INFECTION CONTROL

RISK OF INFECTION IS ALWAYS PRES

A patient may come with an infection before putting
admission in the hospital.
(Community Acquired Infection)
A Patient may get an infection inside the hospital after
putting admission.
(Nosocomial Infection)
Nosocomial Infections are:
infections that appear more than 48 hours after
admission.
those acquired in the hospital but appear after
As a discharge.
Nurse you are at the risk of getting an infection from
your ward. (Occupational Infection)

HOW IS INFECTION CAUSED?

FUNGI

VIRUS
BACTERIA

GENTS OF NOSOCOMIAL INFECTIONS

ENDOGENOUS:
Patients own flora may invade patients tissue during
some surgical operations or instrumental
manipulations
Normal commensals of the skin, respiratory, GI, UG
EXOGENOUS:
tract
From another patient / staff nurse / environment in
the hospital
Environmental sources: Inanimate objects, air,
water, food
Cross infection from: other patients, hospital staff
(suffering from infections or asymptomatic

The Normal Flora

The normal flora of humans are exceedingly complex
and consist of more than 200 species of bacteria.
A human first becomes colonized by a normal flora
at the moment of birth and passage through the
birth canal. In utero, the fetus is sterile, but when
the mother's water breaks and the birth process
begins, so does colonization of the body surfaces.

COMMENSAL BACTERIA
It is found in the normal flora of healthy people.
significant protective role by preventing colonization
by pathogenic microorganisms.
Some commensal bacteria may cause infection if the
host is compromised.
Eg: Staphylococcus epidermidis (cause of i.v.
infections), Escherichia coli (cause of urinary
infections).

OMINANT BACTERIA AT VARIOUS ANATOMICAL LOCATIONS IN AD

ANATOMICAL

PREDOMINANT BACTERIA

LOCATION
Skin
Conjunctiva
Teeth
Mucous membranes
Nares (nasal
membranes)
pharynx (throat)
stomach
small intestine
colon
anterior urethra
vagina

staphylococci and corynebacteria

Gram-positive cocci and Gram-negative rods
streptococci, lactobacilli
streptococci and lactic acid bacteria
staphylococci and corynebacteria
streptococci, neisseria, Gram-negative rods and
cocci
Helicobacter pylori(up to 50%)
lactics, enterics, enterococci, bifidobacteria
bacteroides, lactics, enterics, enterococci,
clostridia, methanogens
staphylococci, corynebacteria, enterics
lactic acid bacteria during child-bearing years;
otherwise mixed

HOW MUCH BACTERIA DO YOU HAVE

The Skin is the major source of bacteria responsible
for hospital acquired infections.
It has been calculated that a human adult houses
about 10000000000000 (Ten Trillion) bacteria on the
100000000000
skin
(Ten Billion) bacteria are present in the
mouth
100000000000000 (30 Triillion) bacteria are present in
GI system

HOW MUCH BACTERIA DO YOU HAVE

The density or number bacteria of the normal flora of
the skin varies with anatomical location.
The high moisture content of the axilla, groin, and
areas between the toes supports the activity and
growth of bacteria.
Generally per square cm of skin contains 100s to
1000s of bacteria.

EXOGENOUS INFECTION SITES

MODES OF TRANSMISSION
CONTACT:

Most common route of transmission

Hands or Clothing:
Hands of staff: important vehicle of spread
Contact of hands & clothing of attendants
Eg: Staphylococcus aureus, Streptococcus pyrogenes
Inanimate objects:
Improper disinfection of Instruments: endoscope,
thermometer, bronchoscope, cystoscope
Eg: Pseudomonas aeruginosa

The Inanimate Environment

Can Facilitate Transmission

MODES OF TRANSMISSION
AIRBORNE:

Droplets:
Droplets of Respiratory infections: transmitted by
inhalation
Eg: Measles, SARS (Severe Acute Respiratory
Syndrome)
Dust:
Dust from bedding, floors, wound exudates & skin
Eg: Pseudomonas aeruginosa, Staphylococcus aureus
Aerosols:
Aerosols from nebulizers, humidifiers & AC

MODES OF TRANSMISSION
ORAL ROUTE:

Hospital food may contain Antibiotic-resistant bacteria

may colonize intestine can cause infections

PARENTERAL ROUTE:

Disposable syringes & needles & Venflons

Certain infections may be transmitted by blood
transfusion, tissue donation, contaminated blood
products
Eg: Hepatitis B, HIV

COMMON NOSOCOMIAL INFECTIONS

URINARY TRACT INFECTION

Most common (40% of Nosocomial infections)

Usually associated with catheterization or
instrumentation of urethra, bladder or kidneys
Eg: E. coli, Klebsiella, Proteus, Serratia, Pseudomonas,
Candida albicans
PNEUMONIA (RESPIRATORY INFECTIONS)

Leading cause of mortality in patients suffering from

Nosocomial infections
During aspiration in unconscious patients & pulmonary
ventilation
Eg: Staph. aureus, Klebsiella, Enterobacter, Serratia,
Proteus, Pseudomonas, Acinetobacter, Legionella, E. coli

COMMON NOSOCOMIAL INFECTIONS

WOUND & SKIN SEPSIS

Follow surgical procedure where causative agents

are introduced into the tissue during operations
Higher in elderly patients
Manifest within a week of surgery
Non-surgical wounds due to burns, bed sores.
Eg: Staph aureus, Pseudomonas aeruginosa, E. coli,
Proteus, Enterococci
GASTROINTESTINAL INFECTIONS

Food poisoning due to Salmonella, Shigella sonnei

Enterotoxic manifestation due to Staphylococcal
contamination of cooked food
Diarrhea due to E. coli

COMMON NOSOCOMIAL INFECTIONS

BACTEREMIA & SEPTICEMIA:

Bacterial invasion of bloodstream

Mostly caused by infected intravenous cannulae
Gram negative bacilli: common pathogens
TETANUS:

Inadequate attention to aseptic precautions during

surgery
Use of contaminated dressings or improperly
sterilized dressings
Improper disinfection of site of intramuscular
injection
Inadequate care while cutting umbilical cord of newborn

INFECTION CONTROL
PRINCIPLES
THE SKIN Is the main source of bacteria responsible for IV infections.
Bacteria sticking on to the skin like Staphylococcus albus may enter the IV site.
CANNULA contamination can occur from skin during insertion of the cannula.
AIRBORNE BACTERIA enter into unprotected IV solutions (e.g. while pricking
needles in IV bags for airflow) which hang during IV infusion.
CONTAMINATION OF IV SOLUTION CAN OCCUR:

By allowing IV bag to hang near bedside for prolonged periods more than 24 hrs.
By leaving IV solution bag open on the shelf.
During handling IV bags if small punctures occur to the bag.
By solutions which got expired (nutrient-rich solutions such as TPN and blood
get expired quicker)

BLOOD may also contain microorganisms such as Hepatitis B and HIV which are
dangerous to the health care worker.

GENERAL MEASURES TO REDUCE INFECTIONS

Use of strict aseptic technique at all times.
Use clean gloves while handling blood and body fluids.
Examine equipment for quality and expiry date.
Careful cannula site preparation in aseptic manner.
Avoid reinsertion of the same cannula to prevent infection.
All insertion equipment are to be single patient use (i.e. IV Sets, Cannulas)
Use of filter needle for IV medications.
Needles should not be recapped, but disposed in a sharps disposal container.
Correct storage and handling of blood products.
Avoid pricking needles in IV bags which hang during infusion.
On-going assessment to find signs of infection early.

INFECTION CONTROL GUIDELINES/ POLICIES

Routine safe Practices like hand hygiene, personal protective equipment, safe disposal of
wastes, and blood and body fluid spills clean-up should be followed.
All IV insertion sites should be cleansed with a scrub using 2% Chlorhexidine with 70%
alcohol solution, and allowed to dry prior to insertion.
Cleanse an area larger than the intended dressing and allow solution to air-dry
completely prior to applying dressing.
All needleless connectors should be cleansed with 70% alcohol for 30 seconds and
allowed to dry completely before accessing.
It is strongly recommended that all IV insertion sites should be covered with a
transparent semi-permeable membrane dressing.
An intact dressing must be used to stabilize the IV cannula in site and reuse of IV sets
should be avoided.
Label the date of IV Insertion over the site and change the IV cannula every 7 days.
A minimum of IV supplies should be taken to the patients bedside and unsealed
solutions, cannulas and IV sets should not be used.
Use sterile articles at all times, any unused supplies(IV Bags, Cannulas, IV sets) that
have been in contact with the patient or their bed side can be wiped with a disinfectant
wipe provided there is no blood or body fluid contamination.
If they are contaminated they should be discarded before leaving the patient bedside or
room.
The use of IV trays is strongly discouraged as there is a potential for crosscontamination between patients.
Do not hang the IV solutions for more than 24hours.
Perform Hand Hygiene and maintain strict aseptic technique during tubing and needle
connector changes.

FIRST PRINCIPLE OF INFECTION PREVENTION

FACT

At least 35-50% of all healthcare-associated

infections are associated
5 PATIENTwith
CARE only
PRACTICES
5 PATIENT CARE PRACTICES

Use and care of urinary catheters

Use and care of vascular access lines

(venflons)

Therapy and support of pulmonary functions

Surveillance of surgical procedures

(ventilators, neb

(Skin Preperation, Surgical wo

Hand hygiene and standard precautions

HAND WASHING
PROPER HAND WASHING IS THE SINGLE MOST
IMPORTANT WAY TO PREVENT AND REDUCE
INFECTIONS

Your Hands can be Dangerous

Wash them with antiseptic hand wash

to keep bacteria away

HAND WASHING
HAND HYGIENE IS THE SINGLE MOST EFFECTIVE INTERVENTION
TO REDUCE THE CROSS TRANSMISSION OF NOSOCOMIAL
INFECTIONS

HANDS SHOULD BE WASHED:

Before and after patient contact
Before putting on gloves and after taking them off
After touching blood and body substances (or
contaminated patient-care equipment), broken skin, or
mucous membranes (even if you wear gloves)
Between different procedures on the same patient

WHEN TO WASH OUR HANDS

1) Before & after an aseptic technique or invasive
procedure.
2) Before & after contact with a patient or caring of a
wound or IV line.
3) After contact with body fluids & excreta removal.
4) After handling of contaminated equipment or laundry.
5) Before the administration of medicines

WHEN TO WASH OUR HANDS

6) After cleaning of spillage.
7) After using the toilet.
8) Before having meals.
9) At the beginning and end of duty.
10) Gloves cannot substitute hand washing which must
be done before putting on gloves and after their
removal.

HOW TO WASH OUR HANDS

1) Jewelry must be removed. If unable to remove rings,
wash and dry thoroughly around them.
2) Wet your hands with running warm water, dispense
about 5 ml of liquid soap or disinfectant into the palm
of the hand.
3) Rub hands together vigorously to lather all surfaces
and wrist paying particular attention to thumbs, finger
tips and webs.

HOW TO WASH OUR HANDS

4) Rinse hands thoroughly.
5) Turn off water using elbow-on elbow taps, dry hands
thoroughly on a paper towel OR where elbow taps are
not present, first dry hands, thoroughly, then turns off
the taps using fresh paper towel.
6) Hand cream can be used on persona basis.
7) If a staff member develops a skin problem, he or she
must consult dermatologist.

The hands are the most important

vehicle of transmission of Hospital
Acquired Infections.

WHY DONT STAFF WASH

THEIR HANDS

How many of you wash your hands before and

after attending a patient?
(Compliance estimated at less than
50%)

WHY DONT STAFF WASH

THEIR HANDS
Skin irritation or wet hands
Inaccessible hand washing
facilities
Wearing gloves
Too busy
Lack of appropriate staff
Being a senior staff

HAND HYGIENE
TECHNIQUES
Alcohol hand rub
Routine hand wash 10-15 seconds
Aseptic procedures 1 minute
Surgical wash 3-5 minutes

ROUTINE HAND WASH

TECHNIQUE

AREAS MOST FREQUENTLY MISSED

DURING HAND WASH

HAND CARE
Nails
Rings
Hand creams
Cuts & abrasions
Chapping become cracked, rough, or sore
Skin Problems

Centers for Disease Control and

Prevention estimated
Hand hygiene: a frequently missed lifesaving
opportunity during patient care.
According to a research study by Trampus and
Widmer
Reducing hospital accquired infections requires
that health care workers take responsibility for
ensuring that hand hygiene becomes an
everyday part of patient care.

ACCORDING TO RESEARCH
If every nurse follows proper hand washing
technique with aseptic soap solution and water.
Then in every shift nurses would spent 1.3 hours
in hand washing alone that is 17% of total
nursing time.
Switching to alcohol hand disinfection would
decrease the time necessary for hand hygiene to
0.3 hours (4% of total nursing time)
Importantly, health care workers simply cannot
afford to use almost one fifth of their time for

Centers for Disease Control and

Prevention estimated
that roughly 1.7 million patients get hospital
acquired infections each year.
And 99,000 people die each year because some
nurse dint wash her hand or follow proper
infection control technique.

Hand hygiene: is one of the most

frequently missed lifesaving
opportunity during patient care.

So take 10-15 seconds to wash your hands and save

patients life.

THANKYOU