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Mircobiology 3.11 Dr.

Procedure/Techniques on Patient Safety DATE: Sept. 30, 2013

OUTLINE • Infections that are present or incubating at the time of

I. Definitions admission
A. Nosocomial infections Iatrogenic Infection
B. Community acquired infections  Physician-induced
C. Iatrogenic Infections  Infections that are the result of medical or surgical treatment
II. Nosocomial Infection by medical personnel
A. Factors
B. Most Common Pathogens Nosocomial Infection
C. Most Common Types Factors
D. High-Risk Patients Sources
E. Contributing Factors
F. 12 Steps to Prevent Antimicrobial Resistance Among  Hospital personnel
Hospitalized Adults  Visitors
III. Infection Control  patients
A. Asepsis and Antisepsis  Dust
B. Disinfectants  wet or moist areas or objects
C. Most Effective Infection Control Technique o Examples: sink drains, showerheads, toilets, mop
D. Standard Precautions buckets, etc.
E. Transmission Based Precautions  kitchen food
i. Airborne
ii. Droplet Virulence
iii. Contact
F. Isolation  Most nosocomial infection pathogens (70%) are usually
G. Handling Food and Eating Utensils DRUG-RESISTANT
H. Handling Fomites o Examples:
I. Medical Waste Disposal  Pseudomonas
J. Infection Control Committee  multidrug-resistant Mycobacterium
K. Clinical Microbiology Laboratory tuberculosis (MDRTB)
 vancomycin-resistant Enterococcusspp (VRE)
Learning Objectives:  methicillin-resistant Staphylococcus aureaus
1. Differentiate among nosocomial, community-acquired and (MRSA)
iatrogenic infections  Staphylococcus epidermidis (MRSE)
2. List the seven pathogens that most commonly cause  Viruses (HIV), fungi (Candida), Protozoa (malaria)
nosocomial infections
3. State the four most common types of nosocomial infections Mechanism of Resistance
4. List six types of patients who are especially vulnerable to Mechanism Effect
nosocomial infections Chromosomal mutation that causes Drug can’t bind to bacterial cell
5. State the three major contributing factors in nosocomial a change in the structure of a drug-
infections binding site
6. Differentiate between medical and surgical asepsis Chromosomal mutation that causes Drug can’t pass through cell
7. State the most important and effective way to reduce the a change in cell membrane membrane (can’t enter cell)
number of nosocomial infections permeability
8. Differentiate between standard precautions and
transmission-based precautions and state the 3 types of Acquisition (by conjugation, Drug destroyed / deactivated by
transmission-based precautions transduction, transformation) of enzyme
9. Differentiate between source and protective (reverse) gene that enables bacteria to
isolation produce enzymes that inactivate
10. Cite 3 important considerations in the handling of each of the drug
following: food, eating utensils, fomites, and sharps
11. List 6 responsibilities of the Infection Control Committee Acquisition (by conjugation, Drug pumped out of cell before it
12. State the 3 ways in which the Clinical Microbiology transduction, transformation) of can kill bacteria
Laboratory participates in infection control gene that enables bacteria to
produce multidrug-resistance pump
Nosocomial Infections
• Infections that are acquired in hospitals or other health care
• Infections that erupt within 14 days of discharge

Community-acquired Infections
• Infections that are acquired outside of hospitals or other
health care facilities

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Most Common Pathogen • Use Antimicrobials Wisely
– Step 5: Engage in local antimicrobial control efforts.
– Step 6:Use local antibiogram of your population.
– Step 7: Treat infection an not the contamination by using
proper antiseptic techniques and culture.
– Step 8: Treat infection, not the prosthetics
– Step 9: Use vancomycin judiciously
– Step 10: Stop antibiotic treatment when the infection is
already cured, cultures are negative, infection unlikely
and infection not diagnosed
• Prevent Transmission
– Step 11: Isolate the pathogen by using standard infection
control precautions
Most Common Types – Step 12: Break the chain of contagion.
The four most common types (listed indescending order of frequency):
1. Urinary tract infections
Infection Control
2. Surgical wound infections (postsurgical)
Asepsis and Antisepsis
3. Lower respiratory tract infections (primarily pneumonia)
Infection Control
4. Bloodstream infections (septicemia)
– Measures taken to prevent infections from occurring in health-
• Others include
care settings
– Clostridium-difficile-associated gastrointestinal diseases
– Eliminate or contain reservoir of infection, interrupt transmission
(gastroenteritis, antibiotic-associated diarrhea (ADD),
of pathogens, protect potential hosts from becoming infected
pseudomembranous colitis (PMC))

High-Risk Patients
1. Elderly patients
2. Women in labor and delivery
3. Premature infants and newborns
4. Surgical (especially transplant) and burn patients
5. Diabetic and cancer patients
6. Patients receiving treatment with steroids, anticancer drugs, anti-
lymphocyte serum, and radiation
7. Immunosuppressed, paralyzed, dialyzed and catheterized patients

Contributing Factors
3 Major factors: Most Effective Infection Control Technique
- Increased number of drug-resistant pathogens • Handwashing
- Failure of healthcare personnel to follow infection control – Single most important measure to reduce the risks of
guidelines transmitting pathogens from one patient to another
- Increased number of immunocompromised patients – (cross-infection) or from one anatomic site to another
Other factors: on the same patient (cross-contamination)
- Indiscriminate use of antimicrobials
 Results in drug-resistant / mulitdrug-resistant pathogens Disinfectant
- Neglect in aseptic techniques & infection control procedures
 Due to false sense of security about antimicrobial agents Disinfectant Mode of Action and Spectrum Uses
- Lengthy & Complicated surgeries
- Overcrowded healthcare facilites & shortage of staff
- Undertrained healthcare providers Hydrogen Produces destructive free Limited clinical
 Unaware of infection control procedures peroxide radicals that are destructive to use; Disinfection
- Increased used of anti-inflammatory & immunosuppressive agents essential cellular bacterial of inanimate
 Radiation, steroids, anticancer chemotherapy, components; same a chlorine surfaces
antilymphocyte serum
Iodine (betadine) Disrupts protein & nucleic Antiseptic
12 steps to prevent antimicrobial resistance acids structure & synthesis;
• Prevent Infection Same spectrum as chlorine
– Step 1: Vaccinate at-risk patients before discharge and
healthcare workers annually. Phenols Disrupts cell walls & Decontamination
– Step 2: Use catheters only when essential. Observe &Phenolics (Lysol) inactivates essential enzyme of noncritical
proper insertion and removal protocols. systems; same spectrum as medical and
• Diagnose and Treat Infection Effectively alcohol surgical items
– Step 3: Target definitive therapy against pathogens by
using culture, hospital antibiogram; empiric and
definitive therapy
– Step 4: Consult infectious disease experts to patients
with serious infections
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– Droplet
Disinfectant Mode of Action and Uses – Vehicular
– Vectors
• Three types of Transmission-based Precautions
Alcohols (60-90% Denaturation of proteins; Disinfection of
A. Airborne Precautions
ethyl, isopropyl, bactericidal, tuiberculocidal, instruments,
 Airborne droplet nuclei or dust particle containing
benzyl) fungicial, virucidal BUT NOT hands, skin prep
 Small-particle residues (≤5µm) of evaporated droplets
Chlorine compounds Denaturation of proteins & Disinfectant of containing microorganisms
(chlorox, zonrox) nucleic acids; Same floors, blood  Isolation rooms
spectrum as alcohols but spills, water  May share room with other pxs with same disease
sporocidal treatment  Visitors must wear protective masks; or they’re immune
to disease
Formaldehyde Alters protein structures & Limited to  Ex. Mycobacterium tuberculosis, rubeola, varicella
(formalin) purine bases; Same preserving
spectrum as chlorine specimens due to B. Droplet Precautions
fumes  Form of contact transmission
 Droplets (≥5µm) produced via coughing, sneezing, talking,
Gluteraldehyde Interferes with DNA, RNA, Disinfection of
(cydex) and proteins synthesis; Same instruments suctioning, bronchoscopy  propelled in short distances 
spectrum as formaldehyde deposited in person’s conjunctiva, nasal mucosa or mouth
but slow tuberculocidal  Ex: adenovirus, Haemophilus influenzae, German measles,
activity Group A Streptococci, Neisseria meningitidis, mumps,
pertussis, diphtheriae, pneumonia

C. Contact Precautions
 Direct (body surface-to-body surface)
Standard Precautions  Indirect (contaminated intermediate object)
- Used for all patients regardless of diagnosis or presumed infection  May share room with other pxs with same disease; use
status exclusive equipments
- Designed to reduce the risk of transmission of bloodborne  Visitors must wear protective masks, gloves, gown; or they’re
pathogens & pathogens from moist body substances immune to disease
 Ex: Clostridium-difficile associated diseases, RSV, scabies,
impetigo, chickenpox, shingles, viral hemorrhagic fever

 Source Isolation

Transmission Based Precautions

• Transmission-based precautions
– Designed for patients known or suspected with highly-
transmissible or epidemiologically important pathogen
which needs additional measures beyond standard
precautions to interrupt spread within hospitals
– Five main routes of transmission of pathogens (hospital
– Contact (direct and/or indirect)
– Airborne
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 Protective (reverse) Isolation Clinical Microbiology Laboratory

1. Monitors types & numbers of pathogens
2. Notifies ICC of outbreaks
3. Processes samples

Edited By: Shan Sy

Handling Food and Eating Utensils

1. Prepare fresh, high quality food
2. Proper storage & refrigeration
3. Proper disposal of uneaten food
4. Thorough hadwashing
5. Proper disposal personal secretions
6. Using aprons, hair net, etc
7. Periodic health examination of food handlers
8. Prohibiting sick food handlers from handling food
9. Cleaning of cooking wares

Handling Fomites
• Fomites
– Any non-living or inanimate objects that may harbor and
transmit microbes
• Examples: gowns, beddings,gloves, ECG
electrodes, etc
• Preventive measures vs. Fomites
– Proper disposal of equipments, supplies
– Use disinfectants
– Avoid re-using equipments
– Sterilization processes

Medical Waste Disposal

• General Regulations
– Receptacle for solid & liquid wastes Leak-free
– Wastes should be disposed ASAP
– Infection Control Program
• Disposal of Sharps
– Do not re-use needles
– “One-hand scoop method”
– Dispose needles in puncture-resistant containers

Infection Control Committee

• Composition
– Medical / surgical services, pathology, nursing services,
hospital administration, housekeeping, food services,
central supply
• Responsibilities
– Reviews infection control programs and measures
– Policy-making
– Monitors nosocomial infection incidence rates
– Patient & environmental surveillance
– Outbreak and epidemic investigation
– Hospital staff education
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