1. Hospital Infection Control: Basic Principles
Infection Control Committee

2. Goals for hospital infection control & prevention program
Protect the patients
Protect the HCW, visitors, and others in the healthcare environment.
cost effective and cost efficient.

4. MMC Infection Control Committee
ICC
MMC Infection Control Committee
Nursing service
Medicine (ICU/telemetry)
Pediatrics (Nursery/PICU)
Surgery (OR)
OB-GYN (DR)
IHC
Pharmacy
Laboratory
Pulmonary
Dietary
Radiology
Housekeeping
Facility Management/Engineering

5. Infection Control Committee
Promote an adequate environment for the patient care program.
Strives to minimize the hazards of hospital-associated infections by:
prevention
investigation
reporting
control

6. The ICC has the following tasks:
Annual plan for infection control
Infection control policies.
Support the IC team & direct resources to address problems as identified
Ensure availability of appropriate supplies
Review epidemiological surveillance data & identify area for intervention.

7. The ICC has the following tasks (cont):
Promote improved practice at all levels of the health care facility
Training in infection control and safety.
New technology & new devices
Outbreak investigation
Link with other committees

8. ISOLATION PRECAUTIONS
Guideline for Isolation Precautions in Hospitals
Centers for Disease Control & Prevention
Hospital Infection Control Practices Advisory Committee
(January 1996; updated 2004)

9. Isolation Precautions – 2-Level Approach:
Standard Precautions
- primary strategy
2. Transmission-Based Precautions

10. STANDARD PRECAUTIONS
reduce the risk of transmission of bloodborne pathogens
applies to all patients receiving care in hospitals, regardless of their diagnosis or presumed infection status.

11. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

12. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

13. STANDARD PRECAUTIONS a. Handwashing between patient contacts
after touching blood, body fluids, secretions, excretions, and contaminated items
after gloves are removed

15. Hand Hygiene Technique
3. Palm to Palm with fingers interlaced
2. Palm of Right hand over back of left hand & vice versa
1. Palm to Palm
4. Back of Fingers to opposing palms with fingers interlocked
5. Rotational rubbing of right thumb clasped in left palm and vice versa
6. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa

16. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

17. STANDARD PRECAUTIONS B. Clean & non-sterile gloves should be worn:
touching blood, body fluids, secretions, excretions, and contaminated items.
performing venipuncture & other vascular access procedures
Wash hands after removing your gloves

18. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

19. STANDARD PRECAUTIONS
Masks & protective eyewear, goggles or face shields should be worn during:
procedures that are likely to generate splashes/droplets of blood or other body fluids to prevent exposure of mucous membrane of the mouth, nose, & eyes.

20. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

21. STANDARD PRECAUTIONS
D. Gowns or aprons should be worn during:
procedures that are likely to generate splashes of blood or other body fluids

22. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

23. STANDARD PRECAUTIONS Soiled patient-care equipment:
- Wear gloves if visibly contaminated & practice routine hand hygiene
Environmental Contact:
- Follow procedure for routine care, cleaning & disinfection of environment surface, especially frequently touched surfaces in patient-care areas.

24. STANDARD PRECAUTIONS Needles and other sharps:
All HCW’s should take precautions to prevent injuries caused by needles, scalpel, & other sharp instruments or devices during procedures
when cleaning used sharp instruments
during disposal of used needles
when handling sharp instruments after procedures

25. STANDARD PRECAUTIONS should not be recapped
Sharps Injuries
to prevent needle stick injuries, needles:
should not be recapped
should not be purposely bent or broken by hand
should not be manipulated by two hands (one hand scoop technique if required can be done)

26. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

27. STANDARD PRECAUTIONS Handling soiled or contaminated linens
-Always use gloves when handling linen.
-Inspect for needles, syringes, etc while stripping.
-Linen should not be placed on the floor.
-Soiled linen should be placed directly in the cloth hamper.
-Contaminated linen should be placed in a yellow doubled plastic bag sealed by a knot.

28. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

29. h. Occupational Health & Bloodborne Pathogens
To prevent injuries when using needles, scalpels, & other sharp instruments or devices
Never recap used needles
Place used disposable syringes & needles, scalpel blades, & other sharp items in appropriate puncture-resistant containers for transport to reprocessing area.
Use mouthpieces, resuscitation bags as an alternative to mouth-to-mouth resuscitation methods in areas where the need for resuscitation is predictable.

31. STANDARD PRECAUTIONS a. Handwashing b. Gloves
c. Mask, Eye Protection, Face Shield
d. Gown
e. Patient Care Equipment
f. Environmental Control
g. Linen
h. Occupational Health & Bloodborne Pathogens
i. Patient Placement

32. STANDARD PRECAUTIONS Patient Placement:
- Prioritize for single-patient room if at increase risk of transmission of infection
- Likely to contaminate the environment

33. STANDARD PRECAUTIONS
Respiratory Hygiene / Cough Etiquette (new TB guideline)
- Instruct symptomatic person to cover mouth/nose when sneezing/coughing
- Use tissue and dispose properly and avoid touching the receptacle bin
- Observe hand hygiene after soiling of hands with respiratory secretions

34. RESPIRATORY
ETIQUETTE

36. Isolation Precautions – 2-Level Approach:
Standard Precautions
2. Transmission-Based Precautions
- Applied to selected patients based on suspected or confirmed diagnosis
- Always implemented in conjunction with Standard Precautions

37. Transmission- based precautions
Based on 3 major modes of transmission:
Airborne Precaution
Droplet Precaution
Contact Precaution
Some diseases may require more than one isolation category

38. Indications for Transmission-based Precautions

39. Known or Suspected Diseases or Pathogens
Airborne
Measles
Tuberculosis, pulmonary or laryngeal
Varicella
Zoster (disseminated or immunocompromised patient)
SARS
Viral hemorrhagic fever

40. Scenarios Requiring Airborne Precautions
Vesicular rash
Maculopapular rash + coryza + fever
Cough, fever, upper lobe pulmonary infiltrate
Cough, fever, any pulmonary infiltrate in an HIV patient (or patient at risk for HIV)

41. Airborne Precautions Private room, keep door closed at all times
Negative air-pressure ventilation, externally exhausted or HEPA filtered air if recirculated
Fitted respirator masks (N95 respirator) worn by susceptible HCW
Susceptible HCW should wear mask or avoid entering room
Patient should wear mask when transported out of isolation room

42. DROPLET PRECAUTIONS
Use for patients known or suspected to be infected with organisms transmitted by respiratory droplet (large particle >5um in size) that can be generated by the patient during coughing, sneezing and talking on the performance of cough inducing procedures.

43. Known or Suspected Diseases or Pathogens
Droplet
Diphtheria (pharyngeal), Pertussis
Meningococcal infections
HI meningitis, epiglottitis, pneumonia
Influenza
Mumps, Rubella (postnatal)
Mycoplasma pneumonia
Parvovirus B19
Adenovirus (infants, children)
Streptococcal (group A) pharyngitis,
pneumonia, scarlet fever

44. Scenarios Requiring Droplet Precautions
Meningitis
Petechial or ecchymotic rash with fever
Paroxysmal or severe persistent cough (periods of pertussis activity)

45. Droplet Precautions
Private Room, may cohort patients with same diseases; if not possible have a distance of 3 feet between patients and visitors
Patient should leave the room only when necessary; If patient required to leave the room, must wear a surgical mask
Use mask (standard surgical mask) if within 3 feet of patient

46. Contact Transmission Two Modes:
Direct- body surface to body contact and physical transfer of micro-organisms; when doing physical exam, turning patients, giving the patient a bath, etc
Indirect- contact of a susceptible host with a contaminated intermediate object (needles, instruments, dressings, hands)

47. Scenarios Requiring Contact Precautions
Acute diarrhea
Vesicular rash
Respiratory infections in infants & young children
History of infection/colonization with MDR organisms
Skin, wound or UT infection in patient with recent hospital or nursing home stay
Abscess or draining wound that cannot be covered

48. Known or Suspected Diseases or Pathogens
Contact
Abscess (drainage not contained)
Adenovirus (infants, children)
Clostridium difficile intercolitis
Conjunctivitis, acute viral
Escherichia coli 0157:h7 colitis
Furunculosis (infants, children)
Grp A Streptococcal major skin, burn or wound infection
Hepatitis A

49. Known or Suspected Diseases or Pathogens
Contact
HSV (neonatal, disseminated, severe primary mucocutaneous)
Impetigo
MDR bacteria (e.g. MRSA, VRE, GISA, GRSA) infection or colonization
Parainfluenza infection (infants, children)
Rotavirus
Rubella, congenital
Shigella (diapered/incontinent patients)
Varicella
Zoster (disseminated/immunocompromised)

50. Contact Precautions
Private room; cohorting permissible (Ensure that the patient are physically separated (>3 feet) from each other and provide curtain)
Clean, nonsterile gloves at all times
Handwashing after glove removal
Gowns at all times, unless patient is continent and contact of clothing with patient or environmental surfaces is not anticipated
Remove gloves and gowns before leaving room

51. Essential Elements of Isolation Precautions
Airborne
Droplet
Contact
Room
-Negative pressure
Private room w/ air exhausted to outdoors or thru high-efficiency filtration
-Door kept closed
-Private room
-Door may remain open
- Dedicate use of non-critical patient-care items to a single patient

52. Essential Elements of Isolation Precautions
Airborne
Droplet
Contact
Mask
-N95 Mask/ Portable Respirator for those entering room
-Surgical mask on patient for transport outside room
-For entering room surgical mask on patient for transport outside room X

53. Essential Elements of Isolation Precautions
Airborne
Droplet
Contact
Gloves X
-when entering room
*When touching blood, body fluids, secretions, excretions, contaminated items, mucous membranes, non-intact skin, remove promptly after use or before touching non-contaminated items & before next patient.

54. Essential Elements of Isolation Precautions
Airborne
Droplet
Contact
Gown X
-if clothing will contact patient, surfaces, items in room
-if patient has diarrhea, ileostomy, colostomy, uncontained wound drainage
-remove gown before leaving the room

55. Essential Elements of Isolation Precautions
Face Shield/
Eye Protection
-For procedures/activities likely to generate splashes/sprays of blood, body fluids, secretions/excretions

56. Transmission-Based Precautions for Hospitalized Patients

58. 1
A 20-yr old employee was admitted for blood-streaked sputum & weight loss. Chest-xray showed Cavitary Pulmonary Tuberculosis.

59. Facts about Tuberculosis
etiologic agent: mycobacterium tuberculosis
mode of transmission: respiratory droplet nuclei <5um or dust particles containing infectious agent
how transmitted: inhalation of infectious particles which remain suspended in air and travel long distances
duration of infectiousness: until 3 consecutive sputum smears are afb (-) or until 2-4 weeks after anti-tb drugs with good response

60. 2
A 60-yr old woman was brought to the emergency room with the following pertinent PE findings: fever (T=39OC), shallow respiration with petechial and violaceous purpuric skin lesions on her lower extremities. The physician immediately suspected Meningococcemia. The patient became apneic and hypotensive and went into cardio-pulmonary arrest.

61. Facts about Meningococcemia
Etiologic agent: Neisseria meningitidis
Mode of transmission: DROPLET
How transmitted: Droplets containing organisms propelled short distances (<3ft), deposited on host’s conjunctivae, nasal mucosa, mouth
Duration of infectiousness: until 24 hours after initiation of effective antibiotic therapy

62. 3
A 15-yr old student was admitted for fever, loss of appetite, nausea and generalized body weakness. On physical examination, he had icteric sclerae and enlarged tender liver. He was diagnosed to have Hepatitis A infection.

63. Facts about Hepatitis A
Etiologic agent: Hepatitis A virus
Mode of transmission: FECAL-ORAL
How transmitted: Ingestion of contaminated food or water
Duration of infectiousness: 1-2 weeks before onset of illness until 1 week after onset of jaundice

64. 4
A 6-yr old boy developed low grade fever and vesicular rash on the face, chest and extremities. Onset of illness was 2 days after admission to the wards. The patient was diagnosed to have Varicella.

65. Facts about Varicella Etiologic agent: Varicella virus
Mode of transmission: CONTACT and AIRBORNE
How transmitted: Direct contact with skin lesions, indirect contact with contaminated items or surfaces, airborne spread of respiratory tract secretions
Duration of infectiousness: 48 hours prior to skin rash until all vesicles have crusted

66. What Type of PPE Would You Wear?
Giving a bed bath?
Suctioning oral secretions?
Transporting a patient in a wheel chair?
Responding to an emergency where blood is spurting?
Listed here are several patient care activities that could indicate a need to wear PPE. What PPE would you wear for the following?
Giving a bed bath? (generally none)
Suctioning oral secretions? (gloves and mask/goggles or a face shield) (Respondents may correctly note that this may depend on whether open or closed suction is being used)
Transporting a patient in a wheelchair? (generally none)
Responding to an emergency where blood is spurting? (gloves, fluid-resistant gown, mask/goggles or a face shield)
Drawing blood from a vein? (gloves)
Cleaning an incontinent patient with diarrhea? (gloves and generally a gown)
Irrigating a wound? (gloves, gown, and mask/goggles or a face shield)
Taking vital signs? (generally none)
NOTE TO TRAINER: Encourage discussion of how healthcare personnel decide for themselves which PPE will be worn. Do they over- or under-protect themselves? If a question is raised about use of gloves for giving an injection, indicate that this is largely a matter of local or state policy. OSHA does not require use of gloves for giving an injection.
PPE Use in Healthcare Settings

67. What Type of PPE Would You Wear?
Drawing blood from a vein?
Cleaning an incontinent patient with diarrhea?
Irrigating a wound?
Taking vital signs?
Listed here are several patient care activities that could indicate a need to wear PPE. What PPE would you wear for the following?
Giving a bed bath? (generally none)
Suctioning oral secretions? (gloves and mask/goggles or a face shield) (Respondents may correctly note that this may depend on whether open or closed suction is being used)
Transporting a patient in a wheelchair? (generally none)
Responding to an emergency where blood is spurting? (gloves, fluid-resistant gown, mask/goggles or a face shield)
Drawing blood from a vein? (gloves)
Cleaning an incontinent patient with diarrhea? (gloves and generally a gown)
Irrigating a wound? (gloves, gown, and mask/goggles or a face shield)
Taking vital signs? (generally none)
NOTE TO TRAINER: Encourage discussion of how healthcare personnel decide for themselves which PPE will be worn. Do they over- or under-protect themselves? If a question is raised about use of gloves for giving an injection, indicate that this is largely a matter of local or state policy. OSHA does not require use of gloves for giving an injection.
PPE Use in Healthcare Settings

68. What Type of PPE Would You Wear?
Giving a bed bath?
Generally none
Suctioning oral secretions?
Gloves and mask/goggles or a face shield – sometimes gown
Transporting a patient in a wheel chair?
Generally none required
Responding to an emergency where blood is spurting?
Gloves, fluid-resistant gown, mask/goggles or a face shield
Drawing blood from a vein?
Gloves
Cleaning an incontinent patient with diarrhea?
Gloves w/wo gown
Irrigating a wound?
Gloves, gown, mask/goggles or a face shield
Taking vital signs?
Listed here are several patient care activities that could indicate a need to wear PPE. What PPE would you wear for the following?
Giving a bed bath? (generally none)
Suctioning oral secretions? (gloves and mask/goggles or a face shield) (Respondents may correctly note that this may depend on whether open or closed suction is being used)
Transporting a patient in a wheelchair? (generally none)
Responding to an emergency where blood is spurting? (gloves, fluid-resistant gown, and mask/goggles or a face shield)
Drawing blood from a vein? (gloves)
Cleaning an incontinent patient with diarrhea? (gloves and generally a gown)
Irrigating a wound? (gloves, gown, and mask/goggles or a face shield)
Taking vital signs? (generally none)
NOTE TO TRAINER: Encourage discussion of how healthcare personnel decide for themselves which PPE will be worn. Do they over- or under-protect themselves?
PPE Use in Healthcare Settings

69. INFECTION CONTROL is…
COMMON SENSE