Air Cleaner Holmes
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Infection control is the discipline concerned with preventing nosocomial infection. As such, it is a practical (rather than an academic) sub-discipline of epidemiology. It is an essential (though often under-recognized and under-supported) part of the infrastructure of health care. Infection control and hospital epidemiology are akin to public health practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.
Infection control addresses factors related to the spread of infections within the health-care setting (whether patient-to-patient, from patients to staff and from staff to patients, or among-staff), including prevention (via hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance), monitoring/investigation of demonstrated or suspected spread of infection within a particular health-care setting (surveillance and outbreak investigation), and management (interruption of outbreaks). It is on this basis that the common title being adopted within health care is "Infection Prevention & Control."
Infection control in healthcare facilities
Aseptic technique is a key component of all invasive medical procedures. Similarly, infection control measures are most effective when applied universally because undiagnosed infection is common.
Hand hygiene
Independent studies by Ignaz Semmelweis in 1847 in Vienna and Oliver Wendell Holmes in 1843 in Boston established a link between the hands of health care workers and the spread of hospital-acquired disease. The Centers for Disease Control and Prevention (CDC) has stated that “It is well-documented that the most important measure for preventing the spread of pathogens is effective handwashing.” In the United States, hand washing is mandatory in most health care settings and required by many different state and local regulations.
In the United States, Occupational Safety and Health Administration (OSHA) standards require that employers must provide readily accessible hand washing facilities, and must ensure that employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon as feasible after contact with blood or other potentially infectious materials (OPIM).
Drying is an essential part of the hand hygiene process. In November 2008, a non-peer-reviewed study was presented to the European Tissue Symposium by the University of Westminster, London, comparing the bacteria levels present after the use of paper towels, warm air hand dryers, and modern jet-air hand dryers. Of those three methods, only paper towels reduced the total number of bacteria on hands, with "through-air dried" towels the most effective.
The presenters also carried out tests to establish whether there was the potential for cross-contamination of other washroom users and the washroom environment as a result of each type of drying method. They found that:
- the jet air dryer, which blows air out of the unit at claimed speeds of 400 mph, was capable of blowing micro-organisms from the hands and the unit and potentially contaminating other washroom users and the washroom environment up to 2 metres away
- use of a warm air hand dryer spread micro-organisms up to 0.25 metres from the dryer
- paper towels showed no significant spread of micro-organisms.
In 2005, in a study conducted by TUV Produkt und Umwelt, different hand drying methods were evaluated . The following changes in the bacterial count after drying the hands were observed:
Cleaning, disinfection and sterilization
Sterilization is a process intended to kill all microorganisms and is the highest level of microbial kill that is possible. Sterilizers may be heat only, steam, or liquid chemical. Effectivness of the sterilizer (e.g., a steam autoclave") is determined in three ways. First by the mechanical indicators and gauges on the machine itself, second the heat sensitive indicators or tape on the sterilizing bag turn color, and thirdly and most importantly is the biological test. With the biological test, a highly heat and chemical resistant microorganism (often the bacterial endospore) is selected as the standard challenge. If the process kills this microorganism, the sterilizer is considered to be effective. It should be noted that in order to be effective, instruments must be cleaned, otherwise the debris may form a protective barrier, shielding the microbes from the lethal process. Similarly care must be taken after sterilization to ensure sterile instruments do not become contaminated prior to use.
Disinfection refers to the use of liquid chemicals on surfaces and at room temperature to kill disease causing microorganisms. Disinfection is a less effective process than sterilization because it does not kill bacterial endospores.
Personal protective equipment
Personal protective equipment (PPE) is specialized clothing or equipment worn by a worker for protection against a hazard. The hazard in a health care setting is exposure to blood, saliva, or other bodily fluids or aerosols that may carry infectious materials such as Hepatitis C, HIV, or other blood borne or bodily fluid pathogen. PPE prevents contact with a potentially infectious material by creating a physical barrier between the potential infectious material and the healthcare worker.
In the United States, the Occupational Safety and Health Administration (OSHA) requires the use of Personal protective equipment (PPE) by workers to guard against blood borne pathogens if there is a reasonably anticipated exposure to blood or other potentially infectious materials.
Components of Personal protective equipment (PPE) include gloves, gowns, bonnets, shoe covers, face shields, CPR masks, goggles, surgical masks, and respirators. How many components are used and how the components are used is often determined by regulations or the infection control protocol of the facility in question. Many or most of these items are disposable to avoid carrying infectious materials from one patient to another patient and to avoid difficult or costly disinfection. In the United States, OSHA requires the immediate removal and disinfection or disposal of worker's PPE prior to leaving the work area where exposure to infectious material took place.
Vaccination of health care workers
Health care workers may be exposed to certain infections in the course of their work. Vaccines are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B; influenza; measles, mumps and rubella; Tetanus, diphtheria, pertussis; N. meningitidis; and varicella. In general, vaccines do not guarantee complete protection from disease, and there is potential for adverse effects from receiving the vaccine.
Post exposure prophylaxis
In some cases where vaccines do not exist Post Exposure prophylaxis is another method of protecting the health care worker exposed to a life threatening infectious disease. For example, the viral particles for HIV-AIDS can be precipitated out of the blood through the use of an antibody injection if given within 4 hours of a significant exposure.
Surveillance for emerging infections
Main article: Disease surveillanceSurveillance is the act of infection investigation using the CDC definitions. Determining an infection requires an Infection Control Practitioner (ICP) to review a patient's chart and see if the patient had the signs and symptom of an infection. Surveillance definition cover infections of the bloodstream, urinary tract, pneumonia, and sugical sites.
Surveillance traditionally involved significant manual data assessment and entry in order to assess preventative actions such as isolation of patients with an infectious disease. Increasingly, integrated computerised software solutions are becoming available that assess incoming risk messages from microbiology and other online sources. By reducing the need for data entry, this software significantly reduces the data workload of ICPs, freeing them to concentrate on clinical surveillance.
As approximately one third of healthcare acquired infections are preventable, surveillance and preventative activities are increasingly a priority for hospital staff. In the United States, a study on the Efficacy of Nosocomial Infection Control Project (SENIC) by the CDC found that hospitals reduced their nosocomial infection rates by approximately 32 per cent by focusing on surveillance activities and prevention efforts.
Isolation
Main article: Isolation (health care)In the health care context, isolation refers to various physical measures taken to interrupt nosocomial spread of contagious diseases. Various forms of isolation exist, and are applied depending on the type of infection and agent involved, to address the likelihood of spread via airborn particles or droplets, by direct skin contact, or via contact with body fluids.
Outbreak investigation
When an unusual cluster of illness is noted, infection control teams undertake an investigation to determine whether there is a true outbreak, a pseudo-outbreak (a result of conta
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