Infection Control and Prevention

Introduction

Microorganisms are a part of everyday life. They are found in the air, water, and soil. Some microorganisms are helpful, while others are harmful. Many bacteria and viruses live in and on our bodies and help us stay healthy. Only a minute portion of microorganisms cause infection. Infection control is essential to prevent and stop infections from spreading in healthcare settings.

When Do Infections Occur?

When microorganisms, such as bacteria or viruses, enter the body and increase in number and lead to sickness or a reaction of the body, it is known as infection. The following are essential for infections to occur:

1. Source: Places where the microorganisms live, such as human skin, surfaces, and other places.

2. Susceptible Person: A person who comes in contact with microorganisms and is prone to allowing microorganisms to enter their body and multiply.

3. Transmission: The method or way the microorganisms enter the susceptible individual.

What Are the Common Sources of Infection in a Healthcare Setting?

Infectious agents or microorganisms refer to bacteria, viruses, fungi, protozoa, parasites, and other germs capable of infecting a person. These infectious agents are found in many places in a healthcare setting. The person infected with the microorganism can get sick with unpleasant symptoms or be a carrier of the microorganism (thus passing the infectious agent on to others). The common sources of infection include:

1. Patients.

2. Healthcare workers (including doctors and nurses).

3. Visitors.

4. Household members.

5. Dry surfaces, such as bed rails, medical tools, equipment, tables, and others, are found in the patient care areas.

6. Wet surfaces, biofilms, and moist environments, including ventilators, sinks, and faucets.

7. Medical devices are inserted into patients, such as catheters and intravenous lines.

8. Dust, debris, wet materials, and other non-specific sources are found in the healthcare environment.

What Are the Modes of Transmission?

Microorganisms do not move by themselves. Instead, they depend on the environment, people, or substrates to travel, lodge, and infect. There are a few common ways microorganisms travel in healthcare settings – through sprays and splashes, direct contact (touch), sharp injuries (accidentally stuck with a sharp needle or instrument), and inhalation.

1. Contact: Microorganisms such as MRSA (methicillin-resistant Staphylococcus aureus) or VRE (vancomycin-resistant Enterococci) spread through contact. For instance, the doctor's hands can become contaminated by touching the microorganisms on medical tools or surfaces. The microorganisms get easily transmitted if the doctor touches a susceptible person without disinfection or proper hand hygiene. Contact with infected equipment and surfaces can also spread infections.

2. Sprays and Splashes: Suppose the patients in the hospital are infected with microorganisms that can spread through air or droplets. When the patient coughs or sneezes, the microorganisms can land (a distance of up to six feet usually) on another person (nose, eyes, or mouth) and cause infections. Examples include pertussis (whooping cough) and meningitis.

3. Inhalation: Certain microorganisms can get aerosolized in tiny particles and survive in the air over large distances and time. As a result, airborne transmission mode can cause infections over greater distances. For example, patients infected with tuberculosis or measles cough, talk, or sneeze can spread the infection to a susceptible person.

4. Sharp Injuries: Serious viral infections such as human immunodeficiency virus (HIV) or hepatitis B infections can spread when needlestick injuries lead to skin puncture (contact with infected blood).

What Are the Standard Precautions for All Patient Care?

It is important to follow certain standard precautions for all patient care. These include:

1. Hand Hygiene: Practicing hand hygiene is a simple and effective way to prevent the spread of infections. Cleaning hands helps to prevent the spread of microorganisms, including those resistant to antibiotics and becoming difficult to treat. It has been estimated that about one in 31 hospital patients gets infected with healthcare-associated infections. Therefore, doctors and other healthcare workers should use an alcohol-based disinfectant (hand wash or hand rub). In addition, washing their hands with soap before and after touching a patient or if they come in contact with infected material or fluids is advised. The healthcare facilities ensure personnel follow and adhere to proper hand hygiene protocols.

2. Use Personal Protective Equipment Under High-Risk Situations: PPE includes gloves, face masks, surgical caps, gowns, and mouth, nose, and eye protection. The healthcare professional must wear PPE when patient interaction requires contact with blood or other body fluids. Care must be taken to prevent contamination of their clothing or skin while removing the PPE. The PPE must be appropriately discarded as per protocol.

3. Respiratory Hygiene and Cough Etiquette: Healthcare workers and doctors are educated on the importance of respiratory hygiene. It is crucial to contain respiratory secretions to prevent fomite or droplet transmission of microorganisms, such as viruses that cause seasonal flu and community infections. In case of a viral outbreak, or seasonal flu, educational signs are posted in strategic places such as entrances, elevators, and cafeterias in the hospital. These highlight how the infection spreads, the symptoms, and how to prevent the transmission of infection, including cough etiquette.

4. Appropriate Patient Placement: The infected patients with uncontained secretions or a bleeding wound, or if they are suspected of gastrointestinal or respiratory infections, must be isolated and placed appropriately in a hospital. They can potentially spread the infection to others and should be placed in a separate space (single patient room when available).

5. Proper Protocol for Patient-Care Equipment and Instruments: Procedures and policies for transporting and handling patients and patient-care instruments, devices, and equipment (contaminated with blood or fluids) have been established and standardized. These protocols must be followed while handling patient care devices.

6. Care of Environment: Environmental surfaces likely to get contaminated must be cleaned and disinfected routinely and frequently. These include bed rails, tables, and frequently touched surfaces like door knobs. In addition, careful disinfection and sterilization of medical equipment and tools are mandatory for infection control.

7. Textiles and Laundry: The used clothes and textiles must be handled per protocol to prevent infections and contamination of air and surfaces.

8. Safe Injection Practices: Injections are commonly used in hospitals and healthcare settings. Safe injection practices prevent the spread of infections among patients and healthcare personnel.

What Are Transmission-Based Precautions for Infection Control?

Transmission-based precautions are considered the second tier of basic infection control. These include contact precautions, airborne precautions, and droplet precautions. They are to be used in addition to standard precautions for patients. These include:

• Source control (use of masks).

• Ensure appropriate patient placement.

• Personal protective equipment use, as per protocol.

• Limit transport or movement of infected patients.

• Use disposable or dedicated patient-care equipment.

• Prioritize cleaning and disinfection of the rooms.

Conclusion

Microorganisms are present all around us. The healthcare setting is no exception. Microorganisms causing infections are commonly present in hospitals, making infection control and prevention protocols mandatory to prevent infection spread. Several basic and transmission-based precautions must be followed in healthcare settings to prevent the spreading of infections among patients and healthcare personnel.