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Dr . Ashraf Selim
Consultant in Oral Surgery
Member in IFIC , ESIC , EDA
Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
In 1969, the Joint
required hospitals to
Dr.T.V.Rao MD 2
Changing Demands on Infection
Today's ICP needs
statistics, patient care
Staff Training in ICP
Education programs for employees
are one method to ensure competent
infection control practices.
It is a unique challenge since
employees represent a wide range of
expertise and educational
The ICP must become knowledgeable
in adult education principles and use
educational tools and techniques that
will motivate and sustain behavioral
CHAIN OF INFECTION
Portal of entry
Modes of Transmission
Vertical transmission (mother to infant)
INFECTIOUS DISEASE DETERMINANTS
1. Virulence (pathogenic properties)
2. Dose (number of microbes)
3. Resistance (body’s defense mechanism)
4. I C Procedures Affect ……?
October 18, 2000:
Consideration of all patients as being infected
with pathogens and therefore applying IC
procedures to the care of all patients
Treat every patient as though infected with
The Same IC Procedures Are Used For ALL
Standard Precautions in Health Care Settings
1. Appropriate hand hygiene
2. Barrier protective equipment:
– if splash, splatter, or sprays can be reasonably
– choose appropriate PPE as needed: gloves, gown,
mask, eye protection (face shield, goggles)
3. Proper use and handling of patient care equipment
4. Proper environmental cleaning and disinfection.
5. Proper Handling of Linen
6. Adherence to Blood-borne Pathogens Standards
7. Proper patient placement
8. Respiratory Hygiene/Cough Etiquette
9. Safe injection practices
Transmission of Infections
• Droplets: land directly on mucosal lining of nose,
mouth, eyes of nearby persons or can be inhaled.
• Highest exposures within 3-6 feet.
• Airborne: aerosols become smaller by evaporation;
small aerosols (≤ 5 microns) remain suspended for
longer periods, if inhaled travel deep into the lungs.
• Contact: Aerosols/ secretions contaminate nearby
surface. Touch surfaces can infect self or others.
Relative contribution of three routes varies with agent.
Expanded Isolation Precautions:
When standard precautions are not enough
Additional measures based on mode of
Hierarchy of Infection Prevention and Control Measures
Elimination of Potential
Elimination of Potential Exposures
• Example: patients with mild influenza
like illness stay home
• Physically separates the employee from the
• Does not require employee compliance to be
–Physical barriers at Triage
–Airborne infection isolation room for patients
with known or suspect airborne infectious
Administrative Controls/ Workplace
• Policies, procedures, and programs that minimize
intensity or duration of exposure
• signs on door of an airborne isolation room
• triage, mask symptomatic patient
• provide tissues/ masks/hand sanitizer to
• Standard procedures/ behaviors in caring for
patients e.g. hand hygiene, HCW vaccination
• Only as good as enforcement
Personal Protective Equipment
• Lowest level of hierarchy - requires employee
compliance for efficacy
• Means higher elements of hierarchy fail to
adequately protect employee
• May involve use of gowns, gloves, eye/splash
protection or respirators
• Last line of defense
Face Masks vs. N95 Respirators
• Loose fitting, not designed to
filter out small aerosols
• Place on coughing patient
• HCW should wear mask to
– protect patient during
certain procedures (e.g.,
– protect HCW
• droplet precautions
• Mask + goggles for
• Tight fitting respirator,
designed to filter the air
• Protects the wearer
• HCW should wear when
transmission by airborne
Personal Protective Equipment
Gown & Gloves for all patient interactions
Don PPE on entry, discard before exiting
room. (in addition to Standard
Examples: MRSA, C difficile, Norovirus, other
GI pathogens, RSV, antibiotic-resistant
Single room preferred, no special ventilation
Patient: Mask if transport necessary. Instruct on
respiratory hygiene/cough etiquette
HCWs wear surgical or procedure mask within 6
feet of patient. Eye protection if splash, spray
(in addition to Standard Precautions)
Airborne Infection Isolation Room (AIIR) if available
Patient: Mask if transport necessary (as tolerated).
Health care workers (HCWs):
N95 respirator prior to entry into room, discarded
Hand hygiene before & after don/doff.
Alert others if need to transfer
(in addition to Standard Precautions)
Separation of a person or group of persons
infected or believed to be infected with a
contagious disease to prevent the spread
of infection (usually associated with
hospital setting) ( Source Isolation .
Protective Environment is a special type of
isolation to protect immunocompromised
Goal of Isolation (Protection of / from)
Management of Environmental Surfaces
1. Cleaning and disinfecting non-critical surfaces in
patient-care areas are part of Standard
2. In general, these procedures do not need to be
changed for patients on Transmission-Based
3. The cleaning and disinfection of all patient-care
areas is important for frequently touched surfaces,
especially those closest to the patient.
4. Also, increased frequency of cleaning may be
needed in a Protective Environment to minimize
5. In general, use of the existing facility
detergent/disinfectant is sufficient to remove
pathogens from surfaces of rooms where
colonized or infected individuals were housed this
includes those pathogens that are resistant to
multiple classes of antimicrobial agents (e.g. MRSA
6. Certain pathogens (e.g., rotavirus, noroviruses,
C. difficile) may be resistant to some routinely
used hospital disinfectants so higher
concentrations may be needed.
Airborne Infectious Isolation Room
1. Negative Pressure room (suit ) with or without
Anteroom and inside bathroom .
2. Minimum Differential Difference ≥ 2.5 Pascal
3. 12 ACH .
4. Minimum leakage maximum 1 inch under room
5. Air is exhaust to outside (No Recirculation ) OR
must pass through HEPA filter in case of
6. Pressure sensor with alarm is a must .
The optimum number of isolation rooms per
facility ranges from 1 per 30 / 100 bed in
general hospital .
In Acute care 1 per 5 bed ( ICU , NICU )
Verifying Negative Pressure
1- Smoke Tube Test
2- Tissue Test
A thin strip of tissue should
be held parallel to the gap
between the floor and
bottom of the door. The
direction of the tissue‘s
will indicate the direction of
It is the engineering and design intervention that
deceases the risk of exposure to environmental fungi
for severely Immunocompromised Allogenic
Hematiopoietic stem cell Transplant (HSCT) during
their highest risk phase usually the first 100 day and
solid organ transplant.
1. Positive pressure room in relation to
corridor with inside bathroom with
minimum 8 Pascal .
2. > 12 ACH is required .
3. Well sealed room.
4. Supply air must pass through HEPA filter.
5. Directed room airflow with air supply on
one side of the room that moves air
across the patient bed and out through
an exhaust on the opposite side of the