Hospital Infection Control:
Basic Principles
Infection Control Committee
Goals for hospital infection
control & prevention program
1. Protect the patients
2. Protect the HCW, visitors, and others in
the healthcare environment.
3. cost effective and cost efficient.
MMC Infection Control Committee
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Nursing service
Medicine (ICU/telemetry)
Pediatrics (Nursery/PICU)
Surgery (OR)
OB-GYN (DR)
IHC
Pharmacy
Laboratory
Pulmonary
Dietary
Radiology
Housekeeping
Facility Management/Engineering
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
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The ICC has the following tasks:
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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.
The ICC has the following tasks (cont):
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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
ISOLATION
PRECAUTIONS
Guideline for Isolation Precautions in Hospitals
Centers for Disease Control & Prevention
Hospital Infection Control Practices Advisory Committee
(January 1996; updated 2004)
Isolation Precautions –
2-Level Approach:
1.
Standard Precautions
- primary strategy
2. Transmission-Based
Precautions
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.
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
STANDARD PRECAUTIONS
 a.
Handwashing
– between patient contacts
– after touching blood, body fluids, secretions,
excretions, and contaminated items
– after gloves are removed
Hand Hygiene Technique
1. Palm to Palm
4. Back of Fingers to
opposing palms with
fingers interlocked
2. Palm of Right hand over
back of left hand & vice versa
5. Rotational rubbing of
right thumb clasped in
left palm and vice versa
3. Palm to Palm with fingers
interlaced
6. Rotational rubbing,
backwards and forwards with
clasped fingers of right hand
in left palm and vice versa
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
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
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
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.
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
STANDARD PRECAUTIONS

D. Gowns or aprons
should be worn during:
– procedures that are
likely to generate
splashes of blood or
other body fluids
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
STANDARD PRECAUTIONS
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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.
STANDARD PRECAUTIONS
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Needles and other sharps:
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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
STANDARD PRECAUTIONS
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)
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
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.
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
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.
STANDARD PRECAUTIONS
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a.
b.
c.
d.
e.
f.
g.
h.
i.
Handwashing
Gloves
Mask, Eye Protection, Face Shield
Gown
Patient Care Equipment
Environmental Control
Linen
Occupational Health & Bloodborne Pathogens
Patient Placement
STANDARD PRECAUTIONS
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Patient Placement:
- Prioritize for single-patient room if at increase
risk of transmission of infection
- Likely to contaminate the environment
STANDARD PRECAUTIONS
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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
RESPIRATORY
ETIQUETTE
Isolation Precautions –
2-Level Approach:
1.
Standard Precautions
2. Transmission-Based
Precautions
- Applied to selected patients based on
suspected or confirmed diagnosis
- Always implemented in conjunction with
Standard Precautions
Transmission- based precautions
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Based on 3 major modes of transmission:
– Airborne Precaution
– Droplet Precaution
– Contact Precaution
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Some diseases may require more than one
isolation category
Indications for
Transmission-based Precautions
Known or Suspected Diseases
or Pathogens
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Airborne
– Measles
– Tuberculosis, pulmonary or laryngeal
– Varicella
– Zoster (disseminated or
immunocompromised patient)
– SARS
– Viral hemorrhagic fever
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)
Airborne Precautions
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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
DROPLET PRECAUTIONS
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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.
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
Scenarios Requiring
Droplet Precautions
– Meningitis
– Petechial or ecchymotic rash with fever
– Paroxysmal or severe persistent cough
(periods of pertussis activity)
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
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Contact Transmission
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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)
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
Known or Suspected Diseases
or Pathogens
Contact
1. Abscess (drainage not contained)
2. Adenovirus (infants, children)
3. Clostridium difficile intercolitis
4. Conjunctivitis, acute viral
5. Escherichia coli 0157:h7 colitis
6. Furunculosis (infants, children)
7. Grp A Streptococcal major skin, burn or
wound infection
8. Hepatitis A
Known or Suspected Diseases
or Pathogens
Contact
9. HSV (neonatal, disseminated, severe primary
mucocutaneous)
10. Impetigo
11. MDR bacteria (e.g. MRSA, VRE, GISA, GRSA)
infection or colonization
12. Parainfluenza infection (infants, children)
13. Rotavirus
14. Rubella, congenital
15. Shigella (diapered/incontinent patients)
16. Varicella
17. Zoster (disseminated/immunocompromised)
Contact Precautions
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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
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Essential Elements of
Isolation Precautions
Airborne
Room
-Negative pressure
Private room w/ air
exhausted to
outdoors or thru
high-efficiency
filtration
-Door kept closed
Droplet
-Private
room
-Door may
remain
open
Contact
-Private room
- Dedicate use
of non-critical
patient-care
items to a single
patient
Essential Elements of
Isolation Precautions
Airborne
Mask
-N95 Mask/ Portable
Respirator for those
entering room
-Surgical mask on
patient for transport
outside room
Droplet
Contact
-For entering
room
surgical
mask on
patient for
transport
outside room
X
Essential Elements of
Isolation Precautions
Gloves
Airborne
Droplet
X
X
Contact
-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.
Essential Elements of
Isolation Precautions
Airborne Droplet
Gown
X
X
Contact
-if clothing will contact
patient, surfaces, items
in room
-if patient has diarrhea,
ileostomy, colostomy,
uncontained wound
drainage
-remove gown before
leaving the room
Essential Elements of
Isolation Precautions
Face Shield/
Eye
Protection
-For procedures/activities likely to
generate splashes/sprays of blood,
body fluids, secretions/excretions
Transmission-Based Precautions for
Hospitalized Patients
Category
Single
Room
Mask
Gown
Gloves
AIRBORNE
Yes, neg.
air P vent
Yes
No
No
DROPLET
Yes*
No
No
CONTACT
Yes*
Yes, for
close
contact
No
Yes
Yes
*Cohorting acceptable
1
A 20-yr old employee was admitted for
blood-streaked sputum & weight loss.
Chest-xray showed Cavitary Pulmonary
Tuberculosis.
Facts about Tuberculosis

etiologic agent: mycobacterium tuberculosis
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mode of transmission: respiratory droplet nuclei
<5um or dust particles containing infectious agent
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how transmitted: inhalation of infectious particles
which remain suspended in air and travel long
distances
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duration of infectiousness: until 3 consecutive
sputum smears are afb (-) or until 2-4 weeks after
anti-tb drugs with good response
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.
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
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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.
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
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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.
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
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What Type of PPE Would You Wear?

Giving a bed bath?
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Suctioning oral
secretions?
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Transporting a patient in a
wheel chair?
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Responding to an
emergency where blood is
spurting?
PPE Use in Healthcare Settings
What Type of PPE Would You Wear?

Drawing blood from a vein?

Cleaning an incontinent
patient with diarrhea?

Irrigating a wound?

Taking vital signs?
PPE Use in Healthcare Settings
What Type of PPE Would You Wear?
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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
PPE Use in Healthcare Settings
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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?
– Generally none
INFECTION CONTROL is…