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Infection Control in Health Care Facilities

Hassan Mostafa Mohammed, Chairman & Chief Executive Officer, ReyadaPro

Implementing infection prevention and control (IPC) practices is paramount in minimizing the spread of infections in healthcare settings. Key IPC measures encompass rigorous hand hygiene, proper utilization of personal protective equipment (PPE), regular environmental cleaning, safe injection practices, and staying up-to-date with immunizations. Furthermore, tailored IPC guidelines exist for diverse healthcare environments and specific infectious diseases, including healthcare-associated infections (HAIs), tuberculosis, and measles. These practices collectively safeguard the well-being of healthcare workers, patients, and the broader community from the transmission of infections.

Infection prevention and control (IPC)

Infection prevention and control (IPC) is a set of evidence-based practices and procedures that, when applied consistently, can prevent, or reduce the risk of transmission of microorganisms to health care providers, clients, patients, residents, and visitors. IPC is essential for ensuring the safety of healthcare workers and patients. Healthcare facilities are at a high risk for the spread of infection because they care for people who are sick or injured.

HCWs should wear PPE as required, following the approved SOP to protect themselves from exposure to infectious diseases during performing their duties. Healthcare workers (HCWs) are at risk because they are exposed to blood, body fluids, and other potentially infectious materials.

Healthcare facilities are equipped should be equipped with competent personnel from different disciplines such as physicians, dentists, nurses, laboratory professionals and technicians, facility maintenance engineers and technicians, human resources specialists, social responsibilities staff, cleaning labors, morgue support labors and specialists, kitchen and food services labors and technicians, and Quality and patient safety staff.

HCWs can be found in a variety of workplace settings, including hospitals, nursing care facilities, outpatient clinics (e.g., medical, and dental offices, and occupational health clinics), ambulatory care centers, and emergency response settings.

Why IPC is important:

• It protects patients from infection: Healthcare-associated infections (HAIs) are infections that patients acquire while they are in a healthcare facility. HAIs can be serious and even life-threatening. IPC programs help to prevent HAIs by reducing the spread of infection.
• It protects healthcare workers from infection: HCWs are at risk for infection because they are exposed to blood, body fluids, and other potentially infectious materials. IPC programs help to protect HCWs from infection by providing them with the training & resources they need to stay safe.
• It saves lives and money: HAIs can be costly to treat and can lead to longer hospital stays. By preventing HAIs, IPC programs can save lives and money.

IPC is a critical part of healthcare safety. By following IPC guidelines, healthcare workers can help to protect themselves, their patients, and their communities from the spread of infection.

What case infection:

Germs are found in everywhere in the healthcare facilities and environment, such as air, soil, drinking water, waste water. Germs live on and inside our bodies. Fortunately majority of them are non-harmful and little percent can cause infection if the conditions are suitable for that.

Germs are also found in the healthcare environment. Only a small portion of germs are known to cause infection. For example:

Germs need three or four elements to flourished and reproductive according to their types “aerobic and non-aerobic]. They need warmth, moisture, and food, air “as pr the type of germs].

Germs distribution and dispersion can be controlled if we control the environment, personnel and ensure the cleanability and sanitization and/or sterilization of machine, equipment, gauges and apparatus used.

Some examples where we can find germs:

• Dry and wet surfaces at the healthcare environment such as wall, floors, beds, trolleys, e.tc
• Medical devices/equipment, tools and other items used during patient care and/or performing operation and if not cleaned and/or sterilized and packed as required following approved SOP.
• Germs do not move themselves Germs travelled/transferred through air, personnel, machines, equipment and other items.
• We need to pay great attention to control our behaviours withing healthcare facility and environment to minimize/reduce germs dispersion.
• All personnel working within healthcare environment should avoid touching tools, medical equipment, and other items without proper gowns [wearing suitable gloves].
• All need to follow the right and correct behaviour while presenting medication to patients, using needle and/or sharp items to avoid contamination.
• All should avoid sneezing, coughing and keep wearing proper mask within the healthcare facility as required.

How do infection occur?

1. Bacteria, virus. Other microbes are types of germs.
2. Germs can cause infectious to patient and/or visitors and even to healthcare provider when following improper procedures within healthcare facility.
3. Germs cause infection. Germs can be transferred from ill personnel to healthy one while talking, shake hands, sneezing, coughing, touching surfaces.
4. To avoid that, we need to follow strict regime in cleaning, sanitation, sterilization as per approved SOP, following the approved SOP, following the instructions of infection control department & Quality and patients safety department  
5. We need to apply approved measure to insulate patient with infection diseases in insulation rooms, consideration the type of infection and applying the approved protocol in dealing with them till complete treatment.

Three things are necessary for an infection to occur:

• Source: Places where infectious agents (germs) live (e.g., sinks, surfaces, human skin).
• Susceptible Person with a way for germs to enter the body.
• Transmission: a way germs are moved to the susceptible person, Source is an infectious agent or germ and refers to a virus, bacteria, or other microbe.

Infections spread through:

• Direct contact: The most common way that infections spread. It occurs when a person comes into direct contact with an infected person or with an object that is contaminated with an infectious agent.
• Indirect contact: This occurs when a person comes into contact with an object that is contaminated with an infectious agent and then transfers the infectious agent to their own body.
• Airborne transmission: This occurs when a person inhales droplets that contain an infectious agent. To avoid that, ill patient shall avoid sneezing and coughing, wearing proper mask all the times, avoid direct contact with healthy persons.

When ill patient make sneezing and/or coughing, cleaning, and sanitation protocol should be applies from housekeeping personnel under complete supervision from nurse to assure proper operation. Change the mask to a new one, keep a distance between patient and staff, visitors, unless wearing PPE.

Best practices in IPC:

• Hand hygiene: Practicing Hand hygiene is the utmost important practice to prevent the spread of infection. It is important to wash your hands with running water for at least for 20 seconds, followed by soap/detergent and finally applying sanitizing agent preferable to be in the form of gel, let it dry off.

Before and after patient care, after visiting the bathroom, and after blowing. Rubbing your nose, coughing, or sneezing, following WHO guidelines for hands hygiene.

• Personal protective equipment (PPE): wearing PPE will protect healthcare workers and patients from exposure to infectious agents. PPE may include gloves, masks, gowns, and eyewear. PPE types depend on each situation and proceeding conditions.

• Environmental cleaning and disinfection: performing required and thorough environmental cleaning and disinfection surfaces, such as countertops, bedrails, tables, chairs, and equipment, should be done regularly and as prescribed in the approved SOP “standard operating procedures to prevent/reduce the possibilities of infection spreading.

• Safe injection practices: Practicing safe injection practices are essential for preventing the transmission of bloodborne infections. This includes using sterile needles and syringes for each injection and disposing of sharps safely with adherence of SOP application.

• Immunization: Immunization considered is the best recommended ways to protect yourself, families and others from infectious diseases- following the protocols of vaccinations. It is recommended for HCP “Healthcare Providers “to stay up-to-date on all recommended vaccinations in time.

The chain of infection

Such as facility, environment, people, animals, tools, machines, equipment, etc.:

1. Infectious agent: The infectious agent is the microorganism that causes the infection. This can be a virus, bacterium, fungus, or parasite.
2. Reservoir: The reservoir is the place where the infectious agent lives and multiplies. This can be a person, animal, plant, or object.
3. Portal of exit: The portal of exit is the way that the infectious agent leaves the reservoir. This can be through coughing, sneezing, vomiting, diarrhea, or contact with blood or other body fluids.
4. Mode of transmission: The mode of transmission is the way that the infectious agent travels from the reservoir to the new host, such as direct contact, indirect contact, airborne transmission, .etc.
5. Portal of entry: The portal of entry is the way that the infectious agent enters the new host. This can be through the mouth, nose, eyes, skin, or wounds.
6. usceptible host: The susceptible host is the person who is at risk for getting the infection. Some people are more susceptible than others due to factors such as age, health status, and vaccination status.

Examples of how to break the chain of infection:

• Infectious agent: Immunization can help to prevent infection by exposing the body to a weakened or inactive form of the infectious agent, which helps the body to develop antibodies against the infection.
• Reservoir: Treating infected people and animals can help to reduce the number of reservoirs of infection.
• Portal of exit: Covering the mouth and nose when coughing or sneezing can help to prevent the spread of airborne droplets. We should wear the proper gloves when handling blood and either body fluids can help to prevent the spread of infection through contact.
• Mode of transmission: Washing hands frequently can help to remove infectious agents from the hands and prevent the spread of infection through contact. Avoiding contact with infected people and animals can also help to prevent infection.
• Portal of entry: Wearing a mask can help to prevent the inhalation of airborne droplets. Covering wounds can help to prevent the entry of infectious agents through the skin.
• Susceptible host: Getting vaccinated is one of the best ways to protect yourself from infection. Eating a healthy diet and getting enough sleep can also help to boost the immune system and make the body more resistant to infection.

Environmental cleaning and disinfection of healthcare

It is essential for preventing the spread and/or help to reduce the risk of infection. Healthcare workers, patients, and visitors can all be exposed to infectious agents on surfaces in the environment.

• Cleaning: Cleaning removes dirt, debris, and some microorganisms from surfaces. Cleaning is typically done with soap and water or a detergent solution.
• Disinfection: Disinfection kills or inactivates microorganisms on surfaces. Disinfection is typically done with a chemical disinfectant.

High-touch surfaces, such as doorknobs, bedrails, and countertops, should be cleaned and disinfected frequently. Surfaces that are contaminated with blood, body fluids, or other potentially infectious materials should be cleaned and disinfected immediately.

Safe injection practices

Safe injection practices are essential for preventing the transmission of bloodborne infections, Such as HCV, HBC, and HIV include:

• Using sterile needles and syringes for each injection: This is the most important practice for preventing the transmission of bloodborne infections. Needles and syringes should be sterile and unopened before each injection.
• Disposing of sharps safely: Sharps, such as needles and syringes, should be disposed of in a puncture-resistant container immediately after use.
• Avoiding the reuse of needles and syringes: Needles and syringes should never be reused, even if they are used on the same patient.
• Using single-dose vials for medication: Single-dose vials should be used for medication. Multi-dose vials should only be used if there is no alternative.
• Recapping needles safely: Needles should be recapped as little as possible. If a needle must be recapped, it should be done using a one-handed technique.

Healthcare-associated infections (HAIs) are infections that patients acquire while they are in a healthcare facility. HAIs can be serious and even life-threatening. Examples of HAIs:

• Catheter-associated urinary tract infections (CAUTIs)
• Central line-associated bloodstream infections (CLABSIs)
• Surgical site infections (SSIs)
• Ventilator-associated pneumonia (VAP)
• Clostridium difficile infections (CDIs)

Microorganisms, including bacteria, viruses, and fungi are the reason of healthcare associated infection withing the healthcare facility and environment.

To prevent HAIs, HCWs should follow:

• Hand hygiene regime, wearing PPEs, performing environmental cleaning and disinfection, and practicing Safe injection practices.
• Follow antimicrobial stewardship:  Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antibiotics. Development and the spread of antibiotic-resistant bacteria.
• Educating patients and their families about HAIs and how to prevent them.
• Screening patients for risk factors for HAIs. Using surveillance systems to track HAIs and identify areas where improvement is needed and implementing quality improvement initiatives to reduce the risk of HAIs.

Outbreak management:

Outbreak management is the process of identifying, investigating, and controlling outbreaks of infectious disease. Outbreak management is essential for protecting public health and preventing the spread of disease.

The first step is to identify the outbreak. By monitoring surveillance data for unusual patterns of disease. The next step is to investigate the outbreak. Via determining the etiology of the outbreak, the mode of transmission, and the risk factors for infection. Then control the outbreak. This occurred due to the following measures:

• Isolation and quarantine: Isolation and quarantine are used to separate infected individuals from the uninfected population.
• Vaccination: Used to protect individuals from infection.
• Treatment: Treatment of infected individuals can help to reduce the severity of the illness and the risk of transmission.
• Environmental cleaning and disinfection: Help to remove infectious agents from the environment and prevent the spread of disease.
• Public health education: Used to inform the public about the outbreak and how to prevent the spread of disease.

IPC measures that can be taken to prevent the spread of specific types of infections:

• Respiratory infections: Influenza and COVID-19, are spread through the air when an infected person coughs or sneezes. This occurred due to the following measures, healthcare facilities should:
   o Implement respiratory hygiene and cough etiquette practices, such as encouraging patients and staff to cover their mouths and noses when coughing or sneezing.
   o Use airborne precautions, such as negative pressure isolation rooms, when caring when handling suspect patient with respiratory infection.
• Wear appropriate PPE, such as N95 respirators, when caring For suspected patient with infection
• Gastrointestinal infections: Norovirus and Clostridium difficile, are spread through contact with contaminated food, water, or surfaces. To prevent the spread of gastrointestinal infections, healthcare facilities should:
   o Implement hand hygiene practices, such as encouraging patients and staff to wash their hands frequently with soap and water.
   o Clean and disinfect environmental surfaces regularly.
   o Use contact precautions, such as wearing gloves and gowns, when caring for patients with known or suspected gastrointestinal infections.
• Bloodborne infections: HIV, hepatitis B, and hepatitis C, are spread through contact with infected blood or body fluids. To prevent the spread of bloodborne infections, healthcare facilities should:
    o Implement safe injection practices, such as using sterile needles and syringes for each injection and disposing of sharps safely.
    o Use universal precautions, such as wearing gloves and gowns, when caring for all patients.
• Screen patients for risk factors for infection, such as recent travel to areas with outbreaks of infectious disease.
• Implement surveillance systems to track infections and identify areas where improvement is needed.
• Develop and implement quality improvement initiatives to reduce the risk of infection.

By following these and other IPC measures, healthcare facilities can help to protect patients, staff, and the public from the spread of infection.

--Issue 02--

Author Bio

Hassan Mostafa Mohammed

Dr. Hassan Mostafa Mohamed, Chairman & Chief Executive Officer at ReyadaPro is an entrepreneurial and growth-driven executive with more than 25 years Of experience in pharmaceutical industries, including, Technical, sales & marketing, Production, Supply chain, Engineering/utilities, Quality, and regulatory issues. Mr. Hassan is an expert in driving pharmaceutical facilities to accomplish corporate goals, Building and leading technical & quality aspects with market consideration for rapid Growth, and efficient operational excellence.

Harvard Medical School - Leadership in Medicine Southeast Asia47th IHF World Hospital Congress