Infection Control

Host
Host infection dependent upon:
Virulence of the organism

Resistance of the host

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Host
Increased susceptibility:
Diabetes mellitus Lymphoma Leukemia Neoplasia Those treated with:
Corticosteroids, irradiation, certain antimicrobials, immunosuppressive agents

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Host
Increased susceptibility:
Age Chronic disease Shock Coma Traumatic injury Surgical procedure

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Host
Most nosocomial pneumonias occur in surgical patients, especially those who have had chest or abdomen procedures

Clearance mechanisms impaired

Bacterial enters lower airway

Intubation Anesthesia Surgical pain Narcotics and sedatives

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Host
Surgical Patients with Highest Risk of Pneumonia
Elderly Severely obese COPD History of smoking Those with artificial airways
Endotracheal / Tracheostomy tubes

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Infection Control Strategies

Infection control aims to break the chain of events causing the spread of infection

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Infection Control Strategies
1. Decrease host susceptibility 2. Eliminate the source of pathogens 3. Interrupt the transmission routes

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Decrease host susceptibility

Hospital efforts focus on employee immunization and chemoprophylaxis

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Decrease host susceptibility
Immunizations
Hepatitis B Varicella (chicken pox) Rubella (German measles) Measles Pertussis (Whooping cough)
When working with infants and children

Influenza

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Decrease host susceptibility
Chemoprophylaxis
Postexposure Treatment
Bordetella pertussis (whooping cough) Neisseria meningitis (meningococcal meningitis) Bacillus anthracis (anthrax) Influenza virus HIV Group A streptococci

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Eliminating Source of Pathogens
Procedure to remove pathogens from the environment fall into two major categories General Sanitation Specialized Equipment Processing

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Eliminating Source of Pathogens
General Sanitation Help keep overall environment clean
Sanitary laundry management Sanitary food preparation Sanitary housekeeping Environmental control of the air Specialized ventilation systems Environmental control of the water

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Eliminating Source of Pathogens
Specialized equipment handling Decontamination of equipment capable of spreading infection
Cleaning Disinfection Sterilization

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Specialized Equipment Handling

Cleaning Removes dirt and organic material from equipment, usually by washing
Failure to do this will render subsequent processing ineffective !!! Should be done in a designated Dirty area

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Specialized Equipment Handling
Cleaning
Soaps, detergents, or enzymatic cleaners should be used
Some contain germicide Automated washers available (pasteurization / chemical disinfection cycle)

Must be rinsed and dried Reassembled aseptically

Designated Clean area

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Specialized Equipment Handling

Disinfection
Destroys the vegetative form of pathogens on inanimate objects except bacterial spores
Physical methods Chemical methods

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Specialized Equipment Handling
Physical Disinfection
Pasteurization
Submersion in a water bath at temperatures below boiling (70 C) for 30 minutes Kills vegetative bacteria and most viruses Does not kill bacteria spores

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Specialized Equipment Handling
Chemical Disinfection
Low-Level Intermediate High-Level

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Specialized Equipment Handling

Low-Level Disinfectants
Kills most bacterial, some viruses and fungi Will not kill Mycobacterium tuberculosis (TB) spores and nonlipid virus

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Specialized Equipment Handling
Low-Level Disinfectants
Acetic acid
Mostly used for homecare equipment (1:3 white vinegar/water solution ) Hospital use surface disinfection, e.g., floors, countertops, walls, etc.

Quaternary ammoniums

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Specialized Equipment Handling

Intermediate Disinfectants
Kills all vegetative bacteria and fungi, but have variable activity against spores and certain viruses

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Specialized Equipment Handling
Intermediate Disinfectants
Alcohol (70% Ethyl, 90% Isopropyl)

Not sporicidal Surface disinfectant, e.g., stethoscopes, ventilators, etc.

Not sporicidal Surface disinfectant (added to detergents to enhance germicidal activity)

Phenolics

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Specialized Equipment Handling

Intermediate Disinfectants
Iodophors (iodine + surace-active organic compounds)
Used on skin and tissue

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Specialized Equipment Handling
High-Level Disinfectants
Glutaraldehyde Hydrogen peroxide Peracetic acid Chlorine (sodium hypochlorite)

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Specialized Equipment Handling
High-Level Disinfectants
Glutaraldehyde (Trade name: CIDEX)
Kills vegetative bacteria, Mycobacterium turburculosis, fungi, viruses and spores in <10 minutes
Commonly used to disinfect/sterilize endoscopes, e.g., fiber optic bronchoscopes, respiratory care equipment, and spirometry tubing

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Specialized Equipment Handling

High-Level Disinfectants
Hydrogen Peroxide
6% solution is bactericidal, fungicidal, viricidal in 10 minutes, Sterilizes (sporicidal) in 6 hours Does not produce harsh fumes

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Specialized Equipment Handling

High-Level Disinfectants
Peracetic acid
Kills all microorganisms, including spores

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Specialized Equipment Handling

High-Level Disinfectants
Sodium Hypochlorite
1:50 dilution kills vegetative bacteria, bacterial spores, and Mycobacterium tuberculosis in 10 minutes 1:10 dilution used to clean blood spills

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Specialized Equipment Handling

Sterilization
Complete destruction of all forms of microbial life

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Specialized Equipment Handling
Sterilization
Incineration Dry heat Boiling Autoclaving Ionizing radiation Ethylene oxide

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Specialized Equipment Handling

Steam Sterilization (Autoclaving)

Steam under pressure

Commonly 15 psi at 121 C for 15 minutes Equipment must be cleaned and wrapped in muslin, linen, or paper Most respiratory equipment can be damaged by this process

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Specialized Equipment Handling
Ethylene Oxide (EtO)
Toxic gas Equipment must be cleaned and wrapped in muslin, paper, or polyethylene using EtO indicator tape Acute exposure may cause:
Airway inflammation Nausea Diarrhea Headache Dizziness Convulsion

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Specialized Equipment Handling

Equipment Handling Procedure

Equipment handling procedures help prevent the spread of pathogens Will be covered in Lab