infection prevention and control

what is the epidemiological triad

three components that must interact for infection to occur

• agent → organism that causes the disease, reside in humans, animals or environmental surfaces

• host → target of the disease

• environment → the surroundings and conditions external to the host, which allows transmission of the disease

the transmission pathways can be direct or indirect

what is route of transmission

• organism moving from one host to another. can occur through direct contact to the susceptible host via

  • contaminated surfaces

  • respiratory droplets

  • airborne droplets

• susceptible host is typically an individual with compromised immunity e.g. patients that are

  • elderly

  • have undergone surgery

  • have chronic illness

what are the different routes of transmission

• Contact Transmission → via direct touch or indirectly through contaminated surfaces and medical equipment.

• Droplet Transmission → large respiratory droplets traveling short distances during coughing or sneezing

• Airborne Transmission → smaller particles that remain suspended and travel long distances in the air.

what are the different ways we can control the spread of infection

• behaviour change → condoms to reduce STDs, regular handwashing, healthy diet, use of insect repellants

• vaccines → reduction and eradication of diseases, herd immunity 

• medication → treat infection, prevent infection before or after exposure to a disease (pre and post-exposure prophylaxis)

• surveillance → monitor disease and characterise disease patterns to detect outbreaks and guides the prioritisation development and evaluation of disease control programs in countries, also guides formularies 

• environment → control or eradicate mosquitoes, safe supply of water, improving sanitation and hygiene 

• infection control → sterilisation pf equipment, PPE,  isolating infectious patients 

why is hospital environment important

hospital is where serious illnesses are treated and also where antibiotic-resistant infections are particularly likely to develop and spread.

• Infections acquired in hospitals and other health-care facilities are called nosocomial infections

• Resistant bacteria exert a heavy toll in terms of illness and mortality, as well as added direct and indirect costs.

• the key to limiting risk is the intense measures for the prevention and control of infection

what are infection prevention and control (IPC) measures

prevent the spread of pathogens, including those with AMR, within and between health-care facilities, and from facilities to the community

• there is a legal requirement to implement “The Code of Practice on the prevention and control of infections” → trusts must have clear arrangements for the effective prevention, detection and control of Healthcare associated infection (HAI), including the procedures to be taken in the event of an outbreak of infection.

• In addition to the standard IPC measures, there are specific recommendations concerning AMR pathogens.

importance of containing Healthcare Associated Infections, HAI

• HAIs can develop either as a direct result of healthcare interventions such as medical or surgical treatment, or from being in contact with a healthcare setting.

• HAI covers a wide range of infections. The most well-known include those caused by methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. difficile).

• HAIs pose a serious risk to patients, staff and visitors. They can incur significant costs for the NHS and cause significant morbidity to those
  infected.

importance of screening and prevention for colonisation 

Screening for Multidrug-Resistant Organisms

• Screening identifies carriers of multidrug-resistant organisms like MRSA and CPE (Carbapenemase-Producing Enterobacterales) upon hospital admission to prevent spread.

Difference Between Colonisation and Infection

• Colonisation means presence without symptoms, while infection involves symptomatic disease requiring treatment.

Benefits of Early Detection

• Early detection enables isolation precautions, reducing transmission risk and preventing outbreaks.

Impact on Patient Safety and Costs

• Screening protects vulnerable patients and reduces healthcare costs by minimising treatment and containment needs

what are standard infection and control measures

• Hand Hygiene

• Respiratory Hygiene (when coughing or sneezing)

• Personal Protective Equipment → using the right gloves, gown, mask and eye protection from the pathogen you are protecting yourself and the patient from

• Occupational Exposure management including Sharps

• Management of Care Equipment

• Safe Care of Linen including Uniforms

• Control of Environment

• Safe Waste Disposal

what is isolation of patients

isolating patients who are colonised or infected with resistant organisms 

• involves application of specific contact precautions/personal protective equipment

• Group several similarly affected patients in a bay. However, isolation in single rooms is not always feasible.

what is Clostridioides difficile infection (CDI)

usually develops when you're taking antibiotics, or when you've finished taking them within the last few weeks. The most common symptoms are:

• watery diarrhoea, which can be bloody

• painful tummy cramps

• feeling sick

• signs of dehydration, such as a dry mouth, headaches and peeing less often than normal

• a high temperature (fever) of above 38C (100.4F)

• loss of appetite and weight loss

what are the risk factors for C dificil

• Have been treated with broad-spectrum antibiotics or several different antibiotics at the same time, or those taking long-term antibiotics

• Have had to stay in a healthcare setting, such as a hospital or care home,  for along time

• Are over 65 years old

• Have certain underlying conditions, including inflammatory bowel disease (IBD), cancer or kidney disease.

• Have a weakened immune system

• Taking a PPI

• Have had surgery on their digestive system

How is Clostridium difficile contracted?

found in the digestive system of about 1 in every 30 healthy adults. the bacteria often live harmlessly because the other bacteria normally found in the bowel keep it under control

• Antibiotics can interfere with the balance of bacteria in the bowel, which can lead to C. difficile bacteria multiplying and produce toxins

• C. difficile can spread easily to other people because the bacteria are passed out of the body in the person's diarrhoea.

• Once out of the body, the bacteria turn into resistant cells called spores.

• These can survive for long periods on hands, surfaces (such as toilets), objects and clothing unless they're thoroughly cleaned.

• Infectious until at least 48 hours after symptoms have cleared up

summary of roles and activities at hospital level

what are the typical activities of the IPC team

core members generally include

• Director of Infection Prevention & Control (DIPC): senior figure, often a Chief Nurse or Consultant, who leads the overall strategy.

• Consultant Microbiologists/Virologists: Medical doctors who provide expert clinical and laboratory advice.

• Infection Prevention and Control Lead Nurses/Specialist Nurses/Practitioners: A team of nurses dedicated to implementing policies, providing education, conducting surveillance, and managing outbreaks.

• Surveillance Officers/Analysts: Staff responsible for collecting, analysing, and reporting infection data

what are the responsibilities of the infection control team

• Staff education and training

• Policy and guideline development e.g. MRSA Screening

• Producing patient information leaflets and visiting patients on request

• Co-ordinating the annual infection prevention and control audit

• Surveillance of specific healthcare associated infections (HAI) e.g. MRSA bloodstream infections and Clostridium difficile infection

• Investigating outbreaks and co-ordinating control measures

• Working closely on issues related to cleanliness of environment and equipment

• Participating in evaluation of new technology link and supporting national infection prevention and control collaborative projects.