categorized into:

 Standard precautions

 Transmission-based or specific precautions.

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STANDARD PRECAUTIONS
▰ IPC practices - to prevent transmission of diseases
▰ These measures should be followed when providing care to:
 All individuals
 All specimens (blood or body fluids)
 All needles and sharps

* Universal Precautions – Term no longer used

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Components of standard
precautions
▰ Hand hygiene
▰ Personal protective equipment
▰ Biomedical waste management
▰ Spillage cleaning
▰ Disinfection of patient care items
▰ Environmental cleaning
▰ Respiratory hygiene and cough etiquette
▰ Safe use and disposal of sharp

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Hand Hygiene

▰ Hands of the HCWs - main source of transmission of infections in

healthcare facilities.

▰ Hand hygiene - most important measure to prevent healthcare-associated

infections.

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Types of Hand Hygiene Methods

Hand Rub:

▰ Alcohol based (70–80% ethyl alcohol) or chlorhexidine (0.5–4%) based

▰ Duration - 20–30 seconds

▰ Advantage: After contact, it gets evaporated on its own

▰ Indications: During routine patient care activities or taking rounds

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Types of Hand Hygiene Methods
(Cont..)
Hand Wash- Antimicrobial soaps (liquid, gel or bars) or ordinary soap and
water

▰ Duration - 40–60 seconds.

▰ Indications:
 When hands are visibly soiled with blood, excreta, pus, etc.
 Before & after eating, after going to toilet and before & after duty
 When caring for diarrhea patient
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Types of Hand Hygiene Methods
(Cont..)
Surgical Hand Scrub

▰ 4% chlorhexidine

▰ Duration – 3-5 mins

▰ Prior to any surgical procedure and in-between cases

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Indications (Five Moments for Hand
Hygiene)

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Steps of Hand Rubbing and Hand
Washing

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Personal Protective Equipment
(PPE)
▰ Used to protect the skin and mucous membranes of HCWs from exposure
to blood and/or body fluids

▰ From the HCW to the patient during sterile and invasive procedures.

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Personal Protective Equipment
(PPE)
(Cont..)
Personal protective equipment (PPE):
A. Gloves; B. heavy duty gloves; C. Surgical
mask; D. N95 respirator; E. Plastic apron; F.
Linen gown; G. Disposable gown; H. Coverall;
I. Goggles; J. Face shield; K. Cap; L. Shoes;
M. Gum boot; N. Shoe cover

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Personal Protective Equipment
(PPE)
(Cont..)
▰ Selection of appropriate PPE is based on:
 Level of risk associated with contamination of skin, mucous membranes,
and clothing by blood and body fluids
 Route of transmission of suspected organisms

** PPE must be removed immediately after the indication of its use

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Use of Gloves:

• The use of gloves is not a substitute for hand

hygiene
• Hands must be cleaned before putting gloves on
and after taking them off
• It’s important to remove or change your gloves if:
• Gloves are damaged
• Moving from a contaminated body site to a clean body
site
• Gloves look dirty, or may have germs or blood or bodily
fluids on them after completing a task
• You leave a patient’s room—gloves are not worn in the
hallways unless being used while cleaning equipment
Blood Spill Management

▰ Spillage of blood and body fluid - substantial risk for the transmission of
BBV

▰ Any spillage (small, few drops to large, few mL) should be considered
infectious - need to be cleaned at the earliest.

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Steps of Spill Management
(CDC)
▰ Any spillage, should be attended immediately

▰ Mark the spill area, place the wet floor signage

▰ Wear appropriate PPE (gloves and gown) as mentioned in the spill kit

▰ Confine the spill and wipe immediately with an absorbent towel or cloth

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Steps of Spill Management
(CDC) (Cont..)
▰ Clean with hypochlorite (freshly prepared)
 For large spills (≥10 cm size): 0.5%

 For small spill (<10 cm size): 0.05%

▰ Allow the disinfectant at least for a contact time of 10 min

▰ Rinse the area with clean water to remove the disinfectant residue.

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TRANSMISSION-BASED
PRECAUTIONS
▰ Set of infection control practices which should be followed over and above
standard precautions.

▰ Should be practiced – handling patients infected with infectious agents

having specific mode of transmission

▰ TBPs include - contact, droplet and airborne

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Contact Precautions

▰ Followed when there is evidence of HAI transmission by direct or indirect

contact during patient care.
▰ Direct transmission - from one person to another person without a contaminated
intermediate object or person.

▰ Indirect transmission - through a contaminated intermediate object (clothes,

patient-care devices, environmental surfaces, fomite) or person

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Agents transmitted through
contact
▰ MDROs – MRSA, CRE, VRE, MDR-NFGNB

▰ Enterically transmitted hepatitis viruses (HAV and HEV)

▰ Agents of conjunctivitis (e.g. adenovirus, gonococcus, Chlamydia)

▰ Contagious skin lesions (abscess, infected ulcers) - GAS, Staphylococcus, HSV

▰ Skin infestations (e.g. scabies)

▰ Agents of diarrhea such as rotavirus, cholera, Clostridium difficile

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IC Measures – Contact
Precautions
▰ Hand hygiene
▰ PPEs –gloves, gowns; ± surgical mask/protective eye wear
▰ Single use- patient dedicated equipment
▰ Patient placement – single isolation room/cohorting
▰ Transfer of patients
▰ Disinfection of the rooms

*Cohorting – Patient with similar infections & with min 3 feet spatial bed separation

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Droplet Precautions
▰ Prevent the spread of infectious agents - transmitted through droplet.

▰ Respiratory droplets - large-particles (>5 µm in size) - generated by a

patient who is coughing, sneezing or talking.

▰ Transmission via large droplets requires close contact (<3 feet) – do not
remain suspended in the air - travel shorter distances.

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Agents transmitted through
droplets
▰ Diphtheria, Hib, [Link] (meningitis, sepsis, pneumonia), pertussis,
pneumonic plague, Mycoplasma pneumonia

▰ Influenza viruses, seasonal

▰ SARS-CoV2 (COVID-19)

▰ Viral hemorrhagic fevers - Lassa, Ebola, Marburg viruses

▰ Other viruses: Mumps, Parvovirus B19, Rhinovirus, Rubella, Adenovirus

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IC Measures- Droplet
Precautions
▰ Hand hygiene

▰ PPEs – Surgical mask or N95 when AGPs are performed

▰ Respiratory Hygiene/Cough Etiquette

▰ Patient placement – Single isolation room or cohorting

▰ Transfer of patients

▰ Disinfection of the rooms

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Airborne Precautions
▰ Prevent the spread of infectious agents - transmitted through aerosols.

▰ Aerosols are small-particles (<5µm) generated by an infectious person

during certain aerosol generating procedures (e.g. intubation)

▰ These smaller droplets remain suspended in air for long periods of time
and may disperse to a distant place along the air current.

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Agents transmitted through
aerosols
▰ Mycobacterium tuberculosis
▰ Measles virus
▰ Varicella (chickenpox and zoster disseminated or in an
immunocompromised host)
▰ Smallpox (variola) and monkeypox virus
▰ Aerosolizable spore-containing powders - Bacillus anthracis
▰ Aspergillus (pulmonary aspergillosis)

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Aerosol-generating Procedures
(AGPs)
▰ AGPs - generate much higher concentrations of aerosols and are
associated with higher risk of pathogen transmission.

▰ Examples: Endotracheal intubation, open respiratory and airway

suctioning, tracheostomy care, cardiopulmonary resuscitation, sputum
induction and bronchoscopy

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IC Measures – Airborne
precautions
▰ PPE – N95 respirator
▰ Patient Placement – Airborne isolation room (AIIR)
▰ Ventilation  In room (A), the seating arrangement is
along with direct of natural
o Natural Ventilation ventilation of air flow, so that the doctor
has higher risk of exposure to the
potentially infected air.
 In room (B), doctor is sitting away from
the direction of natural airflow, thus
has lesser risk of exposure.

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IC Measures – Airborne
precautions
o Mechanical Ventilation(Negative pressure room)
 Minimum 12 ACH per hour in high risk area and 6 in low risk area
 Negative pressure differential of >2.5Pascal
 Door should be kept closed always
 Anteroom should be present
▰ Ultraviolet Germicidal Irradiation (UVGI) - >8 feet from floor
▰ Filtration – Exhaust or HEPA

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IC Measures – Airborne
precautions
▰ Transfer of Patients- patient should wear surgical mask

▰ Respiratory Hygiene and Cough Etiquette

▰ Visitors and Staff – restricted access

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Summary of Measures - Standard
and TBP
Type Isolatio Hand Gloves Apron Mask Eye Handling Visitors
n room hygie or protect of
or ne gown ion equipme
cohorti nt
ng
Standa Not Yes As If As As Single use No
rd required required soiling require require or additiona
likely d d reprocesse l
d precautio
ns
Contac Essentia Yes Essentia Essenti As As Same Same
t l l al require require as precautio
d d standar ns as for
d HCWs
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Summary of Measures - Standard
and TBP
(Cont..)
Type Isolatio Hand Gloves Apron Mask Eye Handling Visitors
n room hygie or gown protec of
or ne tion equipme
cohorti nt
ng
Droplet Essentia Yes As If soiling Surgical As Same Restricte
l require likely mask is require as d.
d essentia d standar Precauti
l d ons
same as
for
HCWs
Airborne Essentia Yes As If soiling N95 As Same as Same as
l require likely respirato require contact for
(negativ d r d droplet
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e Is
pressure essential