Infection Prevention and Control (IP&C)

Learning objectives

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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Time involved

• 35 minutes

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What is IP&C?

• The discipline concerned with preventing nosocomial or healthcare-associated infections• a sub-discipline of epidemiology

• 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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Why is IP&C Important?

• 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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History

• 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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Florence Nightingale• 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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Ignaz Semmelweis - 1• 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 - 2• 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• Resulted in a dramatic outcome - deaths on the

maternity ward fell fivefold

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Joseph Lister - 1

• 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 - 2

• 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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Infection Prevention and Control Programs• 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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Healthcare-Associated Infections (HAI) - 1• HAIs include urinary tract infections, pneumonia,

bloodstream infections and surgical site infections

• The WHO states • urinary tract infection is the most frequent HAI in high-

income countries; surgical site infections in settings with limited resources*

* Statistics in low resource countries are often non-standardized or incomplete

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Healthcare-Associated Infections (HAI)• 30% of patients in intensive care units (ICU) are

affected by at least one HAI in high-income countries• 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*

* Statistics in low resource countries are often non-standardized or incomplete

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Goals of IP&C• 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

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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Functions of IP&C• 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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Practice of IP&C Today• Surveillance• Outbreak investigations• Prevention through practices/guidelines

• 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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References• 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_Statements/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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Web Resources• World Health Organization - http://

www.who.int/csr/bioriskreduction/infection_control/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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Quiz1. 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) Focus on patient health and safetyb) Focus on healthcare worker safetyc) Focus on decreasing costsd) All of the above

3. IP&C programs are relevant to all healthcare settings. T/F?

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International Federation of Infection Control• 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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