Basics of IPCC 2024

A scientific approach and practical solution designed to prevent harm caused by infection to patients and health workers

What is Infection Prevention and Control (IPC) defined as?

Infectious diseases, epidemiology, social science, and health system strengthening

What fields is IPC grounded in?

It occupies a unique position in the field of patient safety and quality universal health coverage, relevant to health workers and patients at every single health-care encounter

What unique position does IPC occupy in healthcare?

The quality standard of health care services to patients and healthcare personnel

According to the World Health Organization (WHO), what is Infection Prevention and Control defined as?

Beyond the acute care hospital to all settings where healthcare is delivered

In the current era, where has the relevance of IPC expanded to?

It identifies the risk of acquiring Healthcare-Associated Infections (HAIs) and prevents and controls them

What two key actions does Infection Prevention and Control perform regarding HAIs?

To provide knowledge of practices that will protect healthcare workers, their families, and the patients they handle

What is the goal of providing knowledge of Infection Prevention and Control practices?

Healthcare Settings and Precautions Hospitals (acute care facilities, critical access hospitals), Acute and Long-term care facilities, Outpatient settings (dialysis centers, ambulatory surgical centers, physician's clinics, ambulatory chemotherapy centers)

List examples of healthcare settings where IPC is relevant

Standard Precautions and Transmission-based Precautions

What are the two main types of precautions to implement?

Standard Precautions are implemented when having contact with ALL patients regardless of patient diagnoses or presumed infection status

When is the right time to implement Standard Precautions?

Transmission-based Precautions are implemented once infection or colonization with a highly transmissible or epidemiologically important pathogen is suspected or documented

When are Transmission-based Precautions implemented?

Standard Precautions To protect Healthcare Workers (HCWs) and patients from contact with infectious agents in recognized and unrecognized sources of infection

What is the purpose of Standard Precautions?

All blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents

What principle are Standard Precautions based on?

Hand hygiene, safe injection practices, use of gloves, gown, mask, eye protection, or face shield (depending on anticipated exposure), and respiratory hygiene/cough etiquette

List the components included in Standard Precautions

To prevent the introduction of oropharyngeal flora, which could lead to meningitis

Why are masks used during the insertion of catheters or injection of material into spinal or epidural spaces via lumbar puncture procedures?

Spread of infection within the healthcare setting and community, increased burden of Healthcare-associated infections, and uncontrolled spread of Antimicrobial-Resistant pathogens

What happens if basic principles of IPC are not observed?

Handwashing

What is the single most important action to stop spreading infection and disease?

Hands

What is the most common vehicle to transmit healthcare-associated pathogens?

When your hands are visibly dirty

When should handwashing with soap and water be performed?

Before and after patient contact

When should alcohol-based hand rubs be used?

On visibly clean hands only

When are alcohol rubs/gels suitable for use?

Rub into hands using the same technique as for hand washing and continue rubbing until dry

How should alcohol rubs/gels be properly used?

Following contact with Clostridium difficile or suspected infectious diarrhea

When are alcohol rubs/gels not suitable for use?

1) before touching a patient, 2) before clean/aseptic procedures, 3) after body fluid exposure/risk, 4) after touching a patient, and 5) after touching patient surroundings

What are the "My 5 Moments for Hand Hygiene"?

Before commencing work/after leaving work area, before preparing or eating food, before handling medicines, before wearing & after removing gloves, after handling contaminated laundry & waste, after using the toilet, after contact with patients in isolation, and after cleaning equipment or the environment

List additional moments for hand hygiene

40-60 seconds

What is the recommended duration for hand hygiene technique with soap and water?

Webs of fingers, thumbs, palms, nails, backs of fingers and hands, and wrists

What are the areas most frequently missed during hand hygiene?

Drying

What is the crucial step in hand hygiene because micro-organisms thrive in a warm, moist environment?

Use paper hand towels, work from fingertips to wrists, dispose of used towel correctly (foot operated bin), and repeat until both hands are completely dry

Describe the proper hand drying technique

Remove jewelry, roll up sleeves, remove wrist watches, always use running water at a comfortable temperature, wet hands thoroughly before applying any soap, and use enough soap to get a visible lather

List tips for effective hand hygiene

Clean all parts of both hands, pay attention to thumbs, fingertips, palms, clean and dry beneath wedding rings, and pay equal attention to dominant and non-dominant hands

What areas should you make sure to clean and pay attention to when performing hand hygiene?

Rinse hands thoroughly under running water to ensure all micro-organisms and soap are washed away

Why is thorough rinsing important during hand hygiene?

Leaving soap on hands or failing to dry properly

What can make hands sore after hand hygiene?

When about to don a pair of sterile gloves prior to performing a (non-operative) aseptic technique

When is the only time you should use soap & water followed by alcohol hand gel?

Risk of skin problems (dermatitis) may increase

What is a potential risk to hands with frequent hand washing?

Bacterial counts increase

What happens to bacterial counts when skin is damaged?

Using alcohol gel instead of washing if appropriate, always applying soap to wet hands, thorough rinsing & drying, moisturizing, only using gloves when necessary, always covering cuts and grazes

How can the risk of skin problems be reduced?

Loss of a smooth skin surface and increased risk of skin colonization with resistant micro-organisms

What does damaged skin lead to?

Increased infection risk and potential sickness absence due to dermatitis

What are the consequences for a healthcare worker of continuing to work with damaged, cracked, or weeping skin?

Occupational Health

Who should any skin rashes be reported to immediately?

Should be aware of how infection is transmitted and the factors involved

What should Healthcare Workers be aware of regarding infection?

Learn effective and applicable measures to prevent and control infection

What must people in the community learn?

Wearing of mask, food and water hygiene and safety

What are some examples of effective and applicable measures for the community?

Always be prepared and find the right source of information

What general advice is given regarding preparedness and information?

40%

According to WHO, what percentage of HAIs are caused by poor hand hygiene?

If only HCWs washed their hands, then 40% of these infections could have been avoided

What is the implication of 40% of HAIs being caused by poor hand hygiene?

Hand hygiene

What is at the heart of every successful infection prevention and control program?

Inoculation (prick/puncture) with an instrument such as a needle or a scalpel blade contaminated with blood or any fluid

What is a "sharps" accident?

Fluid splashed into an eye, onto skin surface with an open cut or abrasion, or onto a mucous membrane

What is a "splash" accident?

Use aseptic technique to avoid contamination of sterile injection equipment

What is the first recommendation for safe injection practices?

Do not administer medications from a syringe to multiple patients, even if the needle or cannula is changed

What is a key rule regarding syringe use for multiple patients?

Needles, cannulae, and syringes are sterile, single-use items and should not be reused for another patient or to access medication/solution for a subsequent patient

What is the classification and recommended use for needles, cannulae, and syringes?

For one patient only and dispose appropriately after use

How should fluid infusion and administration sets (IV bags, tubings, connections) be used?

Consider it contaminated

If a syringe or needle/cannula has been used to enter or connect to a patient’s intravenous infusion or administration set, what should it be considered?

Single-dose vials

What type of vials should be used for parenteral medications whenever possible?

Do not administer medications from single-dose vials or ampules to multiple patients, or combine leftover contents for later use

What is explicitly prohibited regarding single-dose vials or ampules?

Both the needle or cannula and syringe used to access the multidose vial must be sterile

If multidose vials must be used, what must be sterile?

Do not keep them in the immediate patient treatment area, store in accordance with manufacturer's recommendations, and discard if sterility is compromised or questionable

How should multidose vials be handled and stored?

As a common source of supply for multiple patients

What should bags or bottles of intravenous solution not be used as?

HIV: 03% percutaneous, 009% mucous membrane

What is the average risk of acquiring HIV infection via percutaneous and mucous membrane exposure?

HBV: 6-30% percutaneous

What is the average risk of acquiring HBV infection via percutaneous exposure?

Nature and virulence of the suspected organism, volume of fluid the patient has been exposed to, immune status/disease stage/severity of source, and immune status of the exposed staff member

What factors influence the risk of transmission of bloodborne pathogens?

Recapping hypodermic needles after use, manipulating used sharps, one staff member accidentally sticking another with unprotected sharps, finding sharp items in unexpected areas, handling or disposing of waste containing sharps, and sudden client movement during injection

How can healthcare workers become injured from sharps?

Handle hypodermic needles and other sharps minimally and with extreme care, use the "hands free" technique, do not bend/break/cut hypodermic needles before disposal, do not recap needles, dispose of sharps properly, and do not reuse sharps containers

How can injuries from sharps be prevented?

Place the cap on a flat surface, remove hand from cap, with one hand hold syringe and use needle to "scoop up" cap, and when cap covers needle completely, use other hand to secure cap at the bottom only

Describe the One Hand Technique for recapping a needle (note: general rule is not to recap)

The assistant places the instrument in a sterile kidney basin or designated "safe zone," tells the service provider it's there, the service provider picks up/uses/returns it to the basin/safe zone

Describe the steps in the Hands Free Technique when passing sharps during clinical procedures

Wash, flush, or irrigate the affected area; alert supervisor and fill exposure form; identify source patient; report to IPC; do tests (HIV, HBV, HCV); consider Post-Exposure Prophylaxis (PEP); follow up testing and PEP

How should you respond to "sharps/splash" incidents?

Additional precautions used in addition to Standard Precautions

What are Transmission-based Precautions?

In documented or suspected infection or colonization with highly transmissible or epidemiologically important pathogens

When are Transmission-based Precautions used?

To prevent transmissions

What is the purpose of Transmission-based Precautions?

Airborne, Droplet, and Contact

What are the categories of Transmission-based Precautions?

To ensure that organisms infecting or colonizing the patient are not transmitted to other patients or staff

What is the aim of Transmission-based Precautions (Source Isolation)?

It is based on the mode of transmission of the infection

What is the choice of Transmission-based Precaution based on?

Contact Precaution, Droplet Precaution, Airborne Infection Isolation, and Protective (Reverse) Isolation

What are the specific types of Transmission-based Precautions?

Negative pressure room/exhaust fan, open windows, single room

What are the patient placement/environmental requirements for Airborne Precautions?

N95 respirator or higher

What is the essential PPE for Airborne Precautions?

PTB (Pulmonary Tuberculosis), Measles, Varicella (Chickenpox), Varicella Zoster, disseminated herpes zoster, Pulmonary or Pharyngeal Tuberculosis, Rubeola (measles) virus, Varicella-zoster virus, SARS, MERS-CoV

List examples of pathogens/diseases requiring Airborne Precautions

A surgical mask (N95)

What mask should healthcare workers use for Airborne Infection Isolation?

A surgical mask

What should a patient wear if transport is necessary when under Airborne Precautions?

Single room, surgical mask, face shield/goggles as needed

What are the patient placement/PPE requirements for Droplet Precautions?

Large-particle droplets (>5 um in size) generated when patient coughs, sneezes, talks, or during cough-inducing procedures

How are microorganisms transmitted via respiratory droplets in Droplet Precautions?

Bacterial pneumonia, Meningococcemia, Diphtheria, Influenza, Mumps, Pertussis, pneumonic plague, Hib in children, Meningococcal infections, Group A Streptococcal infection in children, Rubella (~7 days after onset of rash), Haemophilus influenzae type b (invasive), Mycoplasma pneumoniae, Neisseria meningitidis (invasive), Parvovirus B19, Rhinovirus, SARS, MERS-CoV, Viral hemorrhagic fevers (Ebola, Lassa, Marburg)

List examples of pathogens/diseases requiring Droplet Precautions

Maintain spatial separation of at least 2 meters or 6 feet between the infected patient and other patients/visitors, and limit movement of the patient

What spatial separation and patient movement recommendations are there for Droplet Precautions?

Meningitis, petechial/ecchymotic rash and fever, paroxysmal or severe persistent cough during periods of pertussis activity

List conditions that require empiric use of droplet isolation

Single room, gloves, gown/apron

What are the patient placement/PPE requirements for Contact Precautions?

Gloves, even on intact skin or surfaces and articles in close proximity to the patient, and a gown whenever anticipating that clothing will have direct contact with the patient or potentially contaminated environmental surfaces

What is the essential PPE for Contact Precautions?

Multidrug-resistant organisms, draining pus/wounds, C difficile diarrhea, Clostridium difficile, rotavirus, congenital Rubella (until 1 year of age), Decubitus ulcer, HAV, diapered or incontinent patients, HSV, impetigo, lice (head, body, pubic), poliomyelitis, RSV, scabies, Adenovirus (contact + droplet), Infectious diarrhea in diapered/incontinent patients, Group A strep wound infections, MDR bacteria (MRSA, VRE), Viral conjunctivitis, Zoster (disseminated or immunocompromised), SARS (Contact + airborne), Herpes simplex virus (neonatal, mucocutaneous, or cutaneous), Herpes zoster (localized with no evidence of dissemination), Pediculosis capitis, Pediculosis corporis, and Pediculosis pubis (lice), Respiratory syncytial virus, Parainfluenza virus, Human metapneumovirus, Enteroviruses, Norovirus, Hepatitis A virus, Salmonella, Shigella species, Escherichia coli O157:H7, Syphilis, Viral hemorrhagic fevers (Ebola, Lassa, Marburg)

List examples of pathogens/diseases requiring Contact Precautions

Acute diarrhea of likely infectious etiology (patient diapered/incontinent), diarrhea in an adult with recent antibiotic use, vesicular rash (contact + airborne), history of infection or colonization with MDR organisms, respiratory infections in infants/young children, skin/wound/urinary tract infection in a patient with recent hospital or nursing home stay where MDR organisms are prevalent, abscess or draining wound that cannot be covered

List conditions that require empiric use of contact isolation

Sterile gown, mask, gloves

What PPE is used for Protective (Reverse) Isolation?

No fresh flowers, limit and screen visitors for any infectious illness

What are the environmental considerations and visitor restrictions for Protective (Reverse) Isolation?

Agranulocytosis, neutropenic patients, lymphoma and leukemia (especially late stages), patients on chronic immunosuppression, severe/extensive dermatitis or eczematous disease, AIDS

Who is Protective (Reverse) Isolation for?

Patient Placement and Syndromic Application Cohorting for similar cases is allowed for all precautions

When is cohorting allowed for patients?

Prioritized for a single patient room

What is the general recommendation for patient placement if a patient has increased risk of transmission, is likely to contaminate the environment, does not maintain appropriate hygiene, or is at increased risk of acquiring infection or developing adverse outcome following infection?

When a high number of patients/residents are colonized or infected with the same organism, grouping them in the same area

When may cohorting be an option for patient placement?

Patients with the same diagnosis are grouped together in one room

Ideally, how are patients grouped in cohorting?

Standard Precautions

What type of precaution is always included in the syndromic application of transmission-based precautions?

Contact

What empiric precaution is recommended for acute diarrhea with a likely infectious cause in an incontinent or diapered patient?

Clostridium difficile

What potential pathogen is associated with diarrhea in an adult with a history of recent antibiotic use?

Contact

What empiric precaution is recommended for diarrhea in an adult with a history of recent antibiotic use?

Neisseria meningitidis

What potential pathogen is associated with Meningitis and petechial/ecchymotic rash with fever?