Infection Control (Encyclopedia of Medicine)
Infection control refers to policies and procedures used to minimize the risk of spreading infections, especially in hospitals and health care facilities.
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 a common vehicle such as food or water.
Infection control in hospitals
Infections obtained in hospitals are also called nosocomial infections. They occur in approximately 5% of all hospital patients. This results in increased time spent in the hospital and, in some cases, death. There are many
|Selected Infectious Diseases And Corresponding Treatments|
(The entire section is 1213 words.)
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Infection Control (Encyclopedia of Nursing & Allied Health)
Infection control is the protection of patients and health care workers by the prevention of infection in the health care setting in a cost-efficient manner.
|Standard precautions for infection control|
|SOURCE: CDC, 1996.|
|Environmental control||Follow hospital procedures for routine care, cleaning, and disinfection of all surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces.|
|Linen||Handle, transport, and process used linen soiled with blood, body fluids, secretions, or excretions in a manner that prevents exposures and contamination of clothing, and avoids transferring microorganisms to other patients and environments.|
|Occupational health and bloodborne pathogens||Prevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles.|
|Never recap used needles using both hands or any other technique that involves pointing the needle toward any part of the body; instead, use a one-handed "scoop" technique or a mechanical device designed for holding the needle sheath.|
|Do not remove used needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp items in puncture-resistant sharps containers located as close as practical to the area in which the items were used, and place reusable syringes and needles in a puncture-resistant container for transport to the processing area.|
|Use resuscitation devices as an alternative to mouth-to-mouth resuscitation.|
|Patient-care equipment||Handle used patient-care equipment soiled with blood, body fluids, secretions, or excretions in a manner that prevents skin and mucous membrane exposures and contamination of other patients and environments. Ensure that reuasable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and single use items are properly discarded.|
|Patient placement||Use a private room for a patient who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control. Consult Infection Control if a private room is not available.|
|Wash hands (plain soap)||Wash after touching blood, body fluids, secretions, excretions, and contaminated items.|
|Wash immediately after gloves are removed and between patient contacts.|
|Avoid transfer of microorganisms to other patients or environments.|
|Wear gloves||Wear when touching blood, body fluids, secretions, excretions, and contaminated items.|
|Put on clean gloves just before touching mucous membranes and nonintact skin.|
|Change gloves btween tasks and procedures on the same patient after contact with material that may contain high concentrations of microorganisms. Remove gloves promptly after use, before touching noncontaminated items and other surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients or environments.|
|Wear gown||Protect skin and prevent soiling of clothing during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Remove a soiled gown as promptly as possible and wash hands to avoid transferring microorganisms to other patients or environments.|
|Wear mask and eye protection or face shield||Protect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.|
The purpose of infection control is to reduce the risk of health care worker exposure and infection and nosocomial (hospital-acquired) infections, which can complicate existing diseases or injuries.
Organized efforts at infection control began in the United States in the 1950s, along with the increase in intensive care units to care for critically ill patients and the emergence of nonsocomial staphylococcal infections. Many hospitals implemented programs in the 1960s and 1970s at the insistence of various organizations. In the 1980s, state and federal agencies, along with professional organizations, began to make recommendations for infection control and require adherence to regulations.
Infection control procedures are followed in hospitals, long term care facilities, rehabilitation units, outpatient facilities, and home care. All infection control programs should encourage actions that limit the spread of nosocomial infections. All healthcare institutions are mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to "develop specific objectives and outcome measures to determine whether or not its infection control goals have been achieved" (AJIC, 1998). Infection control programs must include the means to measure the effectiveness of procedures, policies, or programs to protect patients and health care providers and to determine if these activities are cost-effective.
Health care organizations must be in compliance with regulations and accreditation requirements by various federal and state agencies and governing bodies. JCAHO, for instance, has standards that are incorporated into many state licensing, as well as Medicare and Medicaid, regulations. The facility's administration is responsible for ensuring compliance. Ongoing education and training are an important part of an effective infection control program. Also, the monitoring of patient-care activities can identify areas of concern, and the data obtained is vital to improving the program and ensuring successes.
The Hospital Infections Program (HIP) of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), is the focus for information, surveillance, investigation, prevention, and control of nosocomial infections for the U.S. Public Health Service, state and local health departments, hospitals, and professional organizations in the United States and around the world. Studies indicate that one-third of nosocomial infections can be prevented by well-organized infection control programs, yet only 6-9% are actually prevented. The Study of Efficacy of Nosocomial Infection Control (SENIC) carried out by HIP over ten years showed that, to be effective, nosocomial infection programs must include the following: 1) organized surveillance and control activities, 2) a ratio of one infection control practitioner for every 250 acute care beds, 3) a trained hospital epidemiologist, and 4) a system for reporting surgical wound infection rates back to surgeons (NNIS, 1996). The National Nosocomial Infections Surveillance (NNIS) System has been gathering information for 20 years regarding nosocomial infections. This information is being used to assist hospitals in conducting successful surveillance of these infections.
In 1987, the Centers for Disease Control (CDC) expanded previous recommendations to prevent the spread of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. Previously, certain isolation precautions were recommended only for those patients who were known or suspected to have bloodborne infectious diseases. Because of the growing number of persons infected with HIV and the high mortality rates associated with AIDS, Universal Blood and Body Fluids Precautions were developed. Under these new recommendations, all patients are considered potentially infectious for bloodborne infections. In 1991, the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogen Standard required the use of universal precautions and dictated that all staff must be trained annually on the risk of exposure to bloodborne pathogens. Preventing exposure is the best and safest way to reduce infection.
The effectiveness of infection control programs are evaluated in several ways: lower rates of infection for the patient, shorter periods of hospital stays, decreased morbidity, and reduction of on-the-job exposure of health
|Methods of disinfection|
|SOURCE: Benarde, M.A., ed. Disinfection: A Treatise. New York: Marcel Dekker, 1970.|
|Autoclaving||Sterilize instruments not harmed by heat and water pressure.|
|Boiling water||Kill non-spore-forming pathogenic organisms.|
|Chlorines||Water disinfection; food surface sanitization.|
|Ethylene oxide gas||Sterilization of heat-sensitive materials or those that must be kept dry.|
|Fiberglass filters||Air disinfection.|
|Formaldehyde (formalin)||Drastic disinfection.|
|Formaldehyde gas||Fumigation; sterilization of heat-sensitive materials.|
|Germicidal soaps (hexachlorophene)||Skin degerming.|
|Iodines, tincture||Skin degerming.|
|Iodines, iodophors||General disinfectant.|
|Ionizing||Sterilize medicines, some plastics, sutures, and biologicals.|
|Membrane filtration||Water purification.|
|Quaternary ammonia compounds, tincture||Skin degerming.|
|Quaternary ammonia compounds, aqueous||General disinfectant.|
|Ultraviolet light||Air and surface disinfection.|
|Washing||Disinfect hands and surfaces.|
care workers to infection and contamination from patients. To do this, infection control policies focus on strategies for isolation, barrier precautions, case investigation, health care worker education, immunization services, and employee health programs. When healthcare institutions are successful in their infection control programs, it decreases the cost of care and has a positive impact on the institution's image within the community.
It is the responsibility of infection control to identify problems, collect and analyze data, change policies and procedures when necessary, and monitor data. The specific functions of an infection control program should be based on the needs of the individual healthcare institution. It is most important to monitor infection activity. Data is collected and disseminated based on the principles of epidemiology to implement quality-improvement activities and improve patient outcomes. Policies and procedures of the facility must be based on scientific and valid infection control prevention and be reviewed and updated frequently to reflect practice guidelines and standards.
|SELECTED INFECTIOUS DISEASES AND CORRESPONDING TREATMENT|
|Chicken pox||Rash, low-grade fever||Person to person||None|
|Common cold/Influenza||Runny nose, sore throat, cough, fever, headache, muscle aches||Person to person||None|
|Hepatitis||Jaundice, flu-like symptoms||Sexual contact with an infected person, contaminated blood, food, or water||None|
|Legionnaire's Disease||Flu symptoms, pneumonia, diarrhea, vomiting, kidney failure, respiratory failure||Air conditioning or water systems||Antibiotics|
|Measles||Skin rash, runny nose and eyes, fever, cough||Person to person||None|
|Meningitis||Neck pain, headache, pain caused by exposure to light, fever, nausea, drowsiness||Person to person||Antibiotics for bacterial meningitis, hospital care for viral meningitis|
|Mumps||Swelling of salivary glands||Person to person||Anti-inflammatory drugs|
|Ringworm||Skin rash||Contact with infected animal or person||Antifungal drugs applied topically|
|Tetanus||Lockjaw, other spasms||Soil infection of wounds||Antibiotics, antitoxins, muscle relaxers|
Transmission of infection within a health care organization requires three elements: a source of infecting microorganisms, a susceptible host, and a means of transmission for the microorganism. The skin of patients and personnel can function as a reservoir for infectious agents and as a vehicle for transfer of infectious agents to susceptible persons. The microbial flora of the skin consists of resident and transient microorganisms. Resident microorganisms persist and multiply on the skin. Transient microorganisms are contaminants that can survive for only a limited period of time. Most resident microorganisms are found in superficial skin layers, but about 10-20% inhabit deep epidermal layers. Handwashing with plain soaps is effective in removing many transient microorganisms. Resident microorganisms in the deep layers may not be removed by hand-washing with plain soaps, but usually can be killed or inhibited by antimicrobial products. Handwashing is the single most important measure for preventing nosocomial infections.
Health care workers should wash their hands:
- after removing gloves
- when coming on duty
- when hands are soiled, including after sneezing, coughing, or blowing the nose
- between patient contacts
- before medication preparation
- after personal use of the toilet
- before performing invasive procedures
- before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns
- before and after touching wounds
- before and after eating
- after touching inanimate objects that are likely to be contaminated with pathogenic microorganisms, such as urine-measuring devices and secretion collection apparatuses
- after taking care of infected patients or patients who are likely to be colonized with microorganisms of special clinical or epidemiologic significance; for example, bacteria that are resistant to multiple antibiotics
Routine hand-washing is accomplished by vigorously rubbing together all surfaces of lathered hands followed by thorough rinsing under a stream of water. This should take 10-15 seconds to complete. The hands should be dried with a paper towel. Immediate recontamination of the hands by touching sink fixtures may be avoided by using a paper towel to turn off faucets.
Universal precautions recommend that all health care workers who come into contact with a patient's blood or body fluids that contain visible blood should wear an appropriate type of barrier to prevent the spread of blood-borne pathogens. Other body fluids for which barrier protection is recommended include semen, vaginal secretions, cerebrospinal fluid (CSF), synovial fluid, pleural fluid, pericardial fluid, and amniotic fluid. The type of exposure determines the specific barrier that should be used. Universal precautions are designed to augment, not replace, standard infection control procedures such as hand washing and the use of gloves when touching obviously infected materials.
Adequate routine cleaning and removal of soil should be the environmental sanitation procedure for all healthcare facilities. Microorganisms are normal contaminants of the environment. A healthcare facility's environmental services department should maintain schedules for routine cleaning in all rooms and include equipment and working surfaces. General and infectious wastes are disposed of on a regular schedule. All departments, though, are responsible for implementing infection control policies.
Health care workers must not be complacent about implementing their facility's infection control policies. Perhaps due to long-time exposure to occupationally acquired infections, they have the tendency to minimize or ignore the ramifications. Infections oftentimes go undetected, underreported, or overlooked by health care workers.
If infection control programs are successful, the result will be a reduction in the risk of infection and related adverse outcomes in the healthcare setting, achieved in a cost-efficient manner.
Health care team roles
Much of the responsibility for infection control rests on the shoulders of the clinical staff providing care at the bedside. Because nurses are close to the patient physically, they are able to prevent the spread of infection, but they can also be a means of transmitting infection. Therefore they need to foster compliance with infection control policies to ensure a high quality outcome for the patient. Infection control practices should have a positive effect on not only the clinical staff, but the patient as well.
Jennings, J., and F. Manian. APIC Handbook of Infection Control. Washington, D.C.: Association for Professionals in Infection Control and Epidemiology, 1999.
Barrs, A. "Infection Control Across the Board." Nursing Homes Long Term Care Management 49, Issue 11 (November 2000):38.
Henderson, D. "Raising the Bar: The Need for Standardizing the Use of "Standard Precautions" as a Primary Intervention to Prevent Occupational Exposures to Bloodborne Pathogens." Infection Control and Hospital Epidemiology 22 (February 2001):6.
Heseltine, P. "Why Don't Doctors and Nurses Wash Their Hands?" Infection Control and Hospital Epidemiology 22 (April 2001):4.
Hood, R., and D. Olesen. "Re-evaluating the Role of the Clinical Nurse in Minimizing Health Care Related Infection." Australian Nursing Journal (8 October 2000):1.
Rello, J. "Impact of Nosocomial Infections on Outcome: Myths and Evidence." Infection Control and Hospital Epidemiology 20 (June 1999):6.
"Requirements For Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report." Infection Control and Epidemiology 19 (1998):114-124.
Shimkins, J. "Making the Grade." Health Facilities Management 1 (January 1999):18.
Stratton, C. "Occupationally Acquired Infections: A Timely Reminder." Infection Control and Hospital Epidemiology (January 2001):22.
Hospital Infections Program. Center for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA 30333. <<a href="http://www.cdc.gov/ncidod/publications/brochures/hip.htm">http://www.cdc.gov/ncidod/publications/brochures/hip.htm>.
Infection Control: Hand-Washing and Antisepsis. Johns Hopkins University. 2001.
René A. Jackson, RN
Infection Control (World of Microbiology and Immunology)
Microorganisms are easily transmitted from place to place via vectors such as insects or animals, by humans that can harbor the infectious organism and shed them to the environment, and via movement through the air (in the case of some bacteria, yeast, and viruses). Microorganisms can adapt to antimicrobial treatments (the best example being the acquisition of inheritable antibiotic resistance by bacteria). Thus, the potential for the spread of infection by disease-causing microbes is substantial unless steps are taken to limit the spread. Such strategies are collectively termed infection control.
For many microorganisms, particularly bacteria, contact transmission is a common means of spread of infection. This can involve the fecal-oral route, where hands soiled by exposure to feces are placed in the mouth. Day care workers and the infants under their charge are a significant focus of such Escherichia coli infections. As well, touching a contaminated inanimate surface is a means of transmitting an infectious microorganism.
The contact route of transmission is the most common route in the hospital setting. Various steps can be taken to control the spread of infection through contact with contaminated surfaces. Proper handwashing, in fact, is the single most effective means of preventing the spread of infection. Thorough handwashing prevents spread of bacteria to others and also prevents contamination of work or food preparation surfaces.
The operating theatre is an example of a place where the importance of infection control measures is apparent. In the nineteenth century, before the importance of hygienic procedures was recognized, operations were used as a last resort because of the extremely high mortality rate after surgery. Pioneering efforts by scientists such as Joseph Lister made operating rooms much cleaner, which resulted in a drop in the death rate attributable to surgically acquired infections. In the present day, operating rooms are places where personal hygiene is meticulous, instruments and clothing is sterile, and where post-operative clean up is scrupulous.
In hospitals and particularly in research settings, the control of infections involves the use of filters that can be placed in the ventilation systems. Such filters prevent the movement of particles even as small as viruses from a containment area to other parts of a building. Work surfaces are kept free of clutter and are exposed to disinfectant both before and after work with microbes, to kill any transient organisms that may be on the inanimate surface. Laboratories often contain containment structures called fume hoods, in which organisms can be worked with isolated from the airflow of the remainder of the lab. Even the nature of the work surface is designed to thwart infection. Surfaces are constructed so as to be very smooth and to be watertight. The presence of crevasses and cracks at the junction between surfaces are ideal spots for the collection and breeding of infectious microorganisms.
Some infectious microorganisms can be transferred by animal or insect vectors. One example is the viral agent of Yellow Fever, which is transmitted to humans via the mosquito. Control of such an infection can be challenging. Typically a concerted campaign to kill the breeding population of the vector is required, along with measures to protect people from those vectors that might escape the eradication campaign. To use the Yellow Fever example, spraying in mosquito breeding sites could be supplemented with the use of mosquito netting over the beds of people in particularly susceptible regions.
Another strategy of infection control is the use of antimicrobial or antiviral agents in an effort to either defeat an infection or, in the case of vaccines, to protect against the spread of an infection. Antibiotics are an antimicrobial agent. They have been in common use for less than 75 years, and already history is showing that antibiotics achieve success but that this success should not be assumed to be everlasting. Bacteria are proving to be adept at acquiring resistance to many antibiotics. Indeed, already strains of enterococci and Staphylococcus aureus are known to be resistant to virtually all antibiotics currently in use.
Immunization against infection is a widely practiced and successful infection control strategy. Depending upon the target microbe, the vaccination program may be undertaken to prevent the seasonal occurrence of a malady such as influenza, or to eradicate the illness on a worldwide scale. An example of the latter is the World Health Organization's effort to eradicate polio.
One breeding ground for the development of resistant microbial populations is the hospital. Antibiotics and disinfectants are an important part of the infection control strategy in place in most hospitals. Bacteria are constantly exposed to antibacterial agents. The pressure to adapt is constant.
The degree of infection control is tailored to the institution. For example, in a day care facility, the observance of proper hygiene and proper food preparation may be adequate to protect staff and children. However, in a hospital or nursing home, where people are frequently immunocompromised, additional measures need to be taken to ensure that microbes do not spread. Such measures can include regular disinfection of surfaces, one-time use of specific medical equipment such as disposable needles, and well-functioning ventilation systems.
The focus of infection control strategies has shifted with the emerging knowledge in the 1970s and 1980s of the existence and medical relevance of the adherent bacterial populations known as biofilms. These adherent growths can remain viable on surfaces after being treated with concentrations of chemicals that swiftly kill their free-floating counterparts. Infection control in areas such as physician and dentist offices, now focus on ensuring that equipment is free from biofilms, because the bacteria could be easily transferred from the equipment to a patient.
See also Bacteria and bacterial infection; Disinfection and disinfectants; Epidemics and pandemics; Hygiene