Lecture for undergraduate nursing students

1. Concepts of Infection
Control
Prepared by: Zuhair Rushdi Mustafa
Lecturer
University of Duhok/College of
Nursing

2. Patient may acquire infection before admission to the
hospital which is called Community acquired
infection.
Patient may get infected inside the hospital which is
called Nosocomial infection (NI).
Nosocomial infection includes:
1. infections that appear more than 48 hours after
admission.
2. those acquired in the hospital but appear after
discharge
3. also occupational infections among staff.
The risk of infection is always present.
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3. INFECTION
• Definition:
Injurious contamination of body or parts of the body by bacteria, viruses,
fungi, protozoa and rickettsia or by the toxin that these microorganisms
may produce.
- Infection may be local or generalized and spread throughout the body.
- Once the infectious agent enters the host it begins to proliferate and
reacts with the defense mechanisms of the body producing infection.
-Signs and symptoms of infection include: pain, swelling, redness,
functional disorders, rise in temperature and pulse rate and increase
White blood cells. 3

4. A Nosocomial Infection
• known as a hospital-acquired infection
(HAI)
• Is an infection whose development from
hospital environment,
• such as one acquired by a patient during a
hospital visit or one developing among
hospital staff.
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5. Frequency of Nosocomial infection
 Nosocomial infections occur worldwide.
 The incidence is about 5-8% of hospitalized patients,
1/3 of which is preventable.
 The highest frequencies are in East Mediterranean
and South-East Asia.
 A high frequency of N.I. is evidence of poor quality
health service delivered.
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6. Impact of Nosocomial Infection
They lead to functional disability and emotional
stress to the patient.
They are one of the leading causes of death.
The increased economic costs are high:
Increased length of hospital stay, extra
investigations, extra use of drugs and extra
health care by doctors and nurses.
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7. Organisms causing N.I. can be transmitted to
the community through discharged patients,
staff and visitors.
If organisms are multi-resistant they may cause
significant disease in the community.
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8. • ANTIBIOTIC-RESISTANT ORGANISMS
• The two most common antibiotic-resistant
organisms are MRSA (methicillin-resistant
staphylococcus aureus) and VRE (vancomycin-
resistant enterococcus).
• Other multidrug resistant organisms (MDRO) also
exist and are becoming more common.
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9. Nosocomial Infection Cost
An estimated 1 to 4 extra days for a urinary tract
infection, 7 – 8 days for a surgical site infection,
7 – 21 days for a blood stream infection, and 7 – 30
days for pneumonia.
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10. Nosocomial Infection Sites
 Urinary tract infection: most common type of N I (30-40% of
reported cases), associated with an indwelling urinary catheter
or instrumentation.
 Lower respiratory (15%) and surgical wound infections are the
next (15%).
 Less frequent include bacteraemia (5%), intravenous site
infection, gastrointestinal tract and skin infections.
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11. Factors Influencing N.I.
Patient susceptibility
Environmental factors
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12. Patient Susceptibility
Age: infants and old age have
decreased resistance to infection.
Immune status: Patients with chronic diseases
as malignancy, leukaemia, diabetes mellitus, renal
failure or AIDS have increased susceptibility to
infection.
Immunosuppressive drugs or radiation Therapy
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13. Environmental Factors
Crowded conditions within hospital
Frequent transfers of patients between units.
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14. Methods of Transmission of Nosocomial infection
 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 N.I. Are caused by this
way.
 Exogenous cross-infection: Mainly through hands
of healthcare workers, visitors, patients.
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15. Methods of prevention of Nosocomial
infection
1. Use aseptic technique /sterile technique
2. frequent hand washing especially between
patients
3. careful handling, cleaning, and disinfection of
equipment
4. use of single-use disposable items
5. identification of clients at risk for infections
6. patient isolation
7. Air filtration within the hospital (environmental
controls)
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16. Components of Infection Control
Three major components of Infection Control are:
1.Asepsis –
 Hand washing,
 Disinfection
 Sterilization
2.Body Hygiene -- personal hygiene
3.Caring Attitude -- a good sense of right and wrong
essential to the practice of the components of
infection control.
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17. Asepsis
• The state of being free of pathogenic microorganisms.
• The process of removing pathogenic microorganisms.
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18. HANDWASHING
Hand washing is the single most effective precaution for
prevention of infection transmission between patients and
staff.
• Handwashing remains the best method to decontaminate
hands.
Hand washing with plain soap is mechanical removal of
soil and transient bacteria (for 10- 15 sec.)
Hand antisepsis is removal & destroy of skin bacteria by
using anti-microbial soap or alcohol based hand rub (for
15 sec.) 18

19. When to Wash our Hands
1. Before & after an aseptic
technique or invasive procedure.
2. Before & after contact with a patient or
caring of a wound or IV line.
3. After contact with body fluids & blood.
4. After handling of contaminated equipment.
5. Before the administration of medicines
6. When hands are visibly dirty.
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20. 7. Before and after eating, drinking, smoking, applying cosmetics,
using toilet, or preparing food.
8. At the beginning and end of duty.
9. Before and after putting on gloves. Gloves cannot substitute
hand washing.
10. Between patient contacts.
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21. Alcohol-based hand rub are not a substitute for
handwashing.
# Alcohol-based hand rub can be used when soap is
not readily available, but hands should be washed
as soon as possible after using alcohol-based rub
not a substitute
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22. • Differences between handwashing and surgical scrub.
handwashing surgical scrub
1. Play wedding band may be worn. All hand jewelry, including watch, is
removed
2. Faucets with hand control are used;
elbow, knee,, or foot controls are
preferred.
Faucets are regulated with elbow, knee, or
foot controls.
3. Liquid, bar, or powder soap or
detergent is used.
Liquid antibacterial soap is used.
4. Washing lasts a minimum of 10 to 15
seconds.
Scrubbing lasts 2 to 5 minutes.
5. Hands are held lower than the elbows
during washing, rising, and drying.
Hands are held higher than elbows during
washing, rising, and drying.

23. handwashing surgical scrub
6. Area beneath the fingernails
are washed
Area beneath the fingernails are
cleaned with an orange stick or
similar nail cleaner.
7. Friction is produced by
rubbing the hands together.
Friction is produced by scrubbing
with a sponge and hand brush.
8. Hands are dried with paper towels;
the paper is used to turn off hand-
regulated faucet controls.
Hands are dried with sterile towels

24. surgical scrub
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25. sterilization
• Sterilization is a process intended to kill all
microorganisms and is the highest level of
microbial kill that is possible
• Sterilizers may be heat only, steam (e.g., a
steam autoclave), or liquid chemical
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26. Disinfection
• Refers to the use of liquid chemicals on
surfaces and at room temperature to kill
disease causing microorganisms.
• Disinfection is a less effective process than
sterilization because it does not kill
bacterial spores
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27. Antiseptics
• Are antimicrobial substances that are applied to
living tissue/skin to reduce the possibility of
infection, sepsis, or putrefaction
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28. Types of Antiseptic solution and indications of them:
1. Iodine : to clean deep and contaminated wound
2. Povidone Iodine: use to clean the wound, clean
injection site and surgical site.
3. Hebitaine (chlorohexadine) : use to clean
contaminated wound with dirt, clean the injection site,
clean the burn, and use as a surgical soup for surgical
scrubbing. Has pink color. Called surgical soup.
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29. 4. Ethyl alcohol 70%: use to clean small wound, and
clean the injection site and hand rubbing ( hand
washing).
5. Hydrogen Peroxide (H2O2): use to clean deep
contaminated wound like amputation.
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30. Surgical asepsis
• Is a sterile technique that use different precautions
• It includes procedures used to eliminate all microorganisms
including pathogens and spores, from an object or area.
• Surgical asepsis procedures are followed when performing
an invasive procedure into a body cavity.
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31. Surgical Asepsis
Basic Principles of Surgical Asepsis
• Sterile can touch only sterile If Un-sterile touches sterile =
contaminated
• Outside of sterile package is contaminated
• Inside of sterile package is sterile
• Open sterile package by making sure the first edge is away
from you.
• Do not spill on a sterile field
• Hold objects above waist
• Do not reach over field
• If in doubt, treat as contaminated
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32. Barrier Precautions
1. Gloves:
Disposable (or clean) gloves must be worn when:
a) Direct contact with Blood/Body Fluids is expected.
b) Examining a non-intact skin e.g wound dressing.
c) Examination of oropharynx, Gastrointestinal tract,
and dental procedures.
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33. Sterile gloves are used for invasive procedures.
GLOVES MUST BE of good quality, suitable size
and material. Never reused.
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34. 2) Masks & Protective eye wear:
• MUST BE USED WHEN:
engaged in procedures likely
to generate droplets
of Blood and Body Fluid.
• During surgical operations to protect wound from
staff breathings, …
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35. 3) Gowns:
Are required when:
• splashing of blood or body
fluids is anticipated e.g
surgical procedures.
• Gowns must not permit blood or body fluids
to pass through.
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36. Sharp Precaution
 Needle and sharp injuries carry the
risk of blood born infection e.g AIDS, HCV,HBV
and others.
 NEVER TO RECAP NEEDLES
 Dispose of used needles and small
sharps immediately in puncture resistant
boxes (sharp boxes).
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