infection control

Infection Control

Definition

Infection control refers to policies and procedures used to minimize the risk of spreading infections, especially in hospitals and human or animal health care facilities.

Purpose

The purpose of infection control is to reduce the occurrence of infectious diseases. These diseases are usually caused by bacteria or viruses and can be spread by human to human contact, animal to human contact, human contact with an infected surface, airborne transmission through tiny droplets of infectious agents suspended in the air, and, finally, by such common vehicles as food or water. Diseases that are spread from animals to humans are known as zoonoses; animals that carry disease agents from one host to another are known as vectors.

Infection control in hospitals and other health care settings

Infections contracted in hospitals are also called nosocomial infections. They occur in approximately 5% of all hospital patients. These infections result in increased time spent in the hospital and, in some cases, death. There are many reasons nosocomial infections are common, one of which is that many hospital patients have a weakened immune system which makes them more susceptible to infections. This weakened immune system can be caused either by the patient's diseases or by treatments given to the patient. Second, many medical procedures can increase the risk of infection by introducing infectious agents into the patient. Thirdly, many patients are admitted to hospitals because of infectious disease. These infectious agents can then be transferred from patient to patient by hospital workers or visitors.Infection control has become a formal discipline in the United States since the 1950s, due to the spread of staphylococcal infections in hospitals. Because there is both the risk of health care providers acquiring infections themselves, and of them passing infections on to patients, the Centers for Disease Control and Prevention (CDC) established guidelines for infection control procedures. In addition to hospitals, infection control is important in nursing homes, clinics, child care centers, and restaurants, as well as in the home.To lower the risk of nosocomial infections, the CDC began a national program of hospital inspection in 1970 known as the National Nosocomial Infections Surveillance system, or NNIS. The CDC reported that over 300 hospitals participate in the NNIS system as of the early 2000s. Data collected from the participating hospitals show that infection control programs can siginificantly improve patient safety, lower infection rates, and lower patient mortality.Dental health care settings are similar to hospitals in that both personnel and equipment can transmit infection if proper safeguards are not observed. The CDC issued new guidelines in 2003 for the proper maintenance and sterilization of dental equipment, hand hygiene for dentists and dental hygienists, dental radiology, medications, and oral surgery, environmental infection control, and standards for dental laboratories.

Selected Infectious Diseases And Corresponding Treatment
Disease	Symptoms	Transmittal	Treatment
Chicken pox	Rash, low- grade fever	Person to person	None
Common cold/ Influenza	Runny nose, sore throat, cough, fever, headache, muscle aches	Person to person	None
Hepatitis	Jaundice, flu- like symptoms	Sexual contact with an infected per- son, contami- nated blood, food, or water	None
Legionnaire's Disease	Flu symptoms, peneumonia, diarrhea, vomiting, kidney failure, respiratory failure	Air condition- ing or water systems	Antibiotics
Measles	Skin rash, runny nose and eyes, fever, cough	Person to person	None
Meningitis	Neck pain, headache, pain caused by exposure to light, fever, nausea, drowsiness	Person to person	Antibiotics for bacterial meningitis, hospital care for viral meningitis
Mumps	Swelling of salivary glands	Person to person	Anti-inflam- matory drugs
Ringworm	Skin rash	Contact with infected ani- mal or person	Antifungal drugs applied topically
Tetanus	Lockjaw, other spasms	Soil infection of wounds	Antibiotics, antitoxins, muscle relaxers

The newest addition to the infection control specialist's resources is molecular typing, which speeds up the identification of a disease agent. Rapid identification in turn allows for timely containment of a disease outbreak.

Threat of emerging infectious diseases

Due to constant changes in our lifestyles and environments, new diseases are constantly appearing that people are susceptible to, making protection from the threat of infectious disease urgent. Many new contagious diseases have been identified in the past 30 years, such as AIDS, Ebola, and hantavirus. Increased travel between continents makes the worldwide spread of disease a bigger concern than it once was. Additionally, many common infectious diseases have become resistant to known treatments.The emergence of the severe acute respiratory syndrome (SARS) epidemic in Asia in February 2003 was a classic instance of an emerging disease that spread rapidly because of the increased frequency of international and intercontinental travel. In addition, the SARS outbreak demonstrated the vulnerability of hospitals and health care workers to emerging diseases. Clusters of cases within hospitals occurred in the early weeks of the epidemic when the disease had not yet been recognized and the first SARS patients were admitted without isolation precautions.The SARS epidemic also raised a number of ethical and legal questions regarding current attitudes toward infection control.

Problems of antibiotic resistance

Because of the overuse of antibiotics, many bacteria have developed a resistance to common antibiotics. This means that newer antibiotics must continually be developed in order to treat an infection. However, further resistance seems to come about almost simultaneously. This indicates to many scientists that it might become more and more difficult to treat infectious diseases. The use of antibiotics outside of medicine also contributes to increased antibiotic resistance. One example of this is the use of antibiotics in animal husbandry. These negative trends can only be reversed by establishing a more rational use of antibiotics through treatment guidelines.

Bioterrorism

The events of September 11, 2001, and the anthrax scare that followed in October 2001 alerted public health officials as well as the general public to the possible use of infectious disease agents as weapons of terrorism. The Centers for Disease Control and Prevention (CDC) now has a list of topics and resources related to bioterrorism on its web site.

Description

The goals of infection control programs are: immunizing against preventable diseases, defining precautions that can prevent exposure to infectious agents, and restricting the exposure of health care workers to an infectious agent. An infection control practitioner is a specially trained professional, oftentimes a nurse, who oversees infection control programs.Commonly recommended precautions to avoid and control the spread of infections include:

Vaccinate people and pets against diseases for which a vaccine is available. As of 2003, the vaccines used against infectious diseases are very safe compared to most drugs.
Wash hands often.
Cook food thoroughly.
Use antibiotics only as directed.
See a doctor for infections that do not heal.
Avoid areas with a lot of insects.
Be cautious around wild or unfamiliar animals, or any animals that are unusually aggressive. Do not purchase exotic animals as pets.
Do not engage in unprotected sex or in intravenous drug use.
Find out about infectious diseases when you make travel plans. Travelers' advisories and adult vaccination recommendations are available on the CDC web site or by calling the CDC's telephone service at 404-332-4559.

Because of the higher risk of spreading infectious disease in a hospital setting, higher levels of precautions are taken there. Typically, health care workers wear gloves with all patients, since it is difficult to know whether a transmittable disease is present or not. Patients who have a known infectious disease are isolated to decrease the risk of transmitting the infectious agent to another person. Hospital workers who come in contact with infected patients must wear gloves and gowns to decrease the risk of carrying the infectious agent to other patients. All articles of equipment that are used in an isolation room are decontaminated before reuse. Patients who are immunocompromised may be put in protective isolation to decrease the risk of infectious agents being brought into their room. Any hospital worker with infections, including colds, are restricted from that room.Hospital infections can also be transmitted through the air. Thus care must be taken when handling infected materials so as to decrease the numbers of infectious agents that become airborne. Special care should also taken with hospital ventilation systems to prevent recirculation of contaminated air.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Immunizations for Adults." Section 13, Chapter 152. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Ashford, D. A., R. M. Kaiser, M. E. Bales, et al. "Planning Against Biological Terrorism: Lessons from Outbreak Investigations." Emerging Infectious Diseases 9 (May 2003): 515-519.Gostin, L. O., R. Bayer, and A. L. Fairchild. "Ethical and Legal Challenges Posed by Severe Acute Respiratory Syndrome: Implications for the Control of Severe Infectious Disease Threats." Journal of the American Medical Association 290 (December 24, 2003): 3229-3237.Ho, P. L., X. P. Tang, and W. H. Seto. "SARS: Hospital Infection Control and Admission Strategies." Respirology 8, Supplement (November 2003): S41-S45.Jacobson, R. M., K. S. Zabel, and G. A. Poland. "The Overall Safety Profile of Currently Available Vaccines Directed Against Infectious Diseases." Expert Opinion on Drug Safety 2 (May 2003): 215-223.Jarvis, W. R. "Benchmarking for Prevention: the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) System Experience." Infection 31, Supplement 2 (December 2003): 44-48.Kohn, W. G., A. S. Collins, J. L. Cleveland, et al. "Guidelines for Infection Control in Dental Health-Care Settings—2003." Morbidity and Mortality Weekly Reports: Reports and Recommendations 52, RR-17 (December 19, 2003): 1-61.Peng, P. W., D. T. Wong, D. Bevan, and M. Gardam. "Infection Control and Anesthesia: Lessons Learned from the Toronto SARS Outbreak." Canadian Journal of Anaesthesiology 50 (December 2003): 989-997.Petrak, R. M., D. J. Sexton, M. L. Butera, et al. "The Value of an Infectious Diseases Specialist." Clinical Infectious Diseases 36 (April 15, 2003): 1013-1017.Sehulster, L., and R. Y. Chinn. "Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)." Morbidity and Mortality Recommendations and Reports 52, RR-10 (June 6, 2003): 1-42.Subramanian, D., J. A. Sandoe, V. Keer, and M. H. Wilcox. "Rapid Spread of Penicillin-Resistant Streptococcus pneumoniae Among High-Risk Hospital Inpatients and the Role of Molecular Typing in Outbreak Confirmation." Journal of Hospital Infection 54 (June 2003): 99-103.

Organizations

American College of Epidemiology. 1500 Sunday Drive, Suite 102, Raleigh, NC 27607. (919) 861-5573. http://www.acepidemiology.org.American Public Health Association (APHA). 800 I Street NW, Washington, DC 20001-3710. (202) 777-APHA. http://www.apha.org.American Veterinary Medical Association (AVMA). 1931 North Meacham Road, Suite 100, Schaumburg, IL 60173-4360. http://www.avma.org.Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.National Institute of Allergy and Infectious Diseases (NIAID). 31 Center Drive, Room 7A50 MSC 2520, Bethesda, MD, 20892. (301) 496-5717. http://www.niaid.nih.gov.

control

[kon-trōl´] 1. the governing or limitation of certain objects, events, or physical responses.2. a standard against which experimental observations may be evaluated, as a procedure identical to the experimental procedure except for the absence of the one factor being studied.3. conscious restraint and regulation of impulses and suppression of instincts and affects.4. a patient or group differing from the case or treated group under study by lacking the disease or by having a different or absent treatment or regimen. The controls and subjects usually otherwise have certain similarities to allow or enhance comparison between them.automatic brightness control an automated exposure device used in radiology; it senses light and adjusts itself to produce a predetermined fluoroscopic density.automatic exposure control a timer by which the exposure of x-ray film is determined by the radiographer but the length of exposure is determined by the equipment.aversive control in behavior therapy, the use of unpleasant stimuli to change undesirable behavior.birth control see birth control.hemorrhage control in the nursing interventions classification, a intervention" >nursing intervention defined as reduction or elimination of rapid and excessive blood loss.infection control see infection control.infection control: intraoperative in the nursing interventions classification, a intervention" >nursing intervention defined as preventing nosocomial infection in the operating room.motor control the generation and coordination of movement patterns to produce function; it may either control movements of the body in space or stabilize the body in space. See also postural control.postural control motor control that stabilizes the body in space by integrating sensory input about body position (somatosensory, visual, and vestibular input) with motor output to coordinate the action of muscles and keep the body's center of mass within its base of support. An important aspect of postural control is the righting reactions. Called also balance" >balance.stimulus control any influence exerted by the environment on behavior.

infection

[in-fek´shun] invasion and multiplication of microorganisms in body tissues, as in an infectious disease. The infectious process is similar to a circular chain with each link representing one of the factors involved in the process. An infectious disease occurs only if each link is present and in proper sequence. These links are (1) the causative agent, which must be of sufficient number and virulence to destroy normal tissue; (2) reservoirs in which the organism can thrive and reproduce; for example, body tissues and the wastes of humans, animals, and insects, and contaminated food and water; (3) a portal through which the pathogen can leave the host, such as the respiratory tract or intestinal tract; (4) a mode of transfer, such as the hands, air currents, vectors, fomites, or other means by which the pathogens can be moved from one place or person to another; and (5) a portal of entry through which the pathogens can enter the body of (6) a susceptible host. Open wounds and the respiratory, intestinal, and reproductive tracts are examples of portals of entry. The host must be susceptible to the disease, not having any immunity to it, or lacking adequate resistance to overcome the invasion by the pathogens. The body responds to the invasion of causative organisms by the formation of antibodies and by a series of physiologic changes known as inflammation.
The spectrum of infectious agents changes with the passage of time and the introduction of drugs and chemicals designed to destroy them. The advent of antibiotics and the resultant development of resistant strains of bacteria have introduced new types of pathogens little known or not previously thought to be significantly dangerous to man. A few decades ago, gram-positive organisms were the most common infectious agents. Today the gram-negative microorganisms, and Proteus, Pseudomonas, and Serratia are particularly troublesome, especially in the development of hospital-acquired infections. It is predicted that in future decades other lesser known pathogens and new strains of bacteria and viruses will emerge as common causes of infections.
The development of resistant strains of pathogens can be limited by the judicious use of antibiotics. This requires culturing and sensitivity testing for a specific antibiotic to which the identified causative organism has been found to be sensitive. If the patient has been receiving a broad-spectrum antibiotic prior to culture and sensitivity testing, this should be discontinued as soon as the specific antibiotic for the organism has been found. It would be helpful, too, if the general public understood that antibiotics are not cure-alls and that there is danger in using them indiscriminately. In some instances an antibiotic can upset the normal flora of the body, thus compromising the body's natural resistance and making it more susceptible to a second infection (superinfection) by a microorganism resistant to the antibiotic.
Although antibacterials have greatly reduced mortality and morbidity rates for many infectious diseases, the ultimate outcome of an infectious process depends on the effectiveness of the host's immune responses. The antibacterial drugs provide a holding action, keeping the growth and reproduction of the infectious agent in check until the interaction between the organism and the immune bodies of the host can subdue the invaders.
Intracellular infectious agents include viruses, mycobacteria, Brucella, Salmonella, and many others. Infections of this type are overcome primarily by lymphocytes" >T lymphocytes and their products, which are the components of cell-mediated immunity. Extracellular infectious agents live outside the cell; these include species of Streptococcus and Haemophilus. These microorganisms have a carbohydrate capsule that acts as an antigen to stimulate the production of antibody, an essential component of humoral immunity.
Infection may be transmitted by direct contact, indirect contact, or vectors. Direct contact may be with body excreta such as urine, feces, or mucus, or with drainage from an open sore, ulcer, or wound. Indirect contact refers to transmission via inanimate objects such as bed linens, bedpans, drinking glasses, or eating utensils. Vectors are flies, mosquitoes, or other insects capable of harboring and spreading the infectious agent.Patient Care. Major goals in the care of patients with threatening, suspected, or diagnosed infectious disease include the following: (1) prevent the spread of infection, (2) provide physiologic support to enhance the patient's natural curative powers and resources for warding off or recovering from an infection, (3) provide psychologic support, and (4) prepare the patient for self-care if this is feasible.
Special precautions for prevention of the spread of infection can vary from strict isolation of the patient and such measures as wearing gloves, mask, or gown to simply using care when handling infective material. No matter what the diagnosis or status of the patient, handwashing before and after each contact is imperative.
Unrecognized or subclinical infections pose a threat because many infectious agents can be transmitted when symptoms are either mild or totally absent.
In the care of patients for whom special precautions have not been assigned, gloves are indicated whenever there is direct contact with blood, wound or lesion drainage, urine, stool, or oral secretions. Gowns are worn over the clothing whenever there is copious drainage and the possibility that one's clothes could become soiled with infective material.
When a definitive diagnosis of an infectious disease has been made and special precautions are ordered, it is imperative that everyone having contact with the patient adhere to the rules. Family members and visitors will need instruction in the proper techniques and the reason they are necessary.
Physiologic support entails bolstering the patient's external and internal defense mechanisms. Integrity of the skin is preserved. Daily bathing is avoided if it dries the skin and predisposes it to irritation and cracking. Gentle washing and thorough drying are necessary in areas where two skin surfaces touch, for example, in the groin and genital area, under heavy breasts, and in the axillae. Lotions and emollients are used not only to keep the skin soft but also to stimulate circulation. Measures are taken to prevent pressure ulcers from prolonged pressure and ischemia. Mouth care is given on a systematic basis to assure a healthy oral mucosa.
The total fluid intake should not be less than 2000 ml every 24 hours. Cellular dehydration can work against adequate transport of nutrients and elimination of wastes. Maintenance of an acid urine is important when urinary tract infections are likely as when the patient is immobilized or has an indwelling urinary catheter. This can be accomplished by administering vitamin C daily. Nutritional needs are met by whatever means necessary, and may require supplemental oral feedings or total parenteral nutrition. The patient will also need adequate rest and freedom from discomfort. This may necessitate teaching her or him relaxation techniques, planning for periods of uninterrupted rest, and proper use of noninvasive comfort measures, as well as judicious use of analgesic drugs.
Having an infectious disease can alter patients' self-image, making them feel self-conscious about the stigma of being infectious or “dirty,” or making them feel guilty about the danger they could pose to others. Social isolation and loneliness are also potential problems for the patient with an infectious disease.
Patients also can become discouraged because some infections tend to recur or to involve other parts of the body if they are not effectively eradicated. It is important that they know about the nature of their illness, the purposes and results of diagnostic tests, and the expected effect of medications and treatments.
Patient education should also include information about the ways in which a particular infection can be transmitted, proper handwashing techniques, approved disinfectants to use at home, methods for handling and disposing of contaminated articles, and any other special precautions that are indicated. If patients are to continue taking antibacterials at home, they are cautioned not to stop taking any prescribed medication even if symptoms abate and they feel better.

Chain of infection.

Stages of infection. Each period varies with different pathogens and different diseases.airborne infection infection by inhalation of organisms suspended in air on water droplets or dust particles.infection control 1. in the nursing interventions classification, a intervention" >nursing intervention defined as minimizing the acquisition and transmission of infectious agents.2. the use of surveillance, investigation, and compilation of statistical data in order to reduce the spread of infection, particularly nosocomial infections.
Practitioners in infection control are often nurses employed by hospitals. They have titles such as Infection Control Officer and Infection Control Nurse, and they function as liaisons between staff nurses, physicians, department heads, the infection control committee, and the local health department. Such practitioners also assume some responsibility for teaching patients and their families, as well as employees of the hospital.
The centers for disease control and prevention is an excellent source of information related to infection control; their web site is http://www.cdc.gov. Another source of help and support for infection control practitioners is the Association for Practitioners in Infection Control and Epidemiology, 1275 K St., NW, Suite 100, Washington, DC 20005-4006.cross infection infection transmitted between patients infected with different pathogenic microorganisms.droplet infection infection due to inhalation of respiratory pathogens suspended on liquid particles exhaled by someone already infected.dustborne infection infection by inhalation of pathogens that have become affixed to particles of dust.endogenous infection that due to reactivation of organisms present in a dormant focus, as occurs, for example, in tuberculosis.exogenous infection that caused by organisms not normally present in the body but which have gained entrance from the environment.mixed infection infection with more than one kind of organism at the same time.nosocomial infection see nosocomial infection.opportunistic infection infection by an organism that does not ordinarily cause disease but becomes pathogenic under certain circumstances, as when the patient is immunocompromised.pyogenic infection infection by pus-producing organisms, most commonly species of Staphylococcus or Streptococcus.risk for infection a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which an individual is at increased risk for being invaded by pathogenic organisms.secondary infection infection by a pathogen following an infection by a pathogen of another kind.subclinical infection infection associated with no detectable symptoms but caused by microorganisms capable of producing easily recognizable diseases, such as poliomyelitis or mumps; this may occur in an early stage of the infection, with signs and symptoms appearing later during the course of the infection, or the symptoms and signs may never appear. It is detected by the production of antibody, or by delayed hypersensitivity exhibited in a skin test reaction to such antigens as tuberculoprotein.terminal infection an acute infection occurring near the end of a disease and often causing death.urinary tract infection see urinary tract infection.vector-borne infection infection caused by microorganisms transmitted from one host to another by a carrier, such as a mosquito, louse, fly, or tick.waterborne infection infection by microorganisms transmitted in water.

infection control

Medtalk A hospital department that identifes infections occurring in the facility, which is also responsible for instituting safeguards to prevent the transmission of infections

in·fec·tion con·trol

(in-fekshŭn kŏn-trōl) Measures taken to avoid spread of infection within a health care facility or larger area (e.g., neighborhood).