7. TheChain of Infection
Infectious Agent
Bacteria/Virus
Fungi
Reservoir
People/ Environment
Equipment / Water
Portal of Exit
Excretion/ secretions/ skin
/droplets
Means of
Transmission
Contact/ Inhalation
Airborne
Portal of Entry
M M/ Respiratory / GIT
/Broken Skin
Susceptible Host
Patient /Staff
Visitor
HCW
8. Breaking the
chain of
infection
Infectious Agent
Reservoir
Portal of Exit
Means ofTransmission
Portal of Entry
Susceptible
Host
HCW
Rapid identification,
diagnosis, and treatment
Education
Environmental cleanin
Hand Hygiene
PPE
Hand Hygiene,
Aseptic Technique
Wound/catheter care
Hand Hygiene
Transmission based precautions
Environmental Hygiene
Recognition of high
risk patients
Treatment
Immunizations
9. Colonized or Infected Patient?
People who carry bacteria without evidence of
infection (fever, increased white blood cell count)
are colonized
If an infection develops, it is usually from bacteria
that colonize patients
Bacteria that colonize patients can be transmitted
to environment then from one patient to another
by the hands of HCW
9
~ Bacteria can be transmitted even if the
patient is not infected ~
12. Breaking the chain of infection
Equipment cleaning Hand Hygiene Compliance w/ Precautions
13. The EnvironmentAsASource of Nosocomial
Infections
Surfaces
Housekeeping surfaces (bedside tables,
computer keyboards) may lead to the
transmission of potential pathogens if
they are not cleaned between use by
different patients ...
13
15. Household cleaning and surface
disinfection: new insights and strategies
M. Exner,V.Vacata, B.Hornei, E. Dietlein,J.Gebel
Figure 1: Scheme of the mop sweep through four test fields areas. Field
1 is contaminated with 0.05 mL of S. aureus (3 x 107 cfu/mL), areas 2-4
are germ-free surfaces.The arrow shows the cleaning sweep with the
mop.
16
17. General Rules
Warm water and detergent removes 80% of
microorganisms.
Minimizes the scattering of dust and dirt.
Cleaning should begin from the least soiled
area to the most soiled area
The use of friction or scrubbing action
18
18.
19. Disinfection solutions
Housekeeping surfaces (chlorine 5%)
20cm of Chlorine +1 L water for regular
disinfection
100cm Chlorine +1 L water for disinfection
of blood and biological fluid
Nursing surfaces :
Chorine
Alcohol
Quaternary ammonium compounds produces
20
21. When should I wash my
hands with
Soap andWater?
Soap and water
Use when the hands are
visibly soiled.The soap and
water will wash away the
contamination.
Use when in contact with a
patient who has diarrhoea -
alcohol gel won’t work.
Use if the gel starts to feel
‘sticky’ on your hands.
Alcohol gel
Very quick and effective.
Use between patients.
Use when entering or leaving
a ward.
Use after removing gloves
Doesn’t work against
Clostridium difficile or any of
the diarrhoea causing viruses.
Use soap and water instead.
When should I wash
my hands with
Alcohol Gel?
25. Skin Care
Provide healthcare workers with hand lotions or
creams
Get information from manufacturers regarding effects
that hand lotions, creams, or alcohol-based hand rubs
may have on the effectiveness of antimicrobial soaps
30. Three basic routes of transmission
Contact
Direct
Indirect
Droplet
Larger; don’t travel long distances, not infective
over time
Spatial separation (≥ 3 feet)
Airborne
Smaller; infective over time and distance
31. Contact
Precautions
“Contact Precautions are to
prevent transmission of
infectious that spread by:
direct with the patient
indirect contact with the
patient
the patient’s environment
33. Examples of disease transmit
contact
Infections or colonization with
multidrug-resistant bacteria
such as :
• VRE
• MRSA
• CRE
• MDR Ab
Diphtheria (cutaneous)
Herpes simplex virus
Impetigo
abscesses, cellulitis,
Scabies
Staphylococcal furunculosis
Zoster
Viral/hemorrhagic conjunctivitis
Viral hemorrhagic infections (Ebola)
34. Droplet Precautions
Droplet Precautions are intended to prevent
transmission of pathogens spread through close
respiratory or mucous membrane contact with
respiratory secretions. On a distance less than 3
feet
37. Airborne Precautions
“Airborne Precautions prevent transmission of
infectious agents that remain infectious over long
distances when suspended in the air (measles,
chicken pox,TB)”
40. PPE forAirborne Precautions
Clinical Excellence Commission
41
Note the different mask for droplet and airborne precautions:
remember, how transmission or movement of microorganisms
occurs?
What differences can you spot between the two masks (surgical
and P2/N95 masks)?
P2/N95 masks come in
different shapes and colors.
Local supply and availability
may vary.
43. Apply to all patients receiving care in hospitals,
regardless of their diagnosis or presumed
infection status
Designed to reduce the risk of transmission of
microorganisms from both recognized and
unrecognized sources of infections
Under standard precautions, blood and body
fluids of all patients are considered potentially
infectious
Standard Precautions
49. 50
Best practice for administering Injection
1. Select safe medicines:
Proper handling / Check expiry / Label clearly / proper storage
conditions
2. Use of sterile equipment
Use needle and syringe from sealed package
3. Avoid contamination
Wash hands/ Prepare on clean surface
4. Reconstitute drugs or vaccines safely
Use new sterile syringe and needle for each reconstitution
Use the correct diluents/water for injection
5. Dispose of injection wastes and sharps properly
Immediate disposal of needle and syringe in puncture- and leak-
proof container
6. Public health education
52. 53
Do not open glass vials with bare fingers
Use clean pliers, two small hinges, clamps made
from clean bent bottle caps, rigid pieces of plastic
or a carved piece of wood. While rigid materials
protect fingers best, even a piece of gauze is
better than the use of bare hands.
72. Respiratory hygiene/cough etiquette:
Respiratory hygiene and cough etiquette
include covering the mouth and nose during
coughing and sneezing with a tissue
offering a surgical mask to the coughing
patient, discarding the mask
performing hand hygiene
educating healthcare staff, patients, and
visitors
76. 77
18/04/1444 77
Do not recap needles
Rationale:
In many settings, recapping is the most common action that leads to
needle sticks
One handed scooping technique
78. Percutaneous injuries & needle stick injuries risk
for transmission of :
HIV 0.3%
HCV 3%
HBV 30%
Needle stick injuries In the United States have
decreased to 384,325 per year in 2000, from an
estimated 800,000 to 1 million exposures per
year in 1996
Blood Borne Pathogens
