Infection Control in the Hospital Setting

PURPOSES OF EPIDEMIOLOGY

To plan and evaluate interventions and prevention

strategies more effectively by knowing:
The distribution of disease

Its determinants in person, place, and time

 CHAIN OF INFECTION

Infection requires a chain of events

The role of the hospital epidemiologist/infection control
is to understand this chain and the most efficient
means of interrupting transmission
 CHAIN OF INFECTION

Causative agent
Susceptible host Reservoir

Inoculating dose Portal of exit

Portal of entry Environmental

survival
Mode of transmission
 SOURCES OF PATHOGENS

People
Endogenous: Normal flora or reactivation
Exogenous: People (staff, visitors) or environment
Animals
Arthropods (insects)
Environment
 Normal Skin Micro-Flora

Numbers of bacteria that colonize different parts of the body

Numbers per square centimeter of skin surface (cfu/cm 2).

ICU Setting: Multiple Sources of Pathogens
 Basic Modes of Transmission

Contact-victim contact with source

Direct-physical contact between source (e.g., MRSA on medical
students hands) and victim (patient medical student is examining)
Indirect-victim contacts contaminated inanimate object (e.g.,
ultrasound probe contaminated with MRSA or VRE)
Droplet-infectious droplets deposited on mucous membranes
of the nose or mouth
Airborne-airborne phase in disease dissemination
Vectorborne-not a significant source in US healthcare facilities
Isolation Precautions to Prevent the Transmission
of Infections to Patients and Personnel
 STANDARD PRECAUTIONS

Hand hygiene: Before and after each patient contact & after
gloves removed
Gloves: When touching contaminated items (blood, body fluids,
secretions, excretions).
If it is wet and not yours, wear gloves!

Mask, eye protection, face shield: whenever splashes or sprays

of body fluids possible
Gown: Whenever splashes or sprays of body fluids possible
Personal Protective Equipment
(PPE)
Gloves
Gown
Mask
Eyewear

Wear your personal

protective equipment
correctly!
 AIRBORNE PRECAUTIONS

Used for patients with known or suspected diseases

transmitted by airborne droplet nuclei (<5 microns)
Private room
Negative air pressure in relation to the corridor
>6 air exchanges per hour
Direct discharge of air to the outside
Personnel: Respiratory protection required
N-95 respirator
Limit transport of patient to essential purposes
 AIRBORNE PRECAUTIONS

Representative pathogens
M. tuberculosis
Varicella
Zoster
Measles

HCWs required to wear a

respirator to enter room
 SPECIAL AIRBORNE PRECAUTIONS

Used for patients with known or suspected diseases

transmitted by airborne droplet nuclei and contact
Private room (must meet airborne isolation guidelines)
Personnel: Respiratory protection required
N-95 respirator
Eye protection: Shield or goggles
Gowns and gloves when entering room
Limit transport of patient to essential purposes
 SPECIAL AIRBORNE PRECAUTIONS

Representative pathogens
Avian influenza
Monkey pox
SARS Co-V
Smallpox
Viral hemorrhagic fever (e.g., Ebola,
Lassa)
 DROPLET PRECAUTIONS

Used for diseases spread

via large droplets (>5 microns)
Private room
Special air handling not required
Personnel
Surgical mask upon entering room
 DROPLET PRECAUTIONS

Representative pathogens
Invasive N. meningitidis
RSV
Bordetella pertussis
Rubella
Mumps
Group A streptococcal pharyngitis
Influenza

H1NI Precautions
 CONTACT PRECAUTIONS

Used for pathogens that

can easily be transmitted by
contact with patient and/or items
in the patients environment
Private room
Gloves and gown when entering room

Careful hand hygiene

 Representative Pathogens

Methicillin-resistant S. aureus (MRSA)

Vancomycin-resistant enterococcus (VRE)
C. difficile
Norovirus
Multiply-drug resistant (MDR) gram negative rods
(e.g., B. cepacia, P. aeruginosa, Acinetobacter)
All of the above organisms can survive on environmental surfaces for
long periods of time and can be transiently carried on hands.
Bloodborne Pathogens
 BLOODBORNE PATHOGENS
TRANSMITTED BY NEEDLESTICKS

Big 3
Ebola virus infection
Herpes simplex I
Hepatitis B
Leptospirosis
Hepatitis C Malaria
HIV Marburg VHF
Others Mycobacterium marinum
Mycoplasma caviae infection
Argentinean VHF (Junn virus)
Rocky Mountain spotted fever
Blastomycosis
Syphilis
Brucellosis
Toxoplasmosis
Corynebacterium diphtheria Tuberculosis
Cryptococcus Varicella zoster
Dengue West Nile
Diphtheria
Tarantola A, et al. AJIC 2006;34:367-75
Other Communicable Diseases with Risk of Occupational
Exposure

Tuberculosis
Varicella zoster
Pertussis
Influenza
Meningococcal Meningitis
Parvo Virus-B19
Health Care Associated Infections
(HAIs)
 Impact of HAIs
2002 data from CDC National Nosocomial Infections Surveillance Systems

Estimated number of HAIs: 1.7 million

Estimated number of deaths associated with the HAI:98,987
Pneumonia: 35,967
Bloodstream: 30,665
Urinary tract: 13,088
Surgical site: 8,205
Other sites: 11,062

Klevens RM. Public Health Rep. 2007, 122(2):160-6

What is the most effective and simplest method to
protect your health and to help prevent HAIs?
 Hand Hygiene: Methods

Soap and water

Hand washing with antimicrobial soap (e.g.CHG) and water for 15
seconds
Alcohol-based handrubs (e.g. Alcare) when
Hands are not visibly soiled, or
Hand washing facilities are not available in patient rooms
Use soap and water when
Patient known or suspected to have C. difficile disease or norovirus
infection (alcohol not effective against spores or nonenveloped
viruses)
 Indications for Handwashing and Hand
Antisepsis

Before having direct contact with patients.

Before donning sterile gloves for sterile/aseptic
procedures (e.g., central venous catheter placement)
After glove removal
After patient contact
After contact with a contaminated instrument or
surface
- Artificial nails and nail extenders are prohibited for direct patient
care providers.
 In Review
Infections can be transmitted in the hospital setting via contact, droplet, or
airborne spread
Adherence to Isolation Precautions prevents transmission of disease to
you and to other persons
Appropriate use of PPE and safe handling of sharp devices can reduce
your risk of exposure to bloodborne pathogens
Hand hygiene reduces the risk of transmission of pathogenic organisms
Questions related to infection prevention and control: contact Hospital
Epidemiology @ 6-1638 and after hours on pager 216-6652
Thank You!

I don't see the glass as half-empty or

I see it as a glass somebody else has a
their lousy germs on.
Maxine