Prevention of Healthcare Associated Infections

MERS
H1N1
SARS
HIV
EBOLA
HBV
MALARIA
GUIDELINE
Prevention Of Healthcare-Associated Infections
Dr. Nora Mahfouf
Februry 2020

CONTENTS
 Introduction
 Epidemic phases and response interventions
 Focus 1: Community engagement during epidemics
 Focus 2: Risk communication - a life saving- action in public health emergencies
 Focus 3: Treating patients and protecting the health workforce

Introduction
How to prevent infections ?
 Understanding how infections are transmitted can help you avoid getting sick
 Following a few basic principles can go a long way in helping to prevent infections.
Infections are caused by microscopic organisms known
as pathogens—bacteria, viruses, fungi, or parasites—
that enter the body, multiply, and interfere with normal
functions. Infectious diseases are a leading cause of
illness and death in the United States and around the
world.

1- Epidemic phases
Most microbes enter through openings in the body—our noses, mouths, ears, anuses, and genital
passages. They can also be transmitted through our skin through insect or animal bites. The best way
to prevent infections is to block pathogens from entering the body.
Epidemic phases and response interventions

2- Response interventions
Anticipation
Early detection
Containment
Control and mitigation
Elimination or eradication

Epidemic phases and response interventions

Response tips and checklists
The following response tips are used to organize
ideas and to make sure no important point is
overlooked. They are organized into four main
blocks:
 Coordinating responders
 Health Information
 Communicating risk
 Health Interventions

Focus 1: Community
engagement during epidemics
 Defining a community
 Why engage communities
 Three elements of community engagement
Ensuring effective community engagement

Defining a community
It defines a distinct group of people
who have a senseof belonging
together. A community may be
defined through the sharing of:
• A common geographical location;
• Common values or interests;
• Common identity;
• Etc.
Why engage
communities?
People live in unique social-cultural
contexts, with relationship
dynamics, and their own perception
of risks, and trusted sources of
advice. These all influence if they
accept health advice or not.
Cultural
beliefs
Religions
Ethnic groups
Languages
Economic
diparties
Target to be effective
Sharing
interests

Three elements of community engagement
Community engagement is essential for the effective control of infectious
diseases, through acceptance of public health interventions. It is based on
three elements:
,
1. Establishing a dialogue
• between responders and communities to
understand the perceptions and beliefs on both
sides, to identify the specific cultural and social
patterns of transmission that exist at
community level.
2. Building trust
• through this mutual understanding to find joint
solutions to reduce transmission.
3. Empowering communities
• providing them with necessary medical and
other supplies to implement the measures
required to stop the disease, and progressively
• transferring knowledge for sustained and safe
interventions within the community

Ensuring effective community engagement
Knowledge
•Communities must know what the disease is, how it is
transmitted, and how to protect against it (social mobilization
messages);
Trust
• It is the most important determinant to ensuring communities heed
public health advice. Communities must be consulted, engaged, and
whenever possible participate in identifying and implementing response
measures that communities and responders want above all to treat
patients and stop the epidemic;
Self-efficacy
• Communities must be able to implement control measures (e.g. access
to soap and water, to gloves, to waste management services, to
transportation, to safe burial teams, etc.).
Understand
• Field responders need to understand the local perceptions of
the disease and of the response measures;
Listen
• Field responders need to listen to communities’ fears and
beliefs and adapt their own behaviours accordingly;
Support
• Field responders need to support communities’ participation,
ownership and resilience.
FOR COMMUNITIES FOR FIELD RESPONDERS

FOCUS 2: Risk communication
 The essence of risk communication
 Health information
 Ten things to know and do

The essence of
risk
communication
• Risk communication is one of the key pillars of
response to outbreaks. It refers to the real-time
exchange of information, advice and opinions
between health experts or officials and people who
face a threat (hazard) to their survival, health or
economic or social well-being. Its ultimate goal is
that everyone at risk is able to take informed
decisions to mitigate the effects a disease
outbreak and take protective and preventive action.
• Effective risk communication not only saves lives
and reduces illness (by informing people on how
to protect their health), it also enables countries and
communities to preserve their social, economic and
political stability in the face of emergencies.

HEALTH INFORMATION
Making it effective
Those affected (communities)
Those in charge (authorities or response teams)
Trust between those who know (experts),

1. Build trust: People must trust those responsible for managing the outbreak and for issuing information about it.
2. Communicate uncertainty proactively :Communication by authorities to the public should include explicit information
about uncertainties associated with risks.
3. Engage communities: Identify people that the community trusts and build relationships with them and involve them in
decision-making to ensure interventions are collaborative
4. Message well: According to the latest evidence, risk should not be explained in technical terms as this is not helpful for
promoting risk mitigation behaviours.
5. Establish and use listening and feedback systems: Use multiple means (surveys, focus group discussions, community
walk-throughs, key informants, feedback from front-line responders, partners’ and stakeholders
Ten things to know and do

Ten things
to know
and do
6. Use social media as appropriate: Social media and traditional media should be part of an integrated
strategy with other forms of communication to achieve convergence of verified, accurate information
7. Risk communication operations requires Resources: Risk communication in epidemics is a massive
operational undertaking and requires people, logistics, material and funds.
8. Treat Emergency risk communication as a strategic role, not an add-on: Emergency risk communication
should be a designated strategic role in global and national emergency preparedness and response leadership
teams.
9. Establish coordination and information systems: Develop and build on agency and organizational
networks across geographic, disciplinary and, where appropriate, national boundaries.
10. Build capacity for the next emergency: Preparation and training of personnel for emergency risk
communication should be organized regularly and focus on coordination across agencies.

Focus 3: Treating patients and protecting
the health workforce
Standard precautions
 Infection Specific Recommendations

STANDARD PRECAUTIONS
1- Hand hygiene
2- Gloves
3- Facial protection (eyes, nose, and mouth)
4- Gown
5- Prevention of needle stick injuries
6- Respiratory hygiene and cough etiquette
7- Environmental cleaning
8- Linens
9- Waste disposal
10- Patient care equipment
11- Antibiotic stewardship

1-Hand hygiene
Hand washing (40–60 sec): wet
hands and apply soap; rub all
surfaces; rinse hands and dry
thoroughly with a single use towel;
use towel to turn off faucet.
Hand rubbing (20–30 sec): apply
enough product to cover all areas of
the hands; rub hands until dry.

Before and after any
direct patient contact
and between patients,
whether or not gloves
are worn.
Immediately after
gloves are removed.
Before handling an
invasive device.
After touching blood,
body fluids, secretions,
excretions, non-intact
skin, and contaminated
items, even if gloves
are worn.
During patient care,
when moving from a
contaminated to a
clean body site of the
patient.
After contact with
inanimate objects in
the immediate vicinity
of the patient.
Summary indications

 Wear when touching blood, body fluids,
secretions, excretions, mucous membranes,
nonintact skin.
 Change between tasks and procedures on the
same patient after contact with potentially
infectious material.
 Remove after use, before touching non-
contaminated items and surfaces, and before
going to another patient.
Perform hand hygiene immediately after
removal.
2- Cloves

Wear a surgical or procedure mask and
eye protection (face shield, goggles) to
protect mucous membranes of the
eyes, nose, and mouth during activities
that are likely to generate splashes or
sprays of blood, body fluids, secretions,
and excretions.
3- Facial protection (eyes, nose,
and mouth)

Wear to protect skin and prevent
soiling of clothing during activities that
are likely to generate splashes or sprays
of blood, body fluids, secretions, or
excretions.
Remove soiled gown as soon as
possible, and perform hand hygiene.
4- Gown

Handling needles, scalpels, and
other sharp instruments or devices.
 Cleaning used instruments.
 Disposing of used needles.
5-Prevention of needle stick injuries

Cover their nose and mouth when
coughing/sneezing with tissue or
mask.
Dispose of used tissues and masks,
and perform hand hygiene after
contact with respiratory secretions.
6. Respiratory hygiene and cough etiquette
Persons with respiratory symptoms
shouldapply source control measures:

 Place acute febrile respiratory symptomatic patients at least
1 metre (3 feet) away from others in common waiting areas, if
possible.
 Post visual alerts at the entrance to health-care facilities
instructing persons with respiratory symptoms to practise
respiratory hygiene/cough etiquette.
 Consider making hand hygiene resources, tissues and masks
available in common areas and areas used for the evaluation
of patients with respiratory illnesses.
Health care facilities should:

• Use adequate procedures for the routine cleaning
and disinfection of environmental and other
frequently touched surfaces.
7- Environmental cleaning

Handle, transport, and process used linen in amanner
which:
 Prevents skin and mucous membrane exposures and
contamination of clothing.
 Avoids transfer of pathogens to other patients and or the
environment.
8- Linens

Ensure safe waste management
Treat waste contaminated with blood,
body fluids, secretions and excretions as
clinical waste, in accordance with local
regulations.
Human tissues and laboratory waste that
is directly associated with specimen
processing should also be treated as
clinical waste.
Discard single use items properly.
9. Waste disposal

• Handle equipment soiled with blood,
body fluids, secretions, and excretions in
a manner that prevents skin and mucous
membrane exposures, contamination of
clothing, and transfer of pathogens to
other patients or the environment.
• Clean, disinfect, and reprocess reusable
equipment appropriately before use
with another patient.
10. Patient care equipment

• The misuse and overuse of antibiotics can put
patients at a risk of contracting infections.
• Inappropriate antibiotic use may also result in
patients becoming resistant to some drugs. If
those patients contract an infection, it becomes
harder to treat them and the risk of it spreading
increases.
• Establishing a program to assist with
appropriate antibiotic selection and dosing. This
helps optimize patient outcomes and minimize
adverse events like C. difficile infection and
antibiotic toxicity.
11- Antibiotic stewardship

The following elements may be considered and prioritized as supplements to the core active
antimicrobial stewardship strategies based on local practice patterns and resources.
A. Education. Education is considered to be an
essential element of any program designed to
influence prescribing behavior and can provide a
foundation of knowledge that will enhance and
increase the acceptance of stewardship strategies
B. Guidelines and clinical pathways. Multidisciplinary
development of evidence-based practice guidelines
incorporating local microbiology and resistance
patterns can improve antimicrobial utilization.
C. Antimicrobial cycling. There are insufficient data to
recommend the routine use of antimicrobial cycling as
a means of preventing or reducing antimicrobial
resistance over a prolonged period of time
.Substituting one antimicrobial for another may
transiently decrease selection pressure and reduce
resistance to the restricted agent.
D. Antimicrobial order forms. Antimicrobial order
forms can be an effective component of antimicrobial
stewardship and can facilitate implementation of
practice guidelines.
E. Combination therapy. Combination therapy does
have a role in certain clinical contexts, including use
for empirical therapy for critically ill patients at risk of
infection with multidrug-resistant pathogens.
G. Dose optimization. Optimization of antimicrobial
dosing based on individual patient characteristics,
causative organism, site of infection, and
pharmacokinetic and pharmacodynamic
characteristics of the drug,

Infection Specific Recommendations
1- Cross contamination
2- Multidrug-Resistant Organisms (MDRO)
3- Urinary tract infections
4- Respiratory infections
5- Surgical site infections
6- Infections associated with intravascular devices
7- Gastrointestinal sytem infections
8- Maternity infections
9- Skin infections
10- Professional risks (bbfe, tuberculosis) and vaccination
11- Dental Infection

Cross-contamination is defined as: Transmission of
certain microorganisms (bacteria, viruses and fungi):
From the environment to a patient
From patient to patient

Isolation of infected patients
Standard precautions
Cleaning
Sterilization
5 tips to prevent cross-contamination

2- Multidrug-Resistant
Organisms

Multidrug-Resistant Organisms (MDRO) are defined as
microorganisms, predominantly bacteria, that are resistant to
one or more classes of antimicrobial agents. Although the
names of certain MDROs describe resistance to only one agent
(e.g., MRSA, VRE), these pathogens are frequently resistant to
most available antimicrobial agents.
When MDRO are
introduced into a
healthcare setting,
a number of factors
aid the
transmission and
persistence of
resistant strains in
the environment.
These include:
The presence of vulnerable patients, such as those with compromised
immunity from underlying medical or surgical conditions
The reservoir of infected or colonised patients
The selective pressure exerted by antimicrobial use
The effectiveness of local infection prevention and control measures

1. Administrative Support
2. Education
3. Judicious Use of Antimicrobial Agents
4. MDRO Surveillance
5. Infection Control Precautions
6. Environmental Measures
7. Decolonization
Management of Multidrug-Resistant Organisms in Healthcare Settings

The prevention of urinary infections relies on a global patient care approach, combining:
A global approach to hygiene for patients, healthcare providers and the
care provided.
Hydration of patients in accordance with the season, their age and
pathology.
Specific measures for care provided in the urogenital area.

Indwelling Catheter-Associated Urinary Tract infections (CAUTI) are the most frequent of
infections associated with care provided in healthcare settings
CHOICE OF CATHETER
• Catheters impregnated with
silver or an antiseptic
appear to reduce the risk of
infection, as is the case with
catheters coated with a
hydrogel.
CATHETER PLACEMENT
• Use of well tolerated
antiseptics, local
anesthesia and lubricants
as well as catheter
insertion by a well-trained
professional.
PENILE SHEATH
• Use of a penile sheath as
an alternative to
indwelling catheterization
in men without bladder
retention or obstruction,
who are able to cooperate.
INTERMITTENT
CATHETERIZATION
• The use of intermittent
catheterization, which
avoids the equipment
having to be kept in
place.

Other
precautions
 Disinfect the hands and pull the gloves on, before any manipulation of the IUC (including
emptying); disinfect the hands following removal of the gloves;
Make aseptic use of the sampling site whenever urine samples are taken;
Place the bag so as to avoid any reflux and prevent it from coming into contact with the
ground;
Empty the collector bags regularly to avoid any reflux; use a clean recipient for each
patient in order to limit contamination of the drainage cocks;
Do not put any antiseptic product in the bag, do not implement any antibioprophylaxis;
Do not systematically change the catheters, except in the case of specific indications
given by the manufacturer;
Routine personal hygiene is sufficient in the case of an IUC;
Irrigations or instillations of the bladder must not be used for the systematic prevention of
urinary infections;
It may be useful to change an IUC in the case of a urinary infection, but this change
must not be made before at least 24 hours of correctly adapted antibiotic treatment;

Bacterial infection of the
lower respiratory tract
is initiated by
colonization of the upper
respiratory tract
followed by aspiration of
small volumes of
contaminated secretions
into the lungs. Failure of
lung antibacterial
defenses results in
pneumonia. Strategies
for prevention involve:
Prevention of colonization
Avoidance of aspiration
Enhancement of lung defenses
Strategies for prevention

1- NON-MEDICINAL MEANS
Non-specific means: Use an alcohol-based handrub before and after contacting an intubated, ventilated or tracheotomized patient, before and after manipulating an artificial
ventilation device used in a patient, with or without gloves. Gloves
Pecific means:
- Intubation, respirator circuits and stomach tube The use of an oral tracheal tube is preferred in adults. The pressure in the intubation catheter balloon should be
maintained between 25 and 30 cm H2O (between 20 and 25 cm H2O in children). It is not necessary to replace respirator circuits, except when they are visibly soiled. If
filters are used, they should be replaced every 48 hours. The stomach tube should be removed as soon as possible, however its removal should weighed up against the
potential benefits of enteral feeding.
Kinesitherapy and position of the patient: The patient should be placed in a semi-seated position, as close as possible to an angle of 45°. A respiratory kinesitherapy
treatment should be carried out, even in ventilated and sedated patients.
2- MEDICINAL MEANS
Selective oral-pharyngeal and digestive decontamination :A nasal and oral-pharyngeal routine decontamination by means of an antiseptic solution should be carried out. -
In adults, SDD combined with a systemic antibiotic treatment has proven efficient in certain groups of patients. However, uncertainties still remain as to the choice and
dosage of molecules, and the duration of SDD and antibiotic treatment.
Prevention are classed according to whether they are based on medication or not.

The prevention of surgical site infections (SSIs) is centered on the perioperative period, in particular that
corresponding to the patient‘s presence in the operating room, for which the principle of increasingly
aseptic conditions is applied.
Risk factors
Terrain related factors
 Age extremes
 Underlying diseases (diabetes,
immunosuppression)
 Obesity
 Malnutrition
 Infection of another site
 Prolonged prior hospitalization
 Smoking
Factors related to the surgical
procedure
Among the risk factors related to the surgical procedure
itself, the Altemeier contamination class is the most
important.
 There are other risk factors:
 Emergency surgery
 Prolonged surgery
 Surgeon‘s experience
 Hemorrhagic surgery or difficult hemostasis
 Need for early surgical revision.

Pre-operative prevention
 PRESENCE OF A PRE-EXISTING INFECTION
This is a recognized risk factor, and the surgical procedure must be
postponed whenever possible, except when the infection is the reason for
which surgery is required.
 SCREENING FOR THE CARRIAGE OF S. AUREUS, MRSA AND OTHER
MDRO
The main risk factors associated with MRSA carriage are:
 the transfer from another hospital, in particular ECR - long term care,
or a recent hospitalization,
 patients older than 75 years,
 the presence of chronic skin wounds or lesions.
 HAIR REMOVAL
the use of a razor for skin preparation must be banned. Hair removal
using clippers may be recommended for some types of surgical
procedure.

Prevention in the operating room
 ANTIBIOPROPHYLAXIS
Antibioprophylaxis is relevant only to operations in the Altemeier
contamination classes I and II, whereas classes III and IV are relevant to
curative antibiotherapy. Its aim is to inhibit the growth of potentially
pathogenic microorganisms, present or introduced during the surgical
procedure itself.
 PATIENT’S CLOTHING IN THE OPERATING ROOM
following the preoperative shower, the patient be dressed in clean, if
possible non-woven, clothing.
 PREPARATION OF THE SURGICAL DRAPES
 Draping
Draping with waterproof drapes must protect as large a zone as possible, including the full surgical site. The drapes must
be made from a material, which is impermeable to liquids and viruses.
 Disinfection of the surgical site
The four-step preparation of the surgical site is effective in reducing the risk of SSI: cleansing with an antiseptic soap,
rinsing, drying, and disinfecting with a disinfectant of proven efficacy, which is left to dry in air.

CLOTHING OF THE SURGICAL TEAM IN THE
OPERATING ROOM The attire of personnel in the
operating room must prevent, as far as possible,
the risk of dissemination of germs from their skin
and hair. A tunic-trouser suit, with shoes
reserved for the operating room, is normally
recommended.
AIR CONDITIONING Air contamination (inert
particles and microorganisms) is the reason for
using an air-conditioning system.
DRESSING OF THE SURGICAL WOUND The most
important factor is the surveillance of the
surgical wound.

6-Infections associated
with intravascular devices

and totally implanted venous catheters (TIVC), affects an increasing number of inpatients,
regardless of their type of stay, as well as outpatients.
The initial risk is linked to the insertion, responsible for the so-called extraluminal contamination,
whereas the prolonged use of catheters induces intraluminal contamination.
The duration of catheterization has an effect on the bacteria colonization mechanism.
Intravascular devices
(IVD)
Peripheral venous catheters
(PVC)
Central venous catheters
(CVC)

 Insertion of intravascular devices
For a CVC or a TIVC, maximum barrier precautions similar to surgical asepsis (the wearing of a cap, mask
and sterile gown, surgical disinfection of the hands, extensive draping of the insertion site) are required
before insertion.
For the insertion of a PVC, the following practices are required: wearing of gloves in order to prevent blood
and body fluid exposure (BBFE), hand hygiene before insertion, and implementation of antisepsis with
alcohol-based antiseptics, preceded by a detersive cleaning phase.
 Manipulation of the intravascular device, tubing and stopcocks
In order to limit the risk of contamination, the manipulation of the IVD, tubing and stopcocks must be carried
out antiseptically, following prior disinfection of the hands.
 Removal of the intravascular device
The risk of phlebitis and colonization increases with the duration of catheterization, Because of a stable
immediate risk, a CVC may be left in place as long as is necessary for the patient's treatment

Recommendations
Insertion of intravascular devices: For a CVC or a TIVC, maximum barrier precautions similar to surgical asepsis (the
wearing of a cap, mask and sterile gown, surgical disinfection of the hands, extensive draping of the insertion site) are
required before insertion.
For the insertion of a PVC, the following practices are required: wearing of gloves in order to prevent blood and body fluid
exposure (BBFE), hand hygiene before insertion, and implementation of antisepsis with alcohol-based antiseptics,
preceded by a detersive cleaning phase.
Manipulation of the intravascular device, tubing and stopcocks: In order to limit the risk of contamination, the
manipulation of the IVD, tubing and stopcocks must be carried out antiseptically, following prior disinfection of the hands.
Removal of the intravascular device: The risk of phlebitis and colonization increases with the duration of catheterization,
Because of a stable immediate risk, a CVC may be left in place as long as is necessary for the patient's treatment

7-Gastrointestinal
sytem infections

Foodborne illness outbreaks (FIO) are defined by the
occurrence of at least two similar grouped cases of
general gastro-intestinal symptoms, the cause of which
can be traced to the same food origin. They may in
particular have symptoms in the form of vomiting,
diarrhea, or a combination of both.
The pathology may be due to the ingestion of food
contaminated by:
 a toxin,
 entero-toxin-producing or
 entero-invasive bacteria,
 as well as viruses or parasites, leading to a
proliferation, and the risk of a secondary contamination.
Foodborne illness outbreaks (FIO

Recommendations
GENERAl
MEASURES
Any patient hospitalized for infectious gastroenteritis should be maintained in an individual room until
the infectious source of the diarrhea has been eliminated.
The movement of infected patient outside their rooms (including transfers) should only be allowed when
strictly necessary.
The use of disposable gloves preceded by an alcohol-based handrub before entering the room of patients
suffering from nosocomial gastroenteritis (because the environment is often contaminated).
C. difficile Infections (CDI)
* Washing the hands with water and soap is recommended, to mechanically eliminate C. difficile
spores.
* After having been used on an infected patient, the medical equipment should be cleaned and disinfected
with a sporicidal product.
* In case of an epidemic or high incidence of CDI, it is recommended to update or implement a
purposeful antibiotics prescription policy, specifically designed to avoid the prescription of risk-prone
antibiotics (second- and third-generation cephalosporins, fluoroquinolones, clindamycin,
amoxicillin/clavulanic acid).

GENERAl
MEASURES
Gastroenteritis of viral origin
* Do not use hand showers to clean bed-pans, because of the risk of producing
contaminated aerosols;
* For enteric virus inactivation, use solutions that are active against naked viruses:
bleach or phenol derivatives such as triclosan.
* In case of a norovirus gastroenteritis, the staff in charge of biocleaning should
wear a mask.
* Group activities should be suspended (in the pediatric or geriatric departments);
* Parents must be educated in diaper handling in pediatric departments.
Recommendations

Nosocomial infections in maternity are a reality, affecting both mothers and newborns.
Main nosocomial infections and risk factors in maternity
Urinary tract infections
Surgical site infections:
Infections in newborns
Breastfeeding
Infectious risk for staff

Recommendations
 ANTIBIOTIC PROPHYLAXIS
Perform antibiotic prophylaxis for any caesarean
section, using an intravenous route and after cord
clamping. In the presence of a B streptococcus infection
risk, perform antibiotic prophylaxis as soon as possible
during delivery. When no search for the B streptococcus
has been performed, per-partum antibiotic prophylaxis
should be carried out in case of pre-term birth, rupture
of membranes after 12 hours, and for mothers with
fever above 38°C (100°F).
 Epidemiologic surveillance
Organize surveillance:
 of SSIs and endometritis in women undergoing
caesarean section;
 of UIs and endometritis for vaginal deliveries;
 of infections in neonates.

GOOD PRACTICE FOR HYGIENE AND THE PREVENTION OF INFECTIOUS RISKS
 General Hygiene Measures
 Hand hygiene
 Individual protection garments
and equipment
 MEASURES TO BE TAKEN DURING DELIVERY
 For all parturients :Restrict the number of vaginal manipulations, in particular after membrane rupture.
 Perform vaginal examinations with a sterile, disposable finger stall after membrane rupture.
 Vaginal birth: Before placing an epidural catheter, prepare the skin (detersive cleansing, rinsing, drying,
antiseptic treatment, waiting until the antiseptic has spontaneously dried)
 MEASURES DURING PREGNANCY
 Ultrasound inspection (intravaginal, abdominal): Use an
appropriate protective disposable sheath for any intravaginal
ultrasound examination.
 Vaginal birth: Before placing an epidural catheter, prepare the skin (detersive cleansing, rinsing, drying,
antiseptic treatment, waiting until the antiseptic has spontaneously dried)
 Cesarean delivery: Prepare, including the case of urgent caesarean sections, the skin of the lining
(cleansing, rinsing, drying, antisepsis), preferably with alcohol-based antiseptics.

 PREVENTING BLOOD EXPOSURE ACCIDENTS
Use double pairs of gloves for delivery, long-sleeved gloves
for uterine scar revision, and gloves to manipulate the
infant. Protect professional clothing and the face of
healthcare workers from splashing (disposable aprons,
facemasks or surgical masks with protective goggles).
 NEONATES IN THE DELIVERY ROOM
 Use an alcohol-based handrub before touching the
neonate.
 CORD CARE
Create, validate and publicize a protocol pertaining to cord
care, specifying hand hygiene, substances and materials to
be used, and the corresponding techniques.

Parasitic skin infections
Scabies
Bacterial skin infections
Staphylococcus aureus
and Streptoccocus pyogenes
Viral skin infections
Herpesviridae: (varicella,
herpes zoster, herpes)
skin infections
The superficial localization of the microorganisms leading to skin infections promotes transmission by (direct
or indirect) contact, and the general prevention of their dissemination involves the implementation of:
Standard precautions
Additional 'contact' type precautions
(cross contamination )

Recommendations
 Parasitic skin infections
 Imperatively wear non-sterile disposable gloves and a short-sleeved gown for any long-lasting continuous contact with
the patient or contaminated object.
 Handle potentially parasite-infested laundry with care, without placing it on the floor; treat it with antiparasitic
products and transfer it to the treatment service without intermediate storage.
 Bacterial skin infections
 Organize a warning system for MDROs (e.g.: MRSA) or epidemic bacteria which may lead to severe infections (e.g.
Streptococcus A.) using, when available, tools enabling rapid diagnoses, which optimize screening and early treatment.
 Viral skin infections
 Screen seronegative staff upon hiring and propose their vaccination.
 Maintain isolation until the lesions become crusty.
 Limit displacements of the index case (or cases).

10-PROFESSIONAL RISKS
(BBFE, TUBERCULOSIS)

Blood exposure accidents &Tuberculosis
Any form of contact which is percutaneous (needlestick injury, cut) or
mucous (eye, mouth), or occurs on injured skin (eczema, wound),
involving blood or a blood-containing body fluid, is defined as a blood or
body fluid exposure accident (BBFE).
Risk of transmission to the caregiver
Whatever the virus under consideration, the risk of transmission to the
caregiver following a BBFE is strongly related to the source patient's level of
plasmatic viral load at the time of the accident.
Tuberculosis (TB), a disease caused by the bacteria Mycobacterium
tuberculosis (M. tuberculosis), is spread from person to person through the
air. TB usually infects the lungs, but it can also infect other body parts such
as the brain, kidneys, or spine.

Environmental Factors that Enhance the Probability that M. tuberculosis Will Be Transmitted
Concentration of infectious bacilli Description
Space The more bacilli in the air, the more probable that M. tuberculosis
will be transmitted
Ventilation Inadequate local or general ventilation that results in insufficient
dilution or removal of infectious droplet nuclei
Air circulation Recirculation of air containing infectious droplet nuclei
Specimen handling Improper specimen handling procedures that generate infectious
droplet nuclei
Air pressure Positive air pressure in infectious patient’s room that causes M.
tuberculosis organisms to flow to other areas
Health care workers in most facilities are at high risk of becoming infected with tuberculosis
(nosocomial transmission).

Recommendations BBFE (Blood and Body Fluid Exposure)
Any BBFE (Blood and Body Fluid Exposure) must be taken care of:
IMMEDIATELY:
 wash and disinfect the wound (in case of pricking) or the contaminated area (in case of splattering);
 contact the source patient's physician to know whether he/she is infected by, or is at risk of being infected by HIV;
WITHIN AN HOUR: contact a referring physician (or, if not available, the emergency physician) to assess the risk of transmission; if the
source patient's HIV serology is unknown, propose serology screening (with the patient's agreement), in particular, by means of a quick
test;
WITHIN AN HOUR:
 inform the professional about the administered medications (intake modalities, duration, side effects...) and ensure that this
information is well understood,
 inquire about the exposed professional's immune status with respect to HBV,
 if the source patient has been identified, document his/her CHV serology at the same time as HIV, as well as his/her HBV serology,
if the exposed professional has not been vaccinated or is not immunized,
 recommend protection (protected intercourse) and prohibit blood donation until the three-month serology check-up (or four months
in case a PET has been prescribed);
WITHIN 24 HOURS:
- report the occupational accident,
- suggest contacting the occupational physician for the follow-up,

 The BCG vaccination of professionals and students in the mentioned healthcare and social sectors (listed in the
appendix of the notice) should no longer be compulsory, but that the tuberculosis test should be maintained as the
reference test on hiring.
 Any case of potentially contagious tuberculosis (pulmonary and otorhinolaryngology tuberculosis with a positive
culture) should be reported by the clinical department and/or laboratory, to the staff's occupational healthcare
department and to the ICT, in order to check whether the isolation measures have been applied and, if necessary, to
carry out a survey.
 Any patient with suspected tuberculosis of the respiratory system should be geographically isolated (in a single room).
 When the patient must move out of his/her room, he/she should first put on a surgical mask.
 Healthcare workers should be trained in the wearing of a mask. Each professional should know how to perform a "fit-
check": obdurate the filtering surface, inhale and make sure the mask is drawn to the face (because of the suction
effect); this should be performed when putting on the mask.
Recommendations Tuberculosis

Vaccination of healthcare
professionals
• The management of infectious risk in
healthcare settings cannot be based solely on
hygienic measures taken on a case-by-case
basis, depending on the risks identified in each
patient, but must also involve systematic
procedures, both in terms of hygiene, whilst
observing the "standard" precaution principles,
and in terms of preventative vaccinations.
• The vaccination of healthcare workers against
infectious agents is part of a global nosocomial
infection prevention methodology and involves
the prevention of both caregiver-to-patient, and
patient-to-caregiver infections.

Vaccination Status Target/Indication Immunization conditions Booster vaccination
Hepatitis B Compulsory
Full vaccination = 3 injections (0-1-6 plan).
Maximum of 6 injections if no response
All professionals in contact with patients or
biological samples
Anti-HbS Ab > 10 None
DT Polio Compulsory All None Every 10 years with a reduced dose of
diphtheria toxoid
Typhoid Compulsory Exposed laboratory staff None Every 3 years
BCG/
Tuberculosis
Pertussis Recommended All One injection at the time of a DTP
booster
None
Influenza Recommended Anyone in contact with patients at risk Every year
Varicella Recommended Non-immunized personnel working in a risk-prone
sector (mater., neonat., infect. diseases,
immuno./hemato., immunosupressed)
No immunity check
Rubella Recommended Not immunized for more than 25 years and with
no rubella history
None
MMR vaccination = 1 injection
No booster
Table summarizing vaccinations for healthcare professionals
French National Guidelines – Surveillance and Prevention of HAI – SF2H – 2010

1- Education and Training: Personnel are more likely to comply with an infection-control program and exposure-control plan if they
understand its rationale. Clearly written policies, procedures, and guidelines can help ensure consistency, efficiency, and effective
coordination of activities.
2- Immunization Programs: Immunization of DHCP before they are placed at risk for exposure remains the most efficient and
effective use of vaccines in health-care settings.
3- Exposure Prevention and Postexposure Management: A combination of standard precautions, engineering, work practice, and
administrative controls is the best means to minimize occupational exposures.
4- Medical Conditions, Work-Related Illness, and Work Restrictions: DHCP are responsible for monitoring their own health status.
DHCP who have acute or chronic medical conditions that render them susceptible to opportunistic infection should discuss with
their personal physicians or other qualified authority whether the condition might affect their ability to safely perform their duties.
5- Preventing Transmission of Bloodborne Pathogens: Exposure to infected blood can result in transmission from patient to DHCP,
from DHCP to patient, and from one patient to another. The majority of attention has been placed on the bloodborne pathogens
HBV, HCV, and HIV, and these pathogens present different levels of risk to DHCP
6- Exposure Prevention Methods: Avoiding occupational exposures to blood is the primary way to prevent transmission of HBV,
HCV, and HIV, to HCP in health-care settings.
Recommendations

1- Education and
Training
2- Immunization
Programs
3- Exposure Prevention
and Postexposure
Management
4- Medical Conditions,
Work-Related Illness,
and Work Restrictions
5- Preventing
Transmission of
Bloodborne Pathogens
6- Exposure Prevention
Methods

7-Postexposure Management and Prophylaxis: A qualified health-care professional should evaluate any occupational exposure incident
to blood or OPIM, including saliva, regardless of whether blood is visible, in dental settings.
8- Hand Hygiene: Hand hygiene (e.g., handwashing, hand antisepsis, or surgical hand antisepsis) substantially reduces potential
pathogens on the hands and is considered the single most critical measure for reducing the risk of transmitting organisms to patients
and HCP.
9- Selection of Antiseptic Agents: Selecting the most appropriate antiseptic agent for hand hygiene requires consideration of multiple
factors.
10- Storage and Dispensing of Hand Care Products: Handwashing products, including plain (i.e., nonantimicrobial) soap and antiseptic
products, can become contaminated or support the growth of microorganisms. Liquid products should be stored in closed containers
and dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling.
11- Lotions: Dental practitioners should obtain information from lotion manufacturers regarding interaction between lotions, gloves,
dental materials, and antimicrobial products.
12- Fingernails and Artificial Nails: Freshly applied nail polish on natural nails does not increase the microbial load from periungual skin
if fingernails are short; however, chipped nail polish can harbor added bacteria (165,166).
13- Personal Protective Equipment: PPE is designed to protect the skin and the mucous membranes of the eyes, nose, and mouth of
DHCP from exposure to blood or OPIM.
Recommendations

7-Postexposure
Management and
Prophylaxis
10- Storage and
Dispensing of Hand
Care Products
8- Hand Hygiene
9- Selection of
Antiseptic Agents
11- Lotion
12- Fingernails and
Artificial Nails
13- Personal Protective
Equipment

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