Infection prevention and control is everybody's business! It is an essential, though often under-recognised and under supported part of the infrastructure of health care. However it saves lives and prevents avoidable morbidity and mortality. This presentation highlights the importance and the practical components of infection prevention and control in the hospital setting.

1. INFECTION
PREVENTION
&
CONTROL
DR KD DELE
DEPT FAMILY MEDICINE
DORA NGINZA
HOSPITAL

3. INTRODUCTION:
WHAT IS
INFECTION
CONTROL?
Infection control is the discipline concerned with
preventing nosocomial or healthcare associated
infection.
Infection control and hospital epidemiology = public
health practice but practiced within the confines of a
particular health care delivery system (rather than
directed at general population.)
It includes all activities, procedures and policies
designed to reduce the spread of infections, usually
within the healthcare facilities.

4. INTRODUCTION:
WHAT IS
INFECTION
CONTROL?
It is an essential, though often under-
recognised and under-supported part of the
infrastructure of health care.
It is part of every healthcare workers’ duty of
care to ensure that no harm is done to
patients, visitors or staff.
All healthcare workers require at least basic
understanding of infection control and
prevention principles and practices.
Infection Control is Everyone’s Business!

5. GOALS OF INFECTION PREVENTION AND CONTROL (IPC)
ESSENTIALLY: Infection control refers to
the policy and procedures implemented to
control and minimize the dissemination of
infections in hospitals and other healthcare
settings with the main purpose of reducing
infection rates.
Primary goals of infection control and
prevention programme :
• To prevent susceptible patients acquiring
pathogenic micro-organisms.
• To limit spread of antimicrobial resistant
infections.

6. IMPORTANCE OF
INFECTION
PREVENTION AND
CONTROL (IPC)
Healthcare facilities are places where sick people congregate, creating
many opportunities for micro-organisms to spread patients, visitors
and healthcare workers.
Medical care is also increasingly complex, with multiple, invasive
procedures increasing the risk of healthcare-associated infections.
Many of these healthcare-associated Infections are preventable.
Research has shown that the infection prevention and control
programmes can make healthcare safer and more affordable by
preventing the suffering, loss of life and cost caused by healthcare-
associated infections.

7. IMPORTANCE OF INFECTION PREVENTION AND CONTROL (IPC)
Hospital acquired
infections are a
common problem –
prevalence about 9%
Hospital acquired
infections contribute to
antimicrobial resistance
(AMR)
Overuse of
antimicrobials ---
(development of AMR)
Poor infection control
practices --- (spread)
Poor or absent infection
control practices,
especially in intensive care
units, results in cross-
transmission of antibiotic-
resistant bacteria.
Resistant bacteria
prompts even greater
antibiotic use by
physicians.

8. IMPORTANCE OF IMPORTANCE OF INFECTION PREVENTION AND
CONTROL (IPC)
Hospital-acquired infections
increase the cost of health
care
(World Bank studies have
shown that two-thirds of
developing countries spend
more than 50% of their health
care budgets on hospitals)
Effective infection control
programs are beneficial: They
decrease spread of
nosocomial infections,
morbidity, mortality, and
health care costs.
Improved perception by
physicians re: poor
sterilization, disinfection, or
patient care practices prompts
increased antibiotic use
(e.g., broad spectrum and
prolonged surgical prophylaxis
to prevent infections).

9. INFECTION
PREVENTION &
CONTROL
PROGRAMME

10. COMPONENTS OF INFECTION AND PREVENTION PROGRAMME
The basic principles apply globally.
However, each country and individual healthcare facility will need to
adapt and add to the core elements based on factors such as:
• their specific circumstances like
• differences in patient population,
• infectious disease profile and
• type of healthcare services delivered.

11. COMPONENTS OF
INFECTION AND
PREVENTION
PROGRAMME
A mandate to implement best- practice standards and
guidelines.
A strong education component, involving all categories of
healthcare workers.
Skilled infection prevention and control practitioner( usually
nurses, occasionally doctors) who coordinates the programme
activities and develop, revise, audit and implement policies.
Surveillance for healthcare- associated infections and
outbreaks.
Accountability for infection prevention and control and
integration of the program as an essential part of healthcare
with direct links to clinical and nonclinical services(e.g.,
healthcare facility management and support services)

12. FUNDAMENTAL CONCEPTS IN IPC
Infection Control
The process by which health care facilities
develop and implement specific policies and
procedures to prevent the spread of
infections among health care staff and
patients
Nosocomial Infection
An infection contracted by a patient or staff
member while in a hospital or health care
facility (and not present or incubating on
admission)
Disinfection
The process of microbial inactivation that
eliminates virtually all recognised pathogenic
microorganisms, but not necessarily all
microbial forms (e.g., spores)
Sterilization
The use of physical or chemical procedures
to destroy all microbial life, including large
numbers of highly resistant bacterial
endospores. Procedures include:
Steam sterilization
Heat sterilization
Chemical sterilization

13. MAIN ACTIVITIES PERFORMED BY HEALTHCARE PRACTITIONER
Organising
surveillance for
healthcare-
associated
infections
Providing advice
and leadership In
outbreak
investigations
Developing and
delivering training
IPC to healthcare
workers.
Developing and
implementing
infection control
related policies
and procedures
Auditing the quality
and effectiveness
of healthcare
facility
environmental
cleaning.
Auditing the quality
and effectiveness
of disinfection and
sterilization
practices.
Implementing local,
national and
international best-
practice guidelines of
infection transmission
in clinical care
In many countries,
has other duties
such as seeing to
occupational
health and quality
management.
Term quality
management refers to
all activities related to
quality planning,
assurance, quality
control and
improvement

14. KEY INDICATORS FOR INFECTION PREVENTION AND CONTROL
PROGRAMMES
Compliance indicators:
These rate how well local or national Department of health guidelines are being followed e.g., percentage of
hand wash basins in a facility with soap, water and towels available.
Process indicators:
These rate how well individuals follow facility- based guidelines but may also include how many individuals were
trained on local infection control and prevention.
Outcome indicators:
These measure the outcome that infection control programmes are trying to prevent, healthcare- associated
infections, e.g., the facility’s infection rate from surgical site infections, urinary tract infections in catheterised
patients and rate of antibiotic resistance infections.

15. 5 STEPS TO IMPROVE QUALITY OF INFECTION CONTROL
 Step 1: Prepare for action.
 Step 2: Make a baseline assessment
 Step 3: Develop and execute an action plan
 Step 4: Evaluate the impact of the plan on the service
 Step 5: Sustain the programme over

16. INFECTION CONTROL PRINCIPLES AND PRACTISES
 They include:
1. Hand hygiene
2. Personal protective equipment (PPE)
3. Waste disposal
4. Respiratory hygiene (cough etiquette)
5. Cleaning and disinfection
6. Safe injection practices
7. Needlestick and sharps injury prevention
8. Isolation

17. HAND HYGIENE

18. HAND HYGIENE
 Hand hygiene is now regarded as one of the most important element of infection control activities
 Practicing hand hygiene is a simple yet effective way to prevent infections.
 Cleaning your hands can prevent the spread of germs, including those that are resistant to
antibiotics

19.  They evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600- bed
healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20
million.
 : The facility survey was carried out in all 46 clinical units of the hospital.
 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least
one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying
facilities.
 A total of 406 HH opportunities were observed among 175 HCWs.
 The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students.
 Based on WHO “5 moments” for HH, average compliance was 21% before patient contact, 23% before aseptic
procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients’
surrounding.
 Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70–
112.88).
 Conclusions: Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor.
Source: https://aricjournal.biomedcentral.com/track/pdf/10.1186/s13756-020-0693-1.pdf

20. USE OF GLOVES
 Sterile gloves-for procedures requiring
sterile field, normally sterile body part
 NON sterile gloves-procedures other
than the above
 General purpose utility gloves-for
housekeeping and cleaning
 Gloves should be changed
 After each contact with patient
 When damaged
 After completion of any task
 After caring patients

21. PROTECTIVE EYEWEAR AND
FACE SHIELDS
Always during procedures with
potential splashing, splattering
or spraying of blood
Or any other body
fluids/substances

22. WASTE DISPOSAL
AND SPILLAGE
 Cytotoxic waste
 Pharmaceutical waste
 Chemical waste
 Radioactive waste

23. ANTIMICROBIAL STEWARDSHIP
 MULTIDISCIPLINARY = this includes infectious disease physician, clinical pharmacist with infection
training
 Clinical microbiologist
 Infection control professional
 Hospital epidemiologist
 Involvement of the administration with their buy in to the program is essential for the success of
any stewardship program.
 Close collaboration between the antimicrobial stewardship team, microbiology lab, hospital
pharmacy and infection control team should be maintained.

24. TRAINING OF
STAFF
Effectiveness of staff education
Bedside education
Education of new staff
Ongoing education HCW
Periodic safety and operational inspection
should be done by building services department.

25. COMPLIANCE MONITORING
Should be done in stringent manner
Non-compliance to a single measure
should be interpreted as failure to
comply

26. NOSOCOMIAL
INFECTION

27. HAI (HOSPITAL-ACQUIRED / HEALTHCARE-ASSOCIATED INFECTIONS)
 Hospital-acquired infections (HAIs), also known as nosocomial infections, are often caused by
bacteria and other pathogens that are prevalent in a healthcare environment.

28. HAI (HOSPITAL-
ACQUIRED /
HEALTHCARE-
ASSOCIATED
INFECTIONS)
 All hospitalized patients are susceptible to contracting a
nosocomial infection
 Some patients are at greater risk than others: young
children, the elderly, and persons with compromised
immune systems.
 Other risk factors are long hospital stays, the use of
indwelling catheters, failure of healthcare workers to
wash their hands, and overuse of antibiotics.
 Infections can be associated with other invasive devices
and medical procedures, such as catheters, ventilators,
central lines, et cetera..

29. FACTORS THAT
FACILITATE HAI
 Lack of training in basic infection control
 Lack of an Infection Control infrastructure and poor
Infection Control practices (procedures)
 Inadequate facilities and techniques for hand hygiene
 Lack of isolation precautions and procedures

30. CAUSES OF HAI
•Invasive devices and procedures
•Complex surgical procedures
•Interventional obstetric practices
•Intravenous catheters, fluids, and medications
•Urinary catheters
•Mechanical ventilators
Use of advanced and complex treatments without adequate training and
supporting infrastructure, including—
Inadequate sterilization and disinfection practices and inadequate
cleaning of hospital

31. TYPES OF HAI
 Some of the most common types of HAIs include the
following:
 Central Line-associated Bloodstream Infection
(CLABSI)
 Methicillin-resistant Staphylococcus aureus (MRSA)
 Catheter-associated Urinary Tract Infections (CAUTI)
 Surgical Site Infections (SSI)
 Clostridium difficile
 Ventilator-associated Pneumonia (VAP)
 Escherichia coli (E coli)

33. SOURCE: WHO Fact Sheet on Patient Safety https://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

34. MORE ON
EPIDEMIOLOGY
 In American hospitals, the Centres for Disease Control
(CDC) estimates that HAIs account for an estimated 1.7
million infections and 99,000 associated deaths each
year.
 32 percent of all healthcare-acquired infection are
urinary tract infections
 22 percent are surgical site infections
 15 percent are pneumonia
 14 percent are bloodstream infections
 (https://patientcarelink.org/improving-patient-
care/healthcare-acquired-infections-hais/) 2020

35. STUDY
 A total of 448 paediatric patients were followed
for 3227 patient days.
 The median age of the patients was 8 months
(IQR: 2–26 months).
 The incidence rate of HAIs was 17.7 per 1000
paediatric days of follow-up; while the overall
cumulative incidence was 12.7% (95% CI 9.8% to
15.8%) over 8months.
 Children who stayed greater than 6 days in the
hospital (median day) (adjusted risk ratio (RR):
2.58, 95%CI 1.52 to 4.38)
 children with underlying disease conditions of
severe acute malnutrition (adjusted RR: 2.83,
95%CI 1.61 to 4.97) had higher risks of developing
HAIs.
 The overall cumulative incidence of HAIs was
about 13 per 100 admitted children.
(Source:
https://bmjopen.bmj.com/content/10/12/e037997)

36. STRATEGIES

37. SURVEILLANCE
OF HAI
 Surveillance in public health is defined as the ongoing
systematic collection, analysis, interpretation and
dissemination of data regarding a health-related event
for use in public health action to reduce morbidity and
mortality and to improve health.
 Focuses on data collection that is used to measure
success of infection prevention and control programs to
identify areas of improvement.
 It is one of the most important functions of a hospital
infection control program.

38. CORE
STRATEGIES TO
REDUCE HAI
 To ensure appropriate hand washing techniques:
 Provide sinks, clean water, and soap at convenient
locations
 Where sinks, clean water, and hand washing supplies
are unavailable,
 Use alcohol-based products which are inexpensive,
produced locally, convenient, and effective for hand
hygiene.
 Monitor compliance
 Use gloves when necessary – almost always!
 Monitor patients at risk – extremes of age, mechanical
ventilation, prior antibiotics/prior hospitalisation in the
referral centre, indwelling catheters, prolonged hospital
stay

39. ISOLATION AND
STANDARD
PRECAUTIONS TO
REDUCE HAI
 Whenever possible, avoid crowding
wards.
 Implement specific policies and
procedures for patients with
communicable diseases:
 Private rooms and wards for patients
with specific diseases
 Visitation policies
 Hand washing and use of gloves
 Gowns, when appropriate
 Masks, eye protection, gowns
 Precautions with sharp instruments
and needles

40. ISOLATION

41. ISOLATION
Isolation precautions should be used for patients
who are either known or suspected to have an
infectious disease, are colonised or infected with
a multi-resistant organism or who are particularly
susceptible to infection.
It is important that standard infection prevention
and control precautions are implemented at all
times and all patients must be assessed on
admission to ensure that they are placed in
appropriate isolation if necessary.

42. ISOLATION: ASSESS NEED FOR ISOLATION
 Patients with certain conditions must be isolated immediately for example:
 Diarrhoea and/or vomiting
 Undiagnosed rashes and fevers
 Known Carbapenem Producing Enterobacteriaceae (CPE) patients/carriers
 Suspected or confirmed Group A streptococcal infection (i.e. necrotizing fasciitis)
 Patients shedding Methicillin-resistant staphylococcus aureus (MRSA)
 Patients with Glycopeptide-resistant enterococci (GRE)
 Patients admitted from an outside hospital who may be infected/colonised with resistant
micro-organisms
 Bacterial meningitis
 Other Known communicable disease

43. ISOLATION: ASSESS TYPE OF ISOLATION
PROTECTIVE ISOLATION – to reduce chances of acquiring opportunistic
infections
SOURCE ISOLATION – aims to confine the infectious agent and prevent
its spread from one patient to another.
Source isolation was previously known as ‘barrier nursing’.

44. ISOLATION: ASSESS TYPE OF ISOLATION
 SOURCE ISOLATION OF INFECTED – to minimize the risk of transmission
 PROTECTIVE ISOLATION – aims to protect an immunocompromised patient who is at high risk of
acquiring micro-organisms from either the environment or from other patients, staff or visitors.

45. SOURCE ISOLATION
 Source isolation can be achieved by nursing the patient in a single room or a negative pressure
isolation room/unit with an en-suite toilet.
 Inclusion of a ventilation system distinguishes an isolation room from a single room.
 Isolation is usually carried out in a single (preferably en-suite) room with hand washing facilities
and with the door kept closed.
 Occasionally cohort nursing (i.e. placing the patient in a room/bay area with other patients who
are infected or colonised with the same microorganism) may be considered.
 The type of IPC precautions required for a patient in source isolation will depend on the mode of
transmission of the organism causing the illness i.e. airborne, droplet, contact, or standard.

47. ISOLATION
 Isolation must be of negative pressure (source isolation)
 Positive pressure for protective isolation
 Immunocompromised individuals should never be placed in the same room or adjacent to people
with a known infection
 Rooms with tight fitting doors
 Glasses partitions for observation

48. MONITORING INFECTION CONTROL
 Process related recommendations
 Hand washing
 Use of gloves
 Eye wear or face shields
 Waste disposal and spillage

49. WHO SHOULD MONITOR
 Designated infection control nurses should supervise the process and help in collection and
compilation of data.
 However, for case of an outbreak/epidemic, the primary investigating team should include the
hospital epidemiologist, the director of employee health, the infection-control team and
microbiologist.
 External consultants might be necessary in some cases

50. HOW TO MONITOR
 Observations
 Interviews
 Surveys and Inspections
 Quality Assurance Activities

51. STAFF HEALTH
…
INFECTION
CONTROL IN
HOSPITAL
PERSONNEL

52. STAFF HEALTH
INFECTION CONTROL IN HOSPITAL PERSONNEL

53. INFECTION CONTROL IN HOSPITAL PERSONNEL
 The working personnel within the hospital may become infected through exposure to infected
patients if proper precautionary measures are not taken or they may be infected whilst in the
community.
 In such cases there is risk of infecting susceptible patients as well as other personnel
 The centre of disease control and Prevention (CDC) recommends an establishment of a personnel
health service in infection control that will be part of the hospital’s general programmes for
infection control that will focus particularly on infection related issues with regards to health
worker personnel.

54. OBJECTIVES OF PERSONNEL HEALTH SERVICE FOR INFECTION
CONTROL
 Stressing maintenance of sound habits in personal hygiene and individual responsibility in
infection control
 Monitoring and investigating infectious diseases, potentially harmful infectious exposures and
outbreaks of infection among personnel
 Providing care to personnel for work-related illnesses or exposures
 Identify infection risks related to employment and instituting appropriate preventative measure
 Containing costs by eliminating unnecessary procedures and by preventing infectious disease that
result in absenteeism and disability

55. ELEMENTS OF A PERSONNEL HEALTH SERVICE IN INFECTION CONTROL
 Placement evaluations
 Personnel health and safety education
 Immunisation programmes
 Protocols for surveillance and management of job related illnesses and exposures to infectious
diseases
 Counselling service for personnel regarding infection risks related to employment or special
conditions
 Guidelines for work restriction because of infectious disease
 Maintenance of health records

56. PLACEMENT EVALUATIONS
 This is used to ensure that personnel are not placed in jobs that would cause undue risk of
infection to them, other personnel, patients ,or visitors.
 A health inventory is an important part of this evaluation.
 It includes
 Immunisation status
 History of any conditions that may predispose the health worker to acquiring or transmitting
infectious diseases (e.g. childhood illness, Hx of hepatitis, open wounds, immunodeficient
conditions
 Physical exam where appropriate

57. PERSONNEL HEALTH AND SAFETY EDUCATION
 Personnel are more likely to comply with the infection control programme when they understand
the rationale behind
 Staff education should central focus of infection control
 Clearly written policies, guidelines and procedures are needed in many instances for uniformity.
Efficiency and effective co-ordination of activities

58. IMMUNISATION PROGRAMMES
 Aims to eliminate risk of acquiring and transmitting vaccine-preventable diseases
 Decision on which vaccines to be included are based on:
 Risk of exposure to an agent in a given area
 Nature of employment
 Size and kind of institution
 Examples include hepatitis B, Rubella, etc.
 Some elements may be too expensive to be done on large scale, e.g serological testing for
susceptibility to specific infectious diseases.

60. MANAGEMENT OF JOB-RELATED ILLNESSES AND EXPOSURES
 Includes
 prompt diagnosis and management of job-related illnesses
 (e.g. injury on duty – complete first medical report)
 Prophylaxis on exposure
 (e.g. PEP for HIV)

61. POST-EXPOSURE PROPHYLAXIS
Source: National Clinical Guidelines Of Post-exposure Prophylaxis (PEP) In Occupational And Non-occupational Exposures.
NDOH 2020

62. HEALTH COUNSELLING
 All personnel should know about infection risks related to employment
 For example, female personnel who may be pregnant or might become pregnant should know
about potential risks to the foetus due to work assignments and preventive measures that will
reduce the risk (e.g. CMV, hepatitis, rubella)

63. WORK RESTRICTION
 Exclusion from direct patient contact may be necessary in some cases of infection with highly
transmissible infections (e.g. COVID 19)
 Guidelines should be formulated for safety of the patients, personnel and also to prevent
unnecessary absenteeism from work

64. CONCLUSION
 Coordinated planning with other departments
 For infection control objectives to be archived, the activities of personnel health service must be
coordinated with the infection control programme and with various hospital departments
 Coordination will assure adequate surveillance of infections in personnel and maintenance of
effective infection control programmes.

65. THANK YOU