This document discusses key concepts of infection control, including definitions of infection and colonization. It notes that healthcare-associated infections are a major problem, with higher rates in developing countries. Factors influencing infection risk include microbial agents, patient susceptibility, and environmental factors. The document outlines standard and transmission-based precautions to prevent infection spread. It emphasizes hand hygiene, personal protective equipment, and cleaning and disinfection as core infection control measures.

1. CONCEPTS
OF
INFECTION CONTROL
By
Dr Anjum Hashmi
MBBS,CCS(USA),MPH
Infection Prevention & Control
Director
Maternity & Children’s Hospital
Najran KSA

2. DEFINITIONS
• INFECTION is invasion and multiplication of
microorganisms in a host, with an associated
host response (e.g. fever, pain, edema, purulent
drainage).
• Infection may be local or generalized.
• Infections may require antibiotic treatment.
• Infection is preceded by colonization.
• COLONIZATION, whereby microorganisms are
present in the host but do not invade or cause
an associated host response, is distinct from
infection. No treatment is needed.

3. RISK OF INFECTION
• The risk of infection is always
present.
• Patient may acquire infection before
admission to a hospital known as
Community acquired infection.
• Patient may get infection inside the
hospital known as Nosocomial
Infection/ Healthcare Associated
Infections (HAIs).

4. HEALTHCARE ASSOCIATED
INFECTIONS (HAIS)
• These includes infections which are
Not present nor incubating at admission.
That appear more than 48 hours after
admission.
Those acquired in the hospital but appear
after discharge.
Occupational infections among staff as a
result of Needle Stick Injury / exposure to
blood & body fluids e.g. HBV, HCV & HIV.

5. PREVALENCE OF HAIs
• Developed countries
• In developed countries, even with
sophisticated treatments and technologies,
HAI continues to account for complications
in 5-10% of admissions to acute-care
hospitals.
• For example, in the U.S. alone there are at
least 80,000 fatalities each year (about 200
deaths/day) from HAI. (WHO 2013)

6. PREVALENCE OF HAIs
• Developing countries
• The impact of HAI is far greater than
developed countries, the prevalence studies
report hospital-wide infection rates usually
higher than 15%. (WHO 2013)
• In these countries, over 4000 children die of
HAI every day.
• Approximately half of all patients admitted to
neonatal intensive care units acquire an
infection, and over half of them die.

7. HAIs INFECTION SITES
Blood stream & Urinary tract infections are
most common (30-40%), these are associated
with an central line or umbilical catheter /
with an indwelling urinary catheter or
instrumentation.
Ventilator Associated Pneumonia ( VAP) and
Surgical Site infections (SSI) are the next
(about 15% each).
Than comes bacteraemia (5%).
Other sites includes gastrointestinal tract,
intravenous site infections and skin infections.

8. FACTORS INFLUENCING HAIs
The microbial agent
Patient susceptibility
Environmental factors

9. MICROBIAL AGENTS
1. Commensal bacteria: found as normal flora
of healthy humans they prevent pathogenic
bacterial colonization of mouth, skin, colon,
vagina etc.
2. Pathogenic bacteria: have great virulence
and causes infection.
3. Viruses:
4. Parasites:
5. Fungi:

10. PATIENT SUSCEPTIBILITY
Age: Infancy and old age has decreased
resistance to infection.
Immune status: Patients with chronic
diseases as malignancy, leukemia,
diabetes mellitus, renal failure or AIDS
have increased susceptibility to infection.
Immunosuppressive drugs or
irradiation

11. ENVIRONMENTAL FACTORS
 Healthcare settings are environment where
both infected and infection susceptible
patients are present.
 Patients may get infection due to crowding
within hospital or due to frequent transfers
between deferent units.
 Microbial flora may contaminate hospital
furniture, rooms, devices and other materials
which if come in contact with susceptible
patients cause infection.

12. ROUTE OF HAIs
Endogenous infection:
When normal patient flora change to
pathogenic bacteria because of change of
normal habitat, damage of skin and
inappropriate antibiotic use.
About 50% of HAIs Are caused by this way.
Exogenous cross-infection:
Mainly through hands of healthcare workers,
visitors, patients.

13. ROUTE OF HAIs
Exogenous environmental infections:
several types of micro-organisms survive well in
the hospital environment (hospital flora):
On linen, equipment and supplies
In water supply and food.
In fine dust and as droplet nuclei.
Invasive procedures:
Increase risk of infection e.g. urinary catheters,
I.V. lines, inhalation therapy, surgery.
Inappropriate use of antibiotics.
Treating colonization with antibiotic.

14. CHAIN OF INFECTION
Portal of
Quant Routes of
entry into Susceptib
ity of Virule
transmission le
nce host
patho host

15. AIM OF INFECTION CONTROL
• Disease transmission can be
prevented by breaking one or more of
the links in the chain of transmission.
• Basic infection control measures
based on reducing the risk of
transmission of pathogens from a
known or unknown source.

16. BASICS OF INFECTION CONTROL
Prevention of HAIs is the responsibility
of all individuals and services providers
of the healthcare setting.
 To practice good asepsis, one should
know: what is dirty, what is clean, what
is sterile and how to keep them separate.
 Hospital Infection Control policies &
procedures are applied to prevent
spread of infection in hospital.

17. INFECTION CONTROL PROGRAM
• A comprehensive, effective and supported program is
essential for reducing infection risk and increasing
hospital safety.
• It includes surveillance, preventive activities and staff
training.
• Hospital ICP should be based on:
1) Preventive efforts keeping in mind patients and staff
safety.
2) Support of senior management and provision of sufficient
resources.
3) Development of an yearly work plan to assess and
promote all infection control health care activities.

18. Hospi t a l Pr o gr a m
I n f e ct io n Conr t o l Team I n f e ct i o n c o ntr o l commi t e e I n f e ct io n cont r o l manual

19. INFECTION CONTROL TEAM
• The optimal structure varies with hospitals
types, needs and resources but ideally ICT
should compose of ICD & ICNs with a separate
office. According to WHO one ICN for 250 beds.
• Hospital can appoint public health specialist or
epidemiologist or infectious disease specialist,
microbiologist to work as Infection Control
Director (ICD).
• Infection control nurse (ICN), having experience
in infection control issues.

20. INFECTION CONTROL COMMITTEE
 It is a multidisciplinary committee
responsible for monitoring IC program policy
implementation and recommendation for
corrective actions.
 It includes representatives from different
concerned hospital departments and
management, and they should meet monthly.
 It establishes standards for patient care,
reviews and assesses IC reports and identifies
areas of intervention.

21. INFECTION CONTROL MANUAL
Every Hospital should have a Infection
Prevention & Control manual (ICM) having
instructions and recommended practices
for patient care.
IC manual should be developed and
updated every two years by the infection
control team.
It should be reviewed and approved by
infection control committee and
distributed to all units for reference.

23. Pr o gr a m Com ponents
Sur v eil a nce Pr e vent iv e Act iv it ie s St a f Tr a in in g

24. NOSOCOMIAL INFECTION
SURVEILLANCE
• The term surveillance implies to regular
analysis of observational data aiming at
the reduction of HAIs rate and their costs.
• HAIs rate of a hospital is an indicator for
quality of service & safety of patient care.
• Surveillance is done to monitor HAIs rate,
which is essential to identify problems and
to evaluate infection control activities.

25. TYPES OF SURVEILLANCE
• Active surveillance (Prevalence and
incidence studies).
• Targeted surveillance (site, unit,
priority-oriented target).
• Requirements For Surveillance
• Trained investigators.
• Standardized methodology.
• Risk- adjusted rates for comparisons.

26. ORGANIZATION FOR SURVEILLANCE
D a t a c o lle c t io n a n d a n a ly s is
W a r d a c t iv ity L a b o r a t o r y r e p o r ts D a t a e le m e n t s & a n a ly s is
d e v ic e s o r p r o c e d u r e s c u lt u r e & s e n s it iv ity p a t ie n t d a t a & in f e c t io n
f e v e r & in f . s ig n s r e s is t a n c e p a t t e r n s p o p u la t io n & r is k s
a n t ib io t ic s & c h a r ts s e r o lo g ic t e s t s c o m p u t e r iz a t io n o f d a ta
F e e d b a c k & d i s s e m e n a ti o n
p ro m p t, re l e v e n t to ta rg e t g ro u p M e e tin g s & d is s c u s s i o n s D is s e m e n a tio n b y c o m m itte e

27. Core Infection
Control Measures
in
Health Care Settings

28. CORE INFECTION CONTROL MEASURES
IN HEALTH CARE SETTINGS
● Early recognition and reporting of HAIs.
● Infection control precautions.
● Hand hygiene: Use of hand wash & alcohol-
based hand rub.
● Personal Protective Equipment PPE: Like gloves,
gowns, masks/respirators, eye protection.
● Patient accommodation.
● Environmental cleaning and waste disposal.
● Occupational health management.

29. INFECTION CONTROL PRECAUTIONS
• Standard Precautions
– Should be applied for ALL patients
• Transmission-based Precautions*
– Contact
– Droplet
– Airborne
*Transmission-based precautions are often used empirically, according to the clinical
syndrome and the likely etiological agent

30. STANDARD PRECAUTIONS
•Hand hygiene.
•Respiratory hygiene/cough etiquette.
•Use of personal protective equipment
(PPE).
•Prevention of needle sticks/sharps
injuries.
•Cleaning and disinfection of the
environment and equipment.

31. Transmission-
Based
Precautions

32. DROPLET PRECAUTIONS
• Use for protection against respiratory
pathogens transmitted by large droplets
• In addition to Standard Precautions:
– Use a surgical/medical mask
– Maintain a distance ≥ 1 meter between
infectious patient and others.
– Place patient in a single room or cohort with
similar patients.
– Limit patient movement.

33. CONTACT PRECAUTIONS
• Use for protection against infections which
spread by contact
• In addition to Standard Precautions:
– Use non-sterile, clean, disposable gloves, gown,
apron (only if gown is not impermeable)
– Use disposable or dedicated reusable
equipment (which must be cleaned and
disinfected before use on other patients)
– Limit patient contact with non-infected persons
– Place patient in a single room or cohort with
similar patients

34. AIRBORNE PRECAUTIONS
• Use for protection against inhalation of tiny
infectious droplet nuclei
• In addition to Standard Precautions:
– Use particulate respirator /N 95 mask
– Place the patient in adequately ventilated room
(≥ 12 air changes per hour)
– Limit patient movement
• Use airborne precautions during performing
of any aerosol-generating procedures
associated with risk pathogen transmission
like bone cutting, dental procedures.

36. HAND HYGIENE IS THE CORNERSTONE OF
INFECTION CONTROL
WHO Five Moments of Hand Hygiene

37. TYPES OF HAND HYGIENE
• Routine Hand wash with plain soap & water is the
mechanical removal of soil and transient bacteria (for
40-60 sec).
• Aseptic hand wash is removal & destruction of transient
flora using anti-microbial soap & water (for 40-60 sec).
• When hands are visibly soiled do wash hands with soap
and water.
• Alcohol hand rub 2cc gel is use (for 15-20 sec).
• Use alcohol-based hand rub when hands are not visibly
soiled.
• Surgical hand scrub: removal / destruction of transient
flora and reduction of resident flora using anti-microbial
soap with effective rubbing (for least 3-5 min).

38. Gloves is not substitute hand washing, it must be done
before putting on gloves and after their removal.

39. RESPIRATORY HYGIENE AND COUGH
ETIQUETTE
• Part of standard precautions.
• Education of health care workers, patients
and visitors.
• Source control measures ( cover mouth to
prevent dissemination of infectious
droplets)
• Proform Hand hygiene
• Spatial separation (> 1 meter) of persons
with acute febrile respiratory symptoms.

40. PERSONAL PROTECTIVE EQUIPMENT
Courtesy of K. Harriman

41. TYPES OF PPE USED IN HEALTHCARE
Gloves – protect hands
Gowns/aprons – protect skin and/or clothing
Masks and respirators– protect mouth/nose
– Respirators /N95 mask – protect
respiratory tract from airborne infectious
agents
Goggles – protect eyes
Face shields – protect face, mouth, nose, and

42. PPE FOR STANDARD PRECAUTIONS
Based on Risk Assessment
• IF direct contact with blood & body fluids, secretions,
excretions, mucous membranes, non-intact skin
– Gloves
– Gown
– Mask
• IF there is the risk of spills onto the body and/or face
– Gloves
– Gown
– Face protection (mask plus eye protection goggle or
visor; face shield)
– Booties

43. PPE FOR TRANSMISSION-BASED
PRECAUTIONS
• Used in addition to Standard
Precautions
• Contact Precautions +
– Gloves
– Gown
• Droplet Precautions
– Surgical/Medical mask
• Airborne Precautions
– Particulate respirator/
N95 mask

44. PATIENT ACCOMMODATION
●Separate wards, areas or establish rooms
for infectious patients where isolation
facilities do not exist.
●Separate patients by at least 1 meter
●Isolate patients with droplet or airborne
spread diseases from other patients.
●Only patients with epidemiological
and clinical information suggestive of a
similar diagnosis should share rooms.

45. PATIENT ACCOMMODATION:
NATURAL VENTILATION ROOM
1 meter

46. SHARP PRECAUTIONS
Needle stick and sharp injuries carry the risk of blood
born infections e.g. AIDS, HCV,HBV and others.
Sharp injuries must be reported and notified so that
treatment & post exposure prophylaxis can possible.
Reusable sharps must be handled with care to avoid
injury during procedure.
Never recap needles, if necessary use one hand scoop
method.
Dispose used needles and other sharps immediately in
puncture resistant boxes (sharp container ).
Sharp Containers: must be easily accessible and at eye
level, must not be overfilled, labeled or color coded.

47. SHARP
ONE HAND SCOOP CONTAINER
METHOD OF RECAPPING

48. HANDLING OF CONTAMINATED MATERIAL
• Cleaning of Blood/Body Fluid spills:
a- wear gloves gown mask.
b- wipe-up the spill with paper towel.
c- apply disinfectant Clorox for 2 to 10 minutes.
• Cleaning & decontamination of equipment:
Protective barriers must be worn like gloves.
• Handling & processing lab specimens: Must be
placed in strong plastic bags with biohazard label.
• Handling and processing linen: Soiled linen must be
handled with barrier precautions like gloves & mask
and sent to laundry in coded bags in designated
trolleys.

49. ENVIRONMENTAL DECONTAMINATION
• Cleaning MUST precede decontamination
• Disinfectant ineffective if any organic matter is
present.
• Use mechanical force
– Scrubbing
– Brushing
– Flush with water
• Wipe nonporous surfaces with sponge or wet cloth
– Allow to dry
• Use fresh diluted Clorox/bleach daily!
100 ml Clorox into 900ml water

50. WASTE DISPOSAL
• Handling and processing infectious
waste:
a. Waste must be placed in color
coded, leakage proof bags,
collected with barrier precautions
like gloves.
b. Contaminated waste incinerated or
better autoclaved prior to disposal
in a landfill according to local

51. PATIENT PROTECTION
• Corrective measures
before major procedure,
vaccination, antibiotics
prophylaxis, proper
use of antibiotics.
• Isolation precautions.
• Limiting endogenous risk.

52. STAFF HEALTH PROMOTION
& EDUCATION
• HCW are at risk of acquiring infection, they can
also transmit infection to patients and other
employee.
• Employee health history must be reviewed,
immunizations recommendations must be
carried out.
• Release from work if sick (Work restriction)
• Occupation injury must be notified.
• Continuous education to improve practice, better
performance of new techniques.

53. Spotted Lake, British Columbia
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