Infection Prevention
and Control (IP&C)
1. Outline the history of infection prevention and
control.
2. Describe the goals of infection prevention and
control programs.
3. Discuss how an IP&C program can make a
positive impact in any healthcare organization.
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Learning objectives
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• 35 minutes
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Time involved
3
• The discipline concerned with preventing
nosocomial or healthcare-associated infections
• a sub-discipline of epidemiology
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What is IP&C?
• Similar to public health activities, mainly
practiced within a health-care delivery system
• Focuses on evidence-based practices and
procedures that can prevent or reduce the risk of
transmission of microorganisms to health care
providers, clients/patients/residents and visitors
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• Infections are a leading cause of morbidity and
mortality in healthcare settings
• Infections can cause pain, suffering and often,
permanent scarring
• Infections cause prolonged hospital stays which
has an impact on costs
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Why is IP&C Important?
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• Pre 1800: Early efforts at wound prophylaxis
• 1800-1940: Nightingale, Semmelweis, Lister, Pasteur
• 1940-1960: Antibiotic era, S. aureus outbreaks in
nurseries
• 1950-1970: Surveillance begins, documentation of need
for infection control programs, infection control
committees develop
• 1980: HIV issues, resistant bacteria, SENIC study and
NNIS in USA
• 1990: Blood-borne pathogens
• 2000: Pandemics, patient safety
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History
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• The first infection prevention and control champion
• Research into hospital sanitary problems made her a firm
believer in pure air, pure water, efficient drainage,
cleanliness, and light
• Nightingale’s firm belief in preventive medicine led to an
established standard of formalized cleanliness and
sanitation in hospitals and the military
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Florence Nightingale
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• Demonstrated that routine hand washing could
prevent the spread of puerperal fever
• Noted that maternity patients were dying at
such an alarming rate that they begged to be
sent home from the hospital to deliver with a
midwife
• Semmelweis’ analysis revealed that medical
students, responsible for deliveries in Division I,
often performed autopsies before assisting in
deliveries, while midwives, who worked in
Division II, did not
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Ignaz Semmelweis - 1
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• Theorized that disinfecting hands could prevent
transmission of infection from a diseased
cadaver to a pregnant patient
• Required medical students to wash their hands
with chlorinated lime before assisting in
deliveries
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Ignaz Semmelweis - 2
• Resulted in a dramatic outcome - deaths on the
maternity ward fell fivefold
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• Troubled by high mortality rates from
post-surgical sepsis
• First to see the connection between
Pasteur's discoveries of the fermentation
process and the suppuration of wounds
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Joseph Lister - 1
10
• In 1867 he published his paper on antisepsis,
stating that
• "all the local inflammatory mischief and general febrile
disturbance which follow severe injuries are due to the
irritating and poisoning influence of decomposing
blood or sloughs."
• He began applying carbolic acid to compound
fracture wounds
• The wounds healed, amputation averted, and
the mortality rate plummeted from 45% to 15%
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Joseph Lister - 2
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• The earliest formal programs were in the 1950s
• Began as an effort to address issues like staphylococcal epidemics
• The first Infection Control Nurses were appointed at this
time; they often had a background in bacteriology
• Surveillance of hospital infections was instituted and
policies and procedures developed
• Early infection control programs focused on
environmental cleanliness
• Antimicrobial resistant pathogens became a concern in
the 1970s
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Infection Prevention and
Control Programs
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• HAIs include urinary tract infections, pneumonia,
bloodstream infections and surgical site
infections
• The WHO states
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Healthcare-Associated
Infections (HAI) - 1
• urinary tract infection is the most frequent HAI in highincome countries; surgical site infections in settings
with limited resources*
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* Statistics in low resource countries are often nonstandardized or incomplete
• 30% of patients in intensive care units (ICU) are
affected by at least one HAI in high-income
countries
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Healthcare-Associated
Infections (HAI)
• In low- and middle-income countries the frequency of
ICU-acquired infection is at least 23 fold higher*
• Newborns are at higher risk of acquiring HAI in
developing countries, with infection rates three
to 20 times higher than in high-income
countries*
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* Statistics in low resource countries are often nonstandardized or incomplete
• To prevent the spread of infections from
•
•
•
•
patient-to-patient
patients to health care providers
health care providers to patients
health care providers to health care providers and to visitors and
others in the health care environment
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Goals of IP&C
CONSEQUENTLY
• To protect patients from HAIs, resulting in
•
•
•
•
improved survival rates
reduced morbidity associated with infections
shorter length of hospital stay
a quicker return to good health
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• To obtain and manage critical data and information
• To implement evidence-based practice, standards and
guidelines through setting-specific policies and
procedures
• To intervene directly to prevent infections
• To provide effective occupational health programs
• To educate and train healthcare workers, patients, and
non-medical caregivers
• To provide communication of infection-related issues and
relevant practices to leaders and staff to facilitate
improvements
• To evaluate the program and improve it as necessary
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Functions of IP&C
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• Surveillance
• Outbreak investigations
• Prevention through practices/guidelines
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Practice of IP&C Today
• hand hygiene, use of barriers, isolation/precautions,
construction/renovation, sterilisation/disinfection,
antibiotic resistance, blood-borne pathogens,
food/water/air safety, cleaning
• Antibiotic use
• Education
• Occupational health
• Audits
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• Cardo D, et al. Moving toward elimination of healthcare-associated
infections: A call to action. Am J Infect Control 2010: 1-5.
http://www.apic.org/Resource_/TinyMceFileManager/Position_Stat
ements/AJIC_Elimin.pdf
• Friedman C, et al. Requirements for infrastructure and essential
activities of infection control and epidemiology in out-of-hospital
settings: A Consensus Panel report. Am J Infect Control 1999;
20:695-705.
• Haley RW, et al. Efficacy of Nosocomlal Infection Control (SENIC
Project): Summary of study. Am J Epidemiol 1980; 111: 472-485.
• Scheckler WE, et al. Requirements for infrastructure and essential
activities of infection control and epidemiology in hospitals: a
consensus panel report. Am J Infect Control 1998;26:47-60.
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References
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• World Health Organization http://www.who.int/csr/bioriskreduction/infection_contr
ol/en/index.html
• Centers for Disease Control and Prevention http://www.cdc.gov/hai/
• National Institute for Health and Clinical Excellence http://guidance.nice.org.uk/CG139
• IFIC - http://www.theific.org/
• International Nosocomial Infection Control Consortium http://www.inicc.org/english/index.php
• National Health and Medical Research Council http://www.nhmrc.gov.au/node/30290
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Web Resources
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1. Infection prevention and control programs have been
proven to be effective. T/F?
2. IP&C is important in health care because of its:
a)
b)
c)
d)
Focus on patient health and safety
Focus on healthcare worker safety
Focus on decreasing costs
All of the above
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Quiz
3. IP&C programs are relevant to all healthcare settings.
T/F?
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• IFIC’s mission is to facilitate international networking in
order to improve the prevention and control of
healthcare associated infections worldwide. It is an
umbrella organisation of societies and associations of
healthcare professionals in infection control and related
fields across the globe .
• The goal of IFIC is to minimise the risk of infection within
healthcare settings through development of a network of
infection control organisations for communication,
consensus building, education and sharing expertise.
• For more information go to http://theific.org/
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International Federation of
Infection Control
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