AL KHAFJI NATIONAL HOSPITAL

Learning and Development Department

Infection Control in Health Care Facility

After reading this module, you must be able to understand how an

infection develops and will be able to effectively manage to prevent the
transmission of microorganism.

Infection prevention and

control is required to prevent the
transmission of communicable
diseases in all health care settings.
Infection prevention and control
demands a basic understanding of
the epidemiology of diseases; risk
factors that increase patient
susceptibility to infection; and the
practices, procedures and treatments
that may result in infections. The risk
of acquiring a healthcare-associated
infection is related to the mode of
transmission of the infectious agent

Management of health-care waste is an integral part of hospital hygiene

and infection control. Health-care waste should be considered as a reservoir
of pathogenic microorganisms, which can cause contamination and give rise
to infection.

If waste is inadequately managed, these microorganisms can be

transmitted by direct contact, in the air, or by a variety of vectors. Infectious
waste contributes in this way to the risk of nosocomial infections, putting the
health of hospital personnel, and patients, at risk. The practices for the proper
management of health-care waste should therefore be strictly followed as part
of a comprehensive and systematic approach to hospital hygiene and infection
control.

This module outlines the basic principles of prevention and control of

the infections that may be acquired in health-care facilities (but does not
address other aspects of hospital hygiene and safety such as pressure sores
and the risk of falls). It should be stressed here that other environmental
health considerations, such as adequate water-supply and sanitation
facilities for patients, visitors, and health-care staff, are of prime importance.

Nosocomial infections—known also as hospital-acquired infections,

hospital-associated infections, and hospital infections—are infections that are
not present in the patient at the time of admission to hospital but develop
during the course of the stay in hospital. There are two forms:
 Endogenous infection, self-infection, or auto-infection. The causative
agent of the infection is present in the patient at the time of admission
to hospital but there are no signs of infection. The infection develops
during the stay in hospital as a result of the patient’s altered resistance.

 Cross-contamination followed by cross-infection. During the stay in

hospital the patient comes into contact with new infective agents,
becomes contaminated, and subsequently develops an infection.

A human with an infection has another organism inside them which gets
its sustenance (nourishment) from that person. It colonizes that person and
reproduces inside them. The human with that organism (germ) inside is called
the host, while the germ or pathogen is referred to as a parasitic organism.
Another name for an organism that causes infection is an infectious agent.
It is only an infection if the colonization harms the host. It uses the host
to feed on and multiply at the expense of the host to such an extent that
his/her health is affected. The normal growth of the bacterial flora in the
intestine is not an infection, because the bacteria are not harming the host.
An organism which colonizes and harms a host's health is often called
a pathogen. Examples include:
 Parasites
 Fungi
 Bacteria
 Prions
 Viroids (plant pathogens, they affect the health of plants
 The Chain of Infection

Elements of the Chain of

Infection

1. INFECTIOUS DISEASE
Is any microorganism
that can cause a disease
such as a bacterium, virus,
parasite, or fungus. Reasons
that the organism will cause
an infection are virulence
(ability to multiply and grow),
invasiveness (ability to enter
tissue), and pathogenicity
(ability to cause disease).

1. RESERVOIR
Is the place where the
microorganism resides, thrives, and reproduces, i.e., food, water, toilet
seat, elevator buttons, human feces, respiratory secretions.

2. PORTAL OF EXIT
Is the place where the organism leaves the reservoir, such as the
respiratory tract (nose, mouth), intestinal tract (rectum), urinary tract,
or blood and other body fluids.

3. MODE OF TRANSMISSION
Is the means by which an organism transfers from one carrier to another
by either direct transmission (direct contact between infectious host and
susceptible host) or indirect transmission (which involves an
intermediate carrier like an environmental surface or piece of medical
equipment).

4. PORTAL OF ENTRY
The opening where an infectious disease enters the host’s body such as
mucus membranes, open wounds, or tubes inserted in body cavities like
urinary catheters or feeding tubes.

5. SUSCEPTIBLE HOST
The person who is at risk for developing an infection from the disease.
Several factors make a person more susceptible to disease including age
(young people and elderly people generally are more at risk), underlying
chronic diseases such as diabetes or asthma, conditions that weaken the
 immune system like HIV, certain types of medications, invasive devices
like feeding tubes, and malnutrition.

Types of Infection Control and Prevention Precautions

Standard Precautions. Standard precautions are a set of infection
control practices used to prevent transmission of diseases that can be
acquired by contact with blood, body fluids, non-intact skin (including
rashes), and mucous membranes. These measures are to be used when
providing care to all individuals, whether or not they appear infectious or
symptomatic.

Transmission Based Precaution. Are designed to supplement

standard precautions in patients/residents with documented or suspected
infection/colonization of highly transmissible or epidemiologically important
pathogens. The three categories of Transmission-Based Precautions include:

 Contact Precautions
 Droplet Precautions
 Airborne Precautions

For diseases that have multiple routes of transmission (e.g., Severe Acute
Respiratory Syndrome (SARS)), more than one Transmission-Based
Precautions category may be used. When used either singularly or in
combination, they are always used in addition to Standard Precautions.

Contact Precautions are designed to

reduce the risk of transmission of
microorganisms by direct or indirect
contact. Direct contact transmission
involves the physical transfer of
microorganisms to a susceptible host
from an infected or colonized person.
Indirect contact transmission
involves contact of a susceptible host
with a contaminated intermediate
object. Examples of Diseases:
gastrointestinal infections (including
diarrhea of unknown origin), wound
and skin infections (e.g. impetigo) and
colonization with multidrug-resistant bacteria (e.g. methicillin-
resistant Staphylococcus aureus (MRSA)).

 Special Factors:
o Private room or rooms with a patient/resident who has a similar
diagnosis.
o Patient/resident should stay in room except for medically
necessary procedures or therapies.
o Gloves for any contact with patient/resident or touching anything
in the room.
o Gown if it is likely that clothing will be in contact with any
patient/resident or any surfaces in the patient/resident care
environment.
 o Mask and eye protection if splashing or splattering of any
contaminated substance is likely.
o Patient/resident care items such as blood pressure cuff,
stethoscopes or thermometer should be “dedicated” (used only for
that patient/resident and disinfected or discarded after the
patient/resident is discharged).

Droplet Precautions are designed to

reduce the risk of droplet transmission
of infectious agents. Infectious
droplets are released when the infected
person sneezes or coughs and the large
droplet spray may spread as far as
three feet. Examples of Diseases:
Influenza, meningococcal meningitis,
mumps, rubella, diphtheria,
pneumonic plague, pertussis and
infections caused by multidrug
resistant Streptococcus pneumonia.

 Special Factors:
o Private room or rooms with a patient/resident who has a similar
diagnosis.
o Patient/resident should stay in their room except for medically
necessary procedures; a mask should be worn when out of the
room.
o A regular/surgical mask should be used for any potential
exposure within three feet of the patient/resident.
o Gloves and gowns are required when delivering patient/resident
care in droplet precautions.
o Patient/resident care items such as blood pressure cuff, etc.
should be dedicated to that patient/resident.
o Patient/resident should be taught to cover their nose and mouth
with tissues when coughing or sneezing and to discard tissues
into a bag.

Airborne Precautions are designed to

reduce the risk or eliminate the airborne
transmission of infectious agents. The
infectious particles are so small that they
can remain suspended in the air for long
periods of time and are carried on air
currents. Examples of Diseases: varicella
(chickenpox), tuberculosis, measles.

 Special Factors:
o Private room with special ventilation;
door must be kept closed.
o The patient/resident should stay in his or her room except for
essential reasons; a special mask should be worn when out of the
room.
 o Respirators are worn by personnel if the patient/resident has or
is suspected of having an airborne illness. In general, students
are not usually fitted for respirators.
o Respirators are worn for chickenpox or measles only if the
employee entering has not had the disease or has not been
immunized.
o Gloves: Worn when in contact with respiratory secretions.
o Patient/resident care items such as blood pressure cuffs, etc.
should be dedicated and disinfected or discarded after the
patient/resident is discharged.
o Patient/resident should be taught to cover their nose and mouth
with tissues when coughing or sneezing and to discard tissues in
a bag.

Infection Control Practices to Prevent

Cross Contamination in Healthcare Facility

Hand Hygiene. Hand hygiene refers to both washing with plain or anti-
bacterial soap and water and to the use of alcohol gel to decontaminate hands.
When hands are not visibly soiled, alcohol gel is the preferred method of hand
hygiene when providing
health care to clients.

Hand hygiene should be

performed before and after
contact with a client,
immediately after touching
blood, body fluids, non-intact
skin, mucous membranes, or
contaminated items (even
when gloves are worn during
contact), immediately after
removing gloves, when
moving from contaminated
body sites to clean body sites
during client care, after
touching objects and medical equipment in the immediate client-care vicinity,
before eating, after using the restroom, and after coughing or sneezing into a
tissue as part of respiratory hygiene.
Personal Protective Equipment (PPE)

PPE includes items such as gloves, gowns, masks,

respirators, and eyewear used to create barriers that
protect skin, clothing, mucous membranes, and the
respiratory tract from infectious agents. PPE is used
as a last resort when work practices and engineering
controls alone cannot eliminate worker exposure. The
items selected for use depend on the type of interaction
a public health worker will have with a client and the
likely modes of disease transmission.

Wear gloves when touching blood, body fluids, non-

intact skin, mucous membranes, and contaminated
items. Gloves must always be worn during activities
involving vascular access, such as performing
phlebotomies.

Wear a surgical mask and goggles or face shield if there is a reasonable chance
that a splash or spray of blood or body fluids may occur to the eyes, mouth,
or nose.

Wear a gown if skin or clothing is likely to be exposed to blood or body

fluids.Remove PPE immediately after use and wash hands. It is important to
remove PPE in the proper order to prevent contamination of skin or clothing.

If PPE or other disposable items are saturated with blood or body fluids such
that fluid may be poured, squeezed, or dripped from the item, discard into a
biohazard bag. PPE that is not saturated may be placed directly in the trash.
Saturated waste generated from the home should be placed in sealable leak-
proof plastic bags before placing in regular trash bags for disposal.

Cleaning and
Disinfection. Client
care areas, common
waiting areas, and
other areas where
clients may have
potentially
contaminated
surfaces or objects
that are frequently
touched by staff and
clients (doorknobs, sinks, toilets, other surfaces and items in close proximity
to clients) should be cleaned routinely with EPA registered disinfectants,
following the manufacturers’ instructions for amount, dilution, and contact
time.

Housekeeping surfaces such as floors and walls do not need to be disinfected

unless visibly soiled with blood or body fluids. They may be routinely cleaned
with a detergent only or a detergent/disinfectant product.

Most disinfectants are not effective in the presence of dirt and organic matter,
therefore cleaning must occur first before disinfection. Wet a cloth with the
disinfectant, wipe away dirt and organic material, then with a clean cloth
apply the disinfectant to the item and allow to air dry for the time specified by
the product manufacturer.

Some pathogens such as norovirus and Clostridium difficile are not

inactivated by commercial disinfectants routinely used in local public health
settings. In situations where contamination with these pathogens is
suspected, a bleach solution (1:10) is recommended for disinfecting
contaminated surfaces and items.

Some patient care items may be damaged or destroyed by certain

disinfectants. Consult with the manufacturer of the items before applying
disinfectants.

Respiratory Hygiene (Cough Etiquette)

Clients in waiting rooms or other common areas can spread infections to

others in the same area or to local public health agency staff. Measures to
avoid spread of respiratory secretions should be promoted to help prevent
respiratory disease transmission. Elements of respiratory hygiene and cough
etiquette include:

 Covering the nose/mouth with a tissue when coughing or sneezing or

using the crook of the elbow to contain respiratory droplets.
 Using tissues to contain respiratory secretions and discarding in the
nearest waste receptacle after use.
 Performing hand hygiene (hand washing
with non-antimicrobial soap and water,
alcohol-based hand rub, or antiseptic hand
wash) immediately after contact with
respiratory secretions and contaminated
objects/materials.
 Asking clients with signs and symptoms
of respiratory illness to wear a surgical mask
while waiting common areas or placing them
immediately in examination rooms or areas
away from others. Provide tissues and no-
touch receptacles for used tissue disposal.
 Spacing seating in waiting areas at least three feet apart to minimize
close contact among persons in those areas.
 Supplies such as tissues, waste baskets, alcohol gel, and surgical
masks should be provided in waiting and other common areas in local
public health agencies. Place cough etiquette signs where the general
public can see them.
Needlestick and Sharps Injury Prevention

Safe handling of needles and other

sharp devices are components of
standard precautions that are
implemented to prevent health care
worker exposure to blood borne
pathogens. The Needlestick Safety
and Prevention Act mandates the
use of sharps with engineered safety
devices when suitable devices exit.

 The safety devices on needles and

other sharps should be activated
immediately after use.
 Used needles should be discarded
immediately after use and not recapped, bent, cut, removed from the
syringe or tube holder, or otherwise manipulated.
 Any used needles, lancets, or other contaminated sharps should be
placed in a leak-proof, puncture-resistant sharps container that is
either red in color or labeled with a biohazard label.
 Do not overfill sharps containers. Discard after 2/3 full or when
contents are at the “full” line indicated on the containers.
 Used sharps containers may be taken to a collection facility such as an
area pharmacy, hospital, or clinic that provides this service.

Waste Disposal

 Sharp items should be

disposed of in containers that
are puncture resistant, leak-
proof, closable, and labeled
with the biohazard symbol or
are red in color. Sharps
containers should be replaced
when filled up to the indicated
“full” line. Items generated by
local public health agencies
that should be discarded into
sharps containers include
contaminated items that may
easily cause cuts or punctures
in the skin (used needles,
lancets, broken glass or rigid plastic vials) and unused needles and
lancets that are being discarded. Syringes or blood collection tube
holders attached to needles must also be discarded still attached to the
needles.

 Non-sharp disposable items saturated with blood or body fluids (i.e.

fluid can be poured or squeezed from the item or fluid is flaking or
dripping from the item) should be discarded into biohazard bags that
are puncture resistant, leak-proof, and labeled with a biohazard symbol
or red in color. Such items may include used PPE and disposable rags
or cloths.