Infection prevention and control is the discipline concerned with preventing
healthcare-associated infection
A hospital-acquired infection, also known as a nosocomial infection (from the Greek , meaning "hospital"), is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is so ...
s; a practical rather than academic sub-discipline of
epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evidenc ...
. In
Northern Europe
The northern region of Europe has several definitions. A restrictive definition may describe Northern Europe as being roughly north of the southern coast of the Baltic Sea, which is about 54th parallel north, 54°N, or may be based on other g ...
, infection prevention and control is expanded from healthcare into a component in
public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
, known as "infection protection" (''smittevern, smittskydd, Infektionsschutz'' in the local languages). It is an essential part of the infrastructure of
health care
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
. Infection control and hospital epidemiology are akin to
public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.
Infection control addresses factors related to the spread of
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
s within the healthcare setting, whether among patients, from patients to staff, from staff to patients, or among staff. This includes
preventive measures such as
hand washing
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap, soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the ...
, cleaning, disinfecting,
sterilizing, and
vaccinating
Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
. Other aspects include surveillance, monitoring, and investigating and managing suspected outbreaks of infection within a healthcare setting.
A subsidiary aspect of infection control involves preventing the spread of antimicrobial-resistant organisms such as
MRSA
Methicillin-resistant ''Staphylococcus aureus'' (MRSA) is a group of Gram-positive bacteria that are genetically distinct from other strains of ''Staphylococcus aureus''. MRSA is responsible for several difficult-to-treat infections in humans. ...
. This in turn connects to the discipline of
antimicrobial stewardship Antimicrobial stewardship is the systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing, in order to stem antimicrobial overuse, and thus antimicrobial resistance. AMS has been an organized eff ...
—limiting the use of
antimicrobials
An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals a ...
to necessary cases, as increased usage inevitably results in the selection and dissemination of resistant organisms. Antimicrobial medications (aka
antimicrobials
An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals a ...
or anti-infective agents) include
antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
,
antibacterials
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
,
antifungals
An antifungal medication, also known as an antimycotic medication, is a pharmaceutical fungicide or fungistatic used to treat and prevent mycosis such as athlete's foot, ringworm, candidiasis (thrush), serious systemic infections such as crypto ...
,
antivirals
Antiviral drugs are a class of medication used for treating viral infections. Most antivirals target specific viruses, while a broad-spectrum antiviral is effective against a wide range of viruses. Unlike most antibiotics, antiviral drugs do no ...
and
antiprotozoals.
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) has set up an ''Infection Prevention and Control'' (IPC) unit in its ''Service Delivery and Safety'' department that publishes related guidelines.
Infection prevention and control
Aseptic technique
Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deriv ...
is a key component of all invasive medical procedures. Similar control measures are also recommended in any healthcare setting to prevent the spread of infection generally.
Hand hygiene
Hand hygiene is one of the basic, yet most important steps in IPC (Infection Prevention and Control). Hand hygiene reduces the chances of HAI (Healthcare Associated Infections) drastically at a floor-low cost. Hand hygiene consists of either hand wash(water based) or hand rubs(alcohol based). Hand wash is a solid 7-steps according to th
''WHO standards'' wherein hand rubs are 5-steps.
The American Nurses Association (ANA) and American Association of Nurse Anesthesiology (AANA) have set specific checkpoints for nurses to clean their hands; the checkpoints for nurses include, before patient contact, before putting on protective equipment, before doing procedures, after contact with patient’s skin and surroundings, after contamination of foreign substances, after contact with bodily fluids and wounds, after taking off protective equipment, and after using the restroom.
To ensure all before and after checkpoints for hand washing are done, precautions such as hand sanitizer dispensers filled with sodium hypochlorite, alcohol, or hydrogen peroxide, which are three approved disinfectants that kill bacteria, are placed in certain points, and nurses carrying mini hand sanitizer dispensers help increase sanitation in the work field. In cases where equipment is being placed in a container or bin and picked back up, nurses and doctors are required to wash their hands or use alcohol sanitizer before going back to the container to use the same equipment.
Independent studies by
Ignaz Semmelweis
Ignaz Philipp Semmelweis (; hu, Semmelweis Ignác Fülöp ; 1 July 1818 – 13 August 1865) was a Hungarian physician and scientist, who was an early pioneer of antiseptic procedures. Described as the "saviour of mothers", he discovered that t ...
in 1846 in
Vienna
en, Viennese
, iso_code = AT-9
, registration_plate = W
, postal_code_type = Postal code
, postal_code =
, timezone = CET
, utc_offset = +1
, timezone_DST ...
and
Oliver Wendell Holmes, Sr.
Oliver Wendell Holmes Sr. (; August 29, 1809 – October 7, 1894) was an American physician, poet, and polymath based in Boston. Grouped among the fireside poets, he was acclaimed by his peers as one of the best writers of the day. His most fa ...
in 1843 in
Boston
Boston (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- mo ...
established a link between the hands of health care workers and the spread of
hospital-acquired disease. The
U.S. Centers for Disease Control and Prevention (CDC) state that "It is well documented that the most important measure for preventing the spread of pathogens is effective handwashing". In the developed world,
hand washing
Hand washing (or handwashing), also known as hand hygiene, is the act of cleaning one's hands with soap, soap or handwash and water to remove viruses/bacteria/microorganisms, dirt, grease, or other harmful and unwanted substances stuck to the ...
is mandatory in most health care settings and required by many different regulators.
In the United States, OSHA standards require that employers must provide readily accessible hand washing facilities, and must ensure that employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon as feasible after contact with blood or other potentially infectious materials (OPIM).
In the UK healthcare professionals have adopted the 'Ayliffe Technique', based on the 6 step method developed by
Graham Ayliffe
Graham Arthur John Ayliffe (2 March 192622 May 2017) was a British medical microbiologist and Emeritus Professor in Medical Microbiology, University of Birmingham, United Kingdom. He was instrumental in founding the International Federa ...
, JR Babb and AH Quoraishi.
Drying is an essential part of the hand hygiene process. In November 2008, a non-peer-reviewed study was presented to the European Tissue Symposium by the
University of Westminster
, mottoeng = The Lord is our Strength
, type = Public
, established = 1838: Royal Polytechnic Institution 1891: Polytechnic-Regent Street 1970: Polytechnic of Central London 1992: University of Westminster
, endowment = £5.1 million ...
, London, comparing the bacteria levels present after the use of
paper towel
A paper towel is an absorbent, disposable towel made from paper. In Britain, paper towels for kitchen use are also known as kitchen rolls, kitchen paper, or kitchen towels. For home use, paper towels are usually sold in a roll of perforated shee ...
s, warm air hand dryers, and modern jet-air hand dryers. Of those three methods, only paper towels reduced the total number of bacteria on hands, with "through-air dried" towels the most effective.
The presenters also carried out tests to establish whether there was the potential for cross-contamination of other washroom users and the washroom environment as a result of each type of drying method. They found that:
* the jet air dryer, which blows air out of the unit at claimed speeds of 400 mph, was capable of blowing micro-organisms from the hands and the unit and potentially contaminating other washroom users and the washroom environment up to 2 metres away
* use of a warm air hand dryer spread micro-organisms up to 0.25 metres from the dryer
* paper towels showed no significant spread of micro-organisms.
In 2005, in a study conducted by TUV Produkt und Umwelt, different hand drying methods were evaluated. The following changes in the bacterial count after drying the hands were observed:
Cleaning, Disinfection, Sterilization
The field of infection prevention describes a
hierarchy of removal of microorganisms from surfaces including medical equipment and instruments. Cleaning is the lowest level, accomplishing substantial removal. Disinfection involves the removal of all pathogens other than bacterial spores. Sterilization is defined as the removal or destruction of ALL microorganisms including bacterial spores.
Cleaning
Cleaning is the first and simplest step in preventing the spread of infection via surfaces and fomites. Cleaning reduces microbial burden by chemical deadsorption of organisms (loosening bioburden/organisms from surfaces via cleaning chemicals), simple mechanical removal (rinsing, wiping), as well as disinfection (killing of organisms by cleaning chemicals).
In order to reduce their chances to contract an infection, individuals are recommended to maintain a good hygiene by washing their hands after every contact with questionable areas or bodily fluids and by disposing of
garbage at regular intervals to prevent
germs from growing.
Disinfection
Disinfection uses liquid chemicals on surfaces and at room temperature to kill disease causing microorganisms. Ultraviolet light has also been used to disinfect the rooms of patients infected with ''
Clostridium difficile'' after discharge. Disinfection is less effective than sterilization because it does not kill bacterial endospores.
Along with ensuring proper hand washing techniques are followed, another major component to decrease the spread of disease is sanitation of all medical equipment. The ANA and AANA set guidelines for sterilization and disinfection based on the Spaulding Disinfection and Sterilization Classification Scheme (SDSCS). The SDSCS classifies sterilization techniques into three categories: critical, semi-critical, and non-critical.
For critical situations, or situations involving contact with sterile tissue or the vascular system, sterilize devices with sterilants that destroy all bacteria, rinse with sterile water, and use chemical germicides.
In semi-critical situations, or situations with contact of mucous membranes or non-intact skin, high-level disinfectants are required. Cleaning and disinfecting devices with high-level disinfectants, rinsing with sterile water, and drying all equipment surfaces to prevent microorganism growth are methods nurses and doctors must follow. For non-critical situations, or situations involving electronic devices, stethoscopes, blood pressure cuffs, beds, monitors and other general hospital equipment, intermediate level disinfection is required. "Clean all equipment between patients with alcohol, use protective covering for non-critical surfaces that are difficult to clean, and hydrogen peroxide gas. . .for reusable items that are difficult to clean."
Sterilization
Sterilization is a process intended to kill all
microorganism
A microorganism, or microbe,, ''mikros'', "small") and ''organism'' from the el, ὀργανισμός, ''organismós'', "organism"). It is usually written as a single word but is sometimes hyphenated (''micro-organism''), especially in olde ...
s and is the highest level of microbial kill that is possible.
Sterilization, if performed properly, is an effective way of preventing
Infections
An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmiss ...
from spreading. It should be used for the cleaning of medical instruments and any type of medical item that comes into contact with the
blood stream
The blood circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, tha ...
and sterile tissues.
There are four main ways in which such items are usually sterilized:
autoclave
An autoclave is a machine used to carry out industrial and scientific processes requiring elevated temperature and pressure in relation to ambient pressure and/or temperature. Autoclaves are used before surgical procedures to perform sterilizat ...
(by using high-pressure
steam
Steam is a substance containing water in the gas phase, and sometimes also an aerosol of liquid water droplets, or air. This may occur due to evaporation or due to boiling, where heat is applied until water reaches the enthalpy of vaporization ...
), dry
heat
In thermodynamics, heat is defined as the form of energy crossing the boundary of a thermodynamic system by virtue of a temperature difference across the boundary. A thermodynamic system does not ''contain'' heat. Nevertheless, the term is al ...
(in an oven), by using chemical sterilants such as glutaraldehydes or
formaldehyde
Formaldehyde ( , ) (systematic name methanal) is a naturally occurring organic compound with the formula and structure . The pure compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde (refer to section F ...
solutions or by exposure to
ionizing radiation
Ionizing radiation (or ionising radiation), including nuclear radiation, consists of subatomic particles or electromagnetic waves that have sufficient energy to ionize atoms or molecules by detaching electrons from them. Some particles can travel ...
. The first two are the most widely used methods of sterilization mainly because of their accessibility and availability. Steam sterilization is one of the most effective types of sterilizations, if done correctly which is often hard to achieve. Instruments that are used in
health care facilities are usually sterilized with this method. The general rule in this case is that in order to perform an effective sterilization, the steam must get into contact with all the surfaces that are meant to be disinfected. On the other hand, dry heat sterilization, which is performed with the help of an oven, is also an accessible type of sterilization, although it can only be used to disinfect instruments that are made of
metal
A metal (from Greek μέταλλον ''métallon'', "mine, quarry, metal") is a material that, when freshly prepared, polished, or fractured, shows a lustrous appearance, and conducts electricity and heat relatively well. Metals are typicall ...
or
glass
Glass is a non-crystalline, often transparent, amorphous solid that has widespread practical, technological, and decorative use in, for example, window panes, tableware, and optics. Glass is most often formed by rapid cooling (quenching) of ...
. The very high
temperatures
Temperature is a physical quantity that expresses quantitatively the perceptions of hotness and coldness. Temperature is measured with a thermometer.
Thermometers are calibrated in various temperature scales that historically have relied o ...
needed to perform sterilization in this way are able to melt the instruments that are not made of glass or metal.
Effectiveness of the sterilizer, for example a
steam autoclave is determined in three ways.
First, mechanical indicators and gauges on the machine itself indicate proper operation of the machine. Second heat sensitive indicators or tape on the sterilizing bags change color which indicate proper levels of heat or steam. And, third (most importantly) is biological testing in which a microorganism that is highly heat and chemical resistant (often the bacterial endospore) is selected as the standard challenge. If the process kills this microorganism, the sterilizer is considered to be effective.
Steam sterilization is done at a temperature of 121 C (250 F) with a pressure of 209 kPa (~2atm). In these conditions, rubber items must be sterilized for 20 minutes, and wrapped items 134 C with pressure of 310 kPa for 7 minutes. The time is counted once the temperature that is needed has been reached. Steam sterilization requires four conditions in order to be efficient: adequate contact, sufficiently high temperature, correct time and sufficient
moisture
Moisture is the presence of a liquid, especially water, often in trace amounts. Small amounts of water may be found, for example, in the air (humidity), in foods, and in some commercial products. Moisture also refers to the amount of water vapo ...
.
Sterilization using steam can also be done at a temperature of 132 C (270 F), at a double pressure.
Dry heat sterilization is performed at 170 C (340 F) for one hour or two hours at a temperature of 160 C (320 F). Dry heat sterilization can also be performed at 121 C, for at least 16 hours.
Chemical sterilization, also referred to as cold sterilization, can be used to sterilize instruments that cannot normally be disinfected through the other two processes described above. The items sterilized with cold sterilization are usually those that can be damaged by regular sterilization. A variety of chemicals can be used including aldehydes, hydrogen peroxide, and peroxyacetic acid. Commonly, glutaraldehydes and formaldehyde are used in this process, but in different ways. When using the first type of disinfectant, the instruments are soaked in a 2–4% solution for at least 10 hours while a solution of 8% formaldehyde will sterilize the items in 24 hours or more. Chemical sterilization is generally more expensive than steam sterilization and therefore it is used for instruments that cannot be disinfected otherwise. After the instruments have been soaked in the chemical solutions, they must be rinsed with sterile water which will remove the residues from the
disinfectants
A disinfectant is a chemical substance or compound used to inactivate or destroy microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than st ...
. This is the reason why
needles and
syringes
A syringe is a simple reciprocating pump consisting of a plunger (though in modern syringes, it is actually a piston) that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside o ...
are not sterilized in this way, as the residues left by the chemical solution that has been used to disinfect them cannot be washed off with
water
Water (chemical formula ) is an inorganic, transparent, tasteless, odorless, and nearly colorless chemical substance, which is the main constituent of Earth's hydrosphere and the fluids of all known living organisms (in which it acts as a ...
and they may interfere with the administered treatment. Although formaldehyde is less expensive than glutaraldehydes, it is also more irritating to the
eyes
Eyes are organs of the visual system. They provide living organisms with vision, the ability to receive and process visual detail, as well as enabling several photo response functions that are independent of vision. Eyes detect light and conve ...
,
skin
Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation.
Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...
and
respiratory tract
The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa.
Air is breathed in through the nose to th ...
and is classified as a potential
carcinogen
A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
,
so it is used much less commonly.
Ionizing radiation
Ionizing radiation (or ionising radiation), including nuclear radiation, consists of subatomic particles or electromagnetic waves that have sufficient energy to ionize atoms or molecules by detaching electrons from them. Some particles can travel ...
is typically used only for sterilizing items for which none of the above methods are practical, because of the risks involved in the process
Personal protective equipment
Personal protective equipment (PPE) is specialized clothing or equipment worn by a worker for protection against a hazard. The hazard in a health care setting is exposure to blood, saliva, or other bodily fluids or aerosols that may carry infectious materials such as
Hepatitis C
Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, a ...
,
HIV
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
, or other blood borne or bodily fluid
pathogen
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...
. PPE prevents contact with a potentially infectious material by creating a physical barrier between the potential infectious material and the healthcare worker.
The United States
Occupational Safety and Health Administration
The Occupational Safety and Health Administration'' (OSHA ) is a large regulatory agency of the United States Department of Labor that originally had federal visitorial powers to inspect and examine workplaces. Congress established the agenc ...
(OSHA) requires the use of
personal protective equipment (PPE) by workers to guard against blood borne pathogens if there is a reasonably anticipated exposure to blood or other potentially infectious materials.
Components of PPE include
gloves
A glove is a garment covering the hand. Gloves usually have separate sheaths or openings for each finger and the thumb.
If there is an opening but no (or a short) covering sheath for each finger they are called fingerless gloves. Fingerless glov ...
,
gowns
A gown, from the Saxon word, ''gunna'', is a usually loose outer garment from knee-to-full-length worn by men and women in Europe from the Early Middle Ages to the 17th century, and continuing today in certain professions; later, the term ''gown ...
, bonnets, shoe covers,
face shields,
CPR mask
A pocket mask, or pocket face mask or CPR mask, is a device used to safely deliver rescue breaths during a cardiac arrest or respiratory arrest. The specific term "Pocket Mask" is the trademarked name for the product manufactured by Laerdal M ...
s,
goggles
Goggles, or safety glasses, are forms of protective eyewear that usually enclose or protect the area surrounding the eye in order to prevent particulates, water or chemicals from striking the eyes. They are used in chemistry laboratories and ...
,
surgical mask
A surgical mask, also known by other names such as a medical face mask or procedure mask, is a personal protective equipment used by healthcare professionals that serves as a mechanical barrier that interferes with direct airflow in and out of re ...
s, and respirators. How many components are used and how the components are used is often determined by regulations or the infection control protocol of the facility in question, which in turn are derived from knowledge of the mechanism of transmission of the pathogen(s) of concern. Many or most of these items are
disposable
A disposable (also called disposable product) is a product designed for a single use after which it is recycled or is disposed as solid waste. The term is also sometimes used for products that may last several months (e.g. disposable air filte ...
to avoid carrying infectious materials from one patient to another patient and to avoid difficult or costly
disinfection
A disinfectant is a chemical substance or compound used to inactivate or destroy microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than st ...
. In the US, OSHA requires the immediate removal and disinfection or disposal of a worker's PPE prior to leaving the work area where exposure to infectious material took place. For health care professionals who may come into contact with highly infectious bodily fluids, using personal protective coverings on exposed body parts improves protection.
Breathable personal protective equipment improves user-satisfaction and may offer a similar level of protection.
In addition, adding tabs and other modifications to the protective equipment may reduce the risk of contamination during donning and doffing (putting on and taking off the equipment).
Implementing an evidence-based donning and doffing protocol such as a one-step glove and gown removal technique, giving oral instructions while donning and doffing, double gloving, and the use of glove disinfection may also improve protection for health care professionals.
Guidelines set by the ANA and ANAA for proper use of disposable gloves include, removing and replacing gloves frequently and when they are contaminated, damaged, or in between treatment of multiple patients. When removing gloves, “grasp outer edge of glove near wrist, peel away from hand turning inside out, hold removed glove in opposite gloved hand, slide ungloved finger under wrist of gloved hand so finger is inside gloved area, peel off the glove from inside creating a ‘bag’ for both gloves, dispose of gloves in proper waste receptacle”.
The inappropriate use of PPE equipment such as gloves, has been linked to an increase in rates of the transmission of infection, and the use of such must be compatible with the other particular hand hygiene agents used. Research studies in the form of randomized controlled trials and simulation studies are needed to determine the most effective types of PPE for preventing the transmission of infectious diseases to healthcare workers. There is low quality evidence that supports making improvements or modifications to personal protective equipment in order to help decrease contamination.
Examples of modifications include adding tabs to masks or gloves to ease removal and designing protective gowns so that gloves are removed at the same time. In addition, there is weak evidence that the following PPE approaches or techniques may lead to reduced contamination and improved compliance with PPE protocols: Wearing double gloves, following specific doffing (removal) procedures such as those from the CDC, and providing people with spoken instructions while removing PPE.
Antimicrobial surfaces
Microorganisms
A microorganism, or microbe,, ''mikros'', "small") and ''organism'' from the el, ὀργανισμός, ''organismós'', "organism"). It is usually written as a single word but is sometimes hyphenated (''micro-organism''), especially in olde ...
are known to survive on non-antimicrobial inanimate 'touch' surfaces (e.g., bedrails, over-the-bed trays, call buttons, bathroom hardware, etc.) for extended periods of time. This can be especially troublesome in hospital environments where patients with
immunodeficiencies are at enhanced risk for contracting nosocomial infections.
Products made with
antimicrobial copper alloy (
brass
Brass is an alloy of copper (Cu) and zinc (Zn), in proportions which can be varied to achieve different mechanical, electrical, and chemical properties. It is a substitutional alloy: atoms of the two constituents may replace each other with ...
es,
bronze
Bronze is an alloy consisting primarily of copper, commonly with about 12–12.5% tin and often with the addition of other metals (including aluminium, manganese, nickel, or zinc) and sometimes non-metals, such as phosphorus, or metalloids such ...
s,
cupronickel
Cupronickel or copper-nickel (CuNi) is an alloy of copper that contains nickel and strengthening elements, such as iron and manganese. The copper content typically varies from 60 to 90 percent. (Monel is a nickel-copper alloy that contains a minimu ...
, copper-nickel-zinc, and others) surfaces destroy a wide range of microorganisms in a short period of time.
The
United States Environmental Protection Agency
The Environmental Protection Agency (EPA) is an independent executive agency of the United States federal government tasked with environmental protection matters. President Richard Nixon proposed the establishment of EPA on July 9, 1970; it be ...
has approved the registration of 355 different
antimicrobial copper alloys and one synthetic copper-infused hard surface that kill ''
E. coli'' O157:H7,
methicillin
Methicillin ( USAN), also known as meticillin ( INN), is a narrow-spectrum β-lactam antibiotic of the penicillin class.
Methicillin was discovered in 1960.
Medical uses
Compared to other penicillins that face antimicrobial resistance ...
-resistant ''
Staphylococcus aureus
''Staphylococcus aureus'' is a Gram-positive spherically shaped bacterium, a member of the Bacillota, and is a usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin. It is often positive ...
'' (
MRSA
Methicillin-resistant ''Staphylococcus aureus'' (MRSA) is a group of Gram-positive bacteria that are genetically distinct from other strains of ''Staphylococcus aureus''. MRSA is responsible for several difficult-to-treat infections in humans. ...
), ''
Staphylococcus
''Staphylococcus'' is a genus of Gram-positive bacteria in the family Staphylococcaceae from the order Bacillales. Under the microscope, they appear spherical (cocci), and form in grape-like clusters. ''Staphylococcus'' species are facultative ...
'', ''Enterobacter aerogenes,'' and ''Pseudomonas aeruginosa'' in less than 2 hours of contact. Other investigations have demonstrated the efficacy of antimicrobial copper alloys to destroy
''
Clostridium difficile'',
influenza A virus
''Influenza A virus'' (''IAV'') causes influenza in birds and some mammals, and is the only species of the genus ''Alphainfluenzavirus'' of the virus family ''Orthomyxoviridae''. Strain (biology)#Microbiology or virology, Strains of all subtypes ...
,
adenovirus
Adenoviruses (members of the family ''Adenoviridae'') are medium-sized (90–100 nm), nonenveloped (without an outer lipid bilayer) viruses with an icosahedral nucleocapsid containing a double-stranded DNA genome. Their name derives from the ...
, and
fungi
A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately from ...
.
As a public hygienic measure in addition to regular cleaning,
antimicrobial copper alloys are being installed in healthcare facilities in the UK, Ireland, Japan, Korea, France, Denmark, and Brazil. The synthetic hard surface is being installed in the United States as well as in Israel.
Vaccination of health care workers
Health care workers may be exposed to certain infections in the course of their work.
Vaccine
A vaccine is a biological Dosage form, preparation that provides active acquired immunity to a particular infectious disease, infectious or cancer, malignant disease. The safety and effectiveness of vaccines has been widely studied and verifie ...
s are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for
hepatitis B
Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. Fo ...
;
influenza
Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms ...
;
measles, mumps and rubella;
Tetanus, diphtheria, pertussis;
N. meningitidis; and
varicella.
Surveillance for infections
Surveillance is the act of infection investigation using the CDC definitions. Determining the presence of a hospital acquired infection requires an infection control practitioner (ICP) to review a patient's chart and see if the patient had the signs and symptom of an infection. Surveillance definitions exist for infections of the bloodstream, urinary tract, pneumonia, surgical sites and gastroenteritis.
Surveillance traditionally involved significant manual data assessment and entry in order to assess preventative actions such as isolation of patients with an infectious disease. Increasingly, computerized software solutions are becoming available that assess incoming risk messages from microbiology and other online sources. By reducing the need for data entry, software can reduce the data workload of ICPs, freeing them to concentrate on clinical surveillance.
As of 1998, approximately one third of healthcare acquired infections were preventable. Surveillance and preventative activities are increasingly a priority for hospital staff. The ''Study on the Efficacy of Nosocomial Infection Control'' (SENIC) project by the U.S. CDC found in the 1970s that hospitals reduced their nosocomial infection rates by approximately 32 per cent by focusing on surveillance activities and prevention efforts.
Isolation and quarantine
In
healthcare facilities, medical isolation refers to various physical measures taken to interrupt
nosocomial
A hospital-acquired infection, also known as a nosocomial infection (from the Greek , meaning "hospital"), is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is ...
spread of contagious diseases. Various forms of
isolation exist, and are applied depending on the type of infection and agent involved, and its route of
transmission
Transmission may refer to:
Medicine, science and technology
* Power transmission
** Electric power transmission
** Propulsion transmission, technology allowing controlled application of power
*** Automatic transmission
*** Manual transmission
*** ...
, to address the likelihood of spread via airborne particles or droplets, by direct skin contact, or via contact with body fluids.
In cases where infection is merely suspected, individuals may be
quarantined
A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...
until the
incubation period
Incubation period (also known as the latent period or latency period) is the time elapsed between exposure to a pathogenic organism, a chemical, or radiation, and when symptoms and signs are first apparent. In a typical infectious disease, the i ...
has passed and the disease manifests itself or the person remains healthy. Groups may undergo quarantine, or in the case of communities, a
cordon sanitaire
''Cordon sanitaire'' () is French for "sanitary cordon". It may refer to:
*Cordon sanitaire (medicine), a cordon that quarantines an area during an infectious disease outbreak
*Cordon sanitaire (politics), refusal to cooperate with certain politic ...
may be imposed to prevent infection from spreading beyond the community, or in the case of
protective sequestration
Protective sequestration, in public health, is social distancing measures taken to protect a small, defined, and still-healthy population from outsiders during an epidemic (or pandemic) ''before'' the infection reaches that population. It is someti ...
, into a community. Public health authorities may implement other forms of
social distancing
In public health, social distancing, also called physical distancing, (NB. Regula Venske is president of the PEN Centre Germany.) is a set of non-pharmaceutical interventions or measures intended to prevent the spread of a contagious disea ...
, such as school closings, when needing to control an
epidemic
An epidemic (from Ancient Greek, Greek ἐπί ''epi'' "upon or above" and δῆμος ''demos'' "people") is the rapid spread of disease to a large number of patients among a given population within an area in a short period of time.
Epidemics ...
.
Barriers and facilitators of implementing infection prevention and control guidelines
Barriers to the ability of healthcare workers to follow PPE and infection control guidelines include communication of the guidelines, workplace support (manager support), the culture of use at the workplace, adequate training, the amount of physical space in the facility, access to PPE, and healthcare worker motivation to provide good patient care.
Facilitators include the importance of including all the staff in a facility (healthcare workers and support staff) should be done when guidelines are implemented.
Outbreak investigation
When an unusual cluster of illness is noted, infection control teams undertake an investigation to determine whether there is a true
disease outbreak
In epidemiology, an outbreak is a sudden increase in occurrences of a disease when cases are in excess of normal expectancy for the location or season. It may affect a small and localized group or impact upon thousands of people across an entire ...
, a pseudo-outbreak (a result of contamination within the diagnostic testing process), or just random fluctuation in the frequency of illness. If a true outbreak is discovered, infection control practitioners try to determine what permitted the outbreak to occur, and to rearrange the conditions to prevent ongoing propagation of the infection. Often, breaches in good practice are responsible, although sometimes other factors (such as construction) may be the source of the problem.
Outbreaks investigations have more than a single purpose. These investigations are carried out in order to prevent additional cases in the current outbreak, prevent future outbreaks, learn about a new disease or learn something new about an old disease. Reassuring the public, minimizing the economic and social disruption as well as teaching
epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evidenc ...
are some other obvious objectives of outbreak investigations.
According to the
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
, outbreak investigations are meant to detect what is causing the outbreak, how the pathogenic agent is transmitted, where it all started from, what is the carrier, what is the population at risk of getting infected and what are the risk factors.
Training in infection control and health care epidemiology
Practitioners can come from several different educational streams. Many begin as nurses, some as medical technologists (particularly in clinical microbiology), and some as physicians (typically infectious disease specialists). Specialized training in infection control and health care epidemiology are offered by the professional organizations described below. Physicians who desire to become infection control practitioners often are trained in the context of an infectious disease fellowship. Training that is conducted "face to face", via a computer, or via video conferencing may help improve compliance and reduce errors when compared with "folder based" training (providing health care professionals with written information or instructions).
In the United States, Certification Board of Infection Control and Epidemiology is a private company that certifies infection control practitioners based on their educational background and professional experience, in conjunction with testing their knowledge base with standardized exams. The credential awarded is CIC, Certification in Infection Control and Epidemiology. It is recommended that one has 2 years of Infection Control experience before applying for the exam. Certification must be renewed every five years.
A course in hospital epidemiology (infection control in the hospital setting) is offered jointly each year by the Centers for Disease Control and Prevention (CDC) and the Society for Healthcare Epidemiology of America.
Standardization
Australia
In 2002, the
Royal Australian College of General Practitioners
The Royal Australian College of General Practitioners (RACGP) is the professional body for general practitioners (GPs) in Australia. The RACGP is responsible for maintaining standards for quality clinical practice, education and training, and re ...
published a revised standard for office-based infection control which covers the sections of managing immunisation, sterilisation and disease surveillance.
However, the document on the personal hygiene of health workers is only limited to hand hygiene, waste and linen management, which may not be sufficient since some of the pathogens are air-borne and could be spread through air flow.
Since 1 November 2019, the Australian Commission on Safety and Quality in Health Care has managed the Hand Hygiene initiative in Australia, an initiative focused on improving hand hygiene practices to reduce the incidence of healthcare-associated infections.
United States
Currently, the federal regulation that describes infection control standards, as related to occupational exposure to potentially infectious blood and other materials, is found at 29 CFR Part 1910.1030 Bloodborne pathogens.
See also
*
* Wong, P., & Lim, W. Y. (2020). Aligning difficult airway guidelines with the anesthetic COVID-19 guidelines to develop a COVID-19 difficult airway strategy: A narrative review. Journal of Anesthesia, 34(6), 924-943.
https://doi.org/10.1007/s00540-020-02819-2
References
External links
Association for Professionals in Infection Control and Epidemiologyis primarily composed of infection prevention and control professionals with nursing or medical technology backgrounds
The Society for Healthcare Epidemiology of Americais more heavily weighted towards practitioners who are physicians or doctoral-level epidemiologists.
Regional Infection Control NetworksThe Certification Board of Infection Control and Epidemiology, Inc.Association for Professionals in Infection Control and Epidemiology
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Epidemiology
Medical hygiene
Infectious diseases