Infection Control

and
Healthcare-related Infections

Dr. Eiman Mokaddas MD

MRCPath
Associate Professor
Microbiology Department
Faculty of Medicine
10/14/08 E.Mokaddas
Community v.s. Hospital-Acquired Infection

 The risk of infection is always present

 Patient may acquire infection before admission to the
hospital = Community acquired infection
 Patient may get infected inside the hospital =
Nosocomial infection

10/14/08 E.Mokaddas
 Factors affecting infectious process

The micro-organism

Infection

The Host The environment

10/14/08 E.Mokaddas
Factors affecting infectious process

 The micro-organism:
 virulence, pathogenicity, invasiveness
 The host:
 immunocompetent vs. immunocompromised
 Immunized vs. non immunized (herd
immunity)
 The environment:
 cleanliness (water supply, hospital
environment, hand hygeine)
 overcrowding, improved socio-economic
conditions

10/14/08 E.Mokaddas
 World Alliance for Patient Safety
Global Patient Safety Challenge 2005-2006
■ Healthcare-associated infections
– affect millions of patients worldwide every year
– more serious illness
– prolong hospital stay
– long-term disability
– high costs on humans and their families
– excess deaths
– massive additional financial burden

10/14/08 E.Mokaddas
10/14/08 E.Mokaddas
 Nosocomial Infections(NI)
( Helthcare-associated Infections (HAI

HCRI is defined as, “an infection that is not

present or incubating when a patient is admitted
to a hospital or a healthcare facility.” (Infection
Control Online)
It is commonly referred to as a Healthcare-
associated infection (HAI)

10/14/08 E.Mokaddas
Types of HAIs

 Urinary Tract Infections

 Respiratory Tract Infections
 Skin and soft tissue infections (wound)
 Catheter-related infections
 Septicemia
 Gastrointestinal infections

10/14/08 E.Mokaddas
Common features of HAIs

 Associated with treatment or procedure e.g. surgery

(wound infection), Urinary catheterization (UTI),
Intravenous infusion (septicemia)
 Usually associated with antibiotic-resistant micro-organisms
e.g. methicillin-resistant Staphylococcus aureus (MRSA)

10/14/08 E.Mokaddas
 Prevention of HAIs

Infection Control
Committee

10/14/08 E.Mokaddas
Prevention of HAIs

1. Education of medical, nursing and ancillary staff in the

basic concepts of infection control:
 Hand washing:
 frequent hand washing is the most important measure
to prevent cross-infection
 Staff must be taught about the principles of hand
hygiene

10/14/08 E.Mokaddas
Prevention of HAIs

 Applying hygiene in all aspects of health care: e.g.

theatre, wound dressing, other surgical techniques, safe
patient environment

10/14/08 E.Mokaddas
 Education-based prevention
of catheter-related infection

10/14/08 E.Mokaddas
hand rub at the point of care

Before and after any patient contact

Before and after glove use
10/14/08 In between different
E.Mokaddas body site care
Time constraint = major obstacle for hand hygiene

handwashing alcohol-based
hand antisepsis hand rub
10/14/08 1 to 1.5 min E.Mokaddas 15 to 20 sec
Prevention of HAIs

2. Sterilization and Disinfection policy:

 Provision of sterile instruments, dressings etc..
 Proper use of disinfectants in the hospital environment
and antiseptics on the skin of patients and on the hands
of staff including various methods of hand rubs
 Use of disposable items such as syringes, catheters etc…

10/14/08 E.Mokaddas
Prevention of HAIs

3. Isolation Policy:
 Single rooms for airborne infections
 Source isolation; prevents spread of infection from
infected patient
 Protective isolation: prevents a susceptible patient
(immunocompromised) from getting an infection

10/14/08 E.Mokaddas
Prevention of HAIs

4. Antibiotic Policy:
 Rational use of antibiotics both for prophylaxis and
treatment

10/14/08 E.Mokaddas
Prevention of HAIs

5. Surveillance: of infections within a hospital

 Done by Infection Control team (nurse, officer)
 To follow the spread of infections within a hospital
 Monitor infection rate within selected units e.g. ICUs,
Surgical wards, neonatal units etc…

10/14/08 E.Mokaddas
Surveillance Principle

 Surveillance is: “Information for Action”

 “If you don't use it, then do not ask for it!”

However:
 “Good surveillance does not necessarily ensure the
making of the right decisions, but it reduces the
chances of the wrong ones”

A. D. Langmuir (1963)

10/14/08 E.Mokaddas
Quiz

 A patient with known blood borne pathogen was operated

in the operating theatre, which involved the use of a
flexible endoscope
 Question 1:
 What is usually done to the reusable items in the theatre?

10/14/08 E.Mokaddas
Quiz

 Question 2:
 Endoscopes are heat-sensitive equipments. How would you
make it fit to be used for the next patient?

10/14/08 E.Mokaddas
Quiz

 There was spillage of blood and body secretions on the

theatre floor during operation.
 Question 3:
 How would you take care of the spillage?

10/14/08 E.Mokaddas
Quiz

 Question 4:
 To what group of disinfectants does gluteraldehyde belong?
 Question 5:
 What is the advantage and disadvantage of gluteraldehyde?

10/14/08 E.Mokaddas
Quiz

 Question 6:
 What type of disinfectant is hypochlorite?
 Question 7:
 What are the advantages and disadvantages of
hypochlorite?
 Question 8:
 What are its uses?

10/14/08 E.Mokaddas