This document discusses hospital infection control and prevention of healthcare-associated infections. It covers major types of infections, transmission modes, and key infection control practices like standard and transmission-based precautions. Standard precautions include hand hygiene, personal protective equipment, and respiratory etiquette. Transmission-based precautions include contact, droplet, and airborne precautions used based on infection type and transmission mode. Proper implementation of infection control protocols can help reduce the risk of transmitting infections to patients and healthcare workers.

1. Hospital infection control (Biosafety in
Health Care Practices to Prevent Health
Care Associated Infections)
By Dr. Rakesh Prasad Sah
Associate Professor, Microbiology

2. Components
• Hospital Acquired Infection
• Major Healthcare-associated infection Types
• Sterilization and Disinfection
• Biomedical waste management
• Needle stick Injury
• Antimicrobial Stewardship
• Environmental Surveillance

3. Hospital Acquired Infection
• An infection acquired by a patient during
hospital care which was neither present
nor incubating at the time of admission.
• Also called as “Nosocomial infection”.

4. Factors affecting HAI
• Immune Status
• Hospital environment
• Hospital organisms
• Diagnostic or therapeutic interventions
• Transfusion
• Poor hospital administration

5. Sources
• Endogenous sources
• Exogenous sources
– Environmental
sources
– Health care
workers
– Other patients

6. • E. coli
• SARS-CoV-2 (COVID-19)
• Candida albicans
• Clostridium difficile
• Blood borne (transfusion and Needle stick injury)
• HIV
• Hep-B
• Hep-C
Microorganisms

7. Mode of Transmission
• Contact
• Droplet
• Airborne

8. Who is at Risk of Infection?
Patient Healthcare worker Healthcare workers family
Patient Patient Patient family
HCW Patient

9. Benefits of Infection Prevention and Control

10. Infection Control Precautions
• Used to reduce transmission of microorganisms in Hospital &
laboratory
• Includes
– Standard Precautions
• Hand hygiene
• Personal protective equipment (PPE)
– Transmission based precautions

11. Prevention of HAIs
• Standard Precautions
• Include a group of infection prevention practices  apply to all patients,
regardless of suspected or confirmed infection status in any setting in
which healthcare is delivered.
• Rationale: all blood, body fluids, secretions(except sweat), excretions,
non-intact skin, and mucous membranes may contain transmissible
infectious agents.

12. Components of Standard Precautions
• Hand hygiene
• PPE (Personal protective equipment)
• Spillage cleaning
• Respiratory hygiene and cough etiquette
• Transmission based precautions
• Biomedical waste including sharps handling
• Disinfection

13. WHY is hand hygiene required?

14. Hand Hygiene
• Main source of transmission of infections
• Most important measures to avoid the transmission of microbes.

15. Hand hygiene
• Hand hygiene
– Hand rubbing
– Hand washing
• “My five moments of hand hygiene”
– Hand rub with alcohols
– Hand wash with soap and water

16. “My five moments of hand hygiene”
1. Before touching a patient
2. Before a procedure
3. After a procedure or body fluid exposure
4. After touching a patient
5. After touching a patient’s surroundings

17. In addition to the above, hand hygiene should be
performed in the following non-clinical situations
1. Before eating/handling of food/drinks (whether own or patients)
2. After hands becoming visible soiled
3. After visiting a toilet
4. After blowing/wiping/touching nose or mouth
5. After putting on and removing personal protective equipment (PPE)
6. After handling laundry/equipment/waste

18. Hand Rub with Alcohols
• They are a suitable and effective alternative to hand washing with
soap and water, provided the hands are visible clean.
• If the hands are soiled, they should be washed using a soap and
water first.
• Alcohol hand rubs must not be placed near electrical sockets,
switches or devices.
• Alcohol must be thoroughly rubbed in until dry before undertaking
any clinical procedure

21. Hand wash with soap and water
Alcohol hand rubs are not suitable:
1. When hands are visibly soiled
2. After using a rest room

23. • Video

24. Personal Protective Equipments (PPE)

25. STEP OF DONNING
1. Hand Rub with sanitizer
2. Gown
3. Mask/respirator
4. Wear goggles/face shield
5. Gloves

26. STEP OF DOFFING
1. Gloves
2. Goggles/Face shield
3. Gown
4. Mask/Respirator

27. Spill management for Blood and Body
Fluids
• Bring the spill kit to the site of spillage
– wear PPE (gloves, gown)  put ‘no
entry’ sign board near the spill area.
• Small volume (<10ml)
– Wipe up spill immediately with
absorbent material and discard into
appropriate bin
– Wipe the area with 10% sodium
hypochlorite and allow it to dry
– Remove PPE and perform hand hygiene

28. • Large volume (>10ml)
– Place disposable paper towels over
spills to absorb the spillage and then
pour 10% sodium hypochlorite on
the top of absorbent paper towels
and leave for 15mins
– Remove the absorbent papers; put
fresh disposable paper towels to
clean the area and then discard these
into appropriate waste bin
Spill management for Blood and Body
Fluids

29. Respiratory hygiene/cough etiquette
• Avoid patient careare as if you havea respiratory infection. Stay home if
possible. Weara mask during hospitalvisits.
Wash hands with soap and water

30. Respiratory hygiene/cough etiquette
• If no tissues are available, cough or
sneeze into the inner elbow rather than
the hand
• Surgical masks can be used on the
coughing person when tolerated and
appropriate

31. Respiratory hygiene/cough etiquette
• Spatial separation, ideally > 6 feet, of persons with
respiratory infections in common waiting areas when
possible

32. Transmission Based Precautions
Introduction
• Additional precautions taken over and above the std.
precautions
• where std. precautions may not be sufficient
• Based on specific MOT

33. Transmission Based Precautions
• Hand Hygiene
• Gown
• Gloves
Contact Precautions
• Hand Hygiene
• Mask
Droplet Precautions
• Hand Hygiene
• Negative pressure room
• N-95 Respirator mask
Airborne Precautions
https://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html

34. Contact Precautions
• Physical contact  infected  susceptible host
• Apply to patients with any of the following conditions and/or disease
 Presence of stool incontinence (may include patients with norovirus, rotavirus,
or Clostridium difficile)
 Draining wounds
 Uncontrolled secretions
 Pressure ulcers or presence of ostomy tubes and/or bags draining body fluids
 Presence of generalized rash
 Highly contagious skin lesions
 MDROs
• MRSA (Methicillin resistant S. aureus)
• VRE (Vancomycin resistant Enterococci)

35. Precautions
• Isolation
– Individual room (optional)
– Cohorting (desirable)
– >3 feet spatial separation between beds is advised to reduce the opportunities for inadvertent sharing of
items between the infected/colonized patient and other patients
• Patient movement
– Confined to room
– If transfer req.  hand hygine, PPE, patient’s colonized area must be covered.
• Patient dedicated equipment
– Stethscope, b.p. cuff, nebulizer  for single patient  must be disinfected before re-use
• Hand washing
– Before and after contact
• Environmental cleaning
– Floor, clothes, toilet and equipment cleaning with appropriate disinfectant

36. DROPLET PRECAUTIONS
• Large particle respiratory droplets (≥5 microns) from a source patient
– Coughing
– Sneezing
– Certain procedures (suctioning)
• Respiratory viruses
– Influenza
– Parainfluenza virus
– Adenovirus
– RSV
• Pertussis
• Meningitis
– N. meningitides
– Group A streptococcus
• Mycoplasma
• C. diptheriae
For first 24 hours of therapy

37. Precautions
• Isolation
– Essential, if single room not available  cohorting spatial separation ≥ 3 feet
– Negative pressure room (desirable)
• Patient movement
– Restricted movement of the patient
– Wears surgical mask  while leaving room
• Surgical mask  healthcare workers while entering the room
• Perform hand hygiene
– before and after touching
– after contact with respiratory secretions and contaminated objects/materials;
– note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)

38. Airborne Precautions
• Airborne
• Small-particle residue (≤5 μm) that remain suspended in the air for
long periods of time
– Varicella
– Pulmonary TB
– Measles
– Chickenpox
– SARS (severe acute respiratory syndrome)
– Herpes zoster (until lesions are crusted over)

39. Precautions
• Isolation
– Place immidiately in an airborne infection isolation room (AIIR)
– Adequate ventillation with negative pressure facility (essential)
• Patient movement  confined to the room all the time
• PPE:
– staff should wear high-efficiency masks (N95) before entering the room.
– Patient may wear surgical mask all the time

40. Will be discussed in other chapters
• Biomedical Waste Management
• Disinfection

41. The Key -
always be alert
Put on protective
gear when
needed
Thank you