By

Arifa Khatoon
Infection Control & Prevention Rn,rm,bscn,dpon,msn*
Program Manager Infection Control &
Prevention
Dhipc Organizer
INTRODUCTION:
Infection prevention and control (IPC) is a quality standard, essential
for the well-being and safety of patients, staff, and visitors. Provision
of an effective IPC program is a key to quality and a reflection of the
overall standard of care provided by a health care institution. Each
institution is unique and its specific needs must be considered when
developing or reorganising an IPC program. Because of these
differing needs, various groups, individuals, and functions within the
organisation may be responsible for the IPC program.
 NATIONAL PROGRAM
The responsible National Health Authority should develop a national program to
support healthcare facilities in reducing the risk of healthcare-associated infections
(HAI). Such programs must:
Set relevant objectives consistent with other national health care objectives.
Develop and continually update guidelines for health care surveillance, prevention,
and practice.
Develop a national system to monitor selected infections and assess the effectiveness
of interventions.
Harmonise initial and continuing training programs for health care professionals.
Facilitate access to products essential for hygiene and safety.
Encourage health care establishments to monitor HAIs, with feedback to the
professionals concerned. The National Health Authority should designate an agency to
oversee the program (a ministerial department, institution, or other body) and plan
national activities with the help of an expert committee. Professionals and academic
organisations must be involved.
 HEALTH CARE
PROGRAMS
The major preventive effort related to HAIs should be focused on hospitals and
other health care facilities. Risk prevention for patients and staff is a concern
of every-one in the facility and must be supported by the senior administration.
A yearly work plan to assess and promote good health care, appropriate
isolation precautions, sterilization and other practices, staff training, and
epidemiological surveillance should be developed.
The manager or medical director is ultimately responsible for safety and
quality. He or she must ensure that appropriate arrangements are in place for
effective IPC practices and that there is an Infection Control Committee (ICC)
and an Infection Control Team (ICT).
If the health care setting is too small for such an organization, experts in IPC
should be available for consultation at regular intervals and in an acute
situation. Providers of home care should also ensure that expertise in IPC is
available for their staff.
INFECTION CONTROL
COMMITTEE
An ICC provides a forum for multidisciplinary input, cooperation,
and information sharing. The ICC is responsible for the planning,
implementation, prioritization, and resource allocation of all matters
relating to IPC. The ICC must report directly to either administration
or the medical staff to promote program visibility and effectiveness.
The committee should act as a liaison between departments
responsible for patient care and support services (e.g., pharmacy,
maintenance).
The ICC membership should reflect the spectrum of clinical services and
administrative arrangements. It should include:
 Chief Executive/Administrator or his/her nominated representative.
Infection Control Doctor/Microbiologist who may act as a chairperson.
This person may also be called an Infection Control Officer (ICO).
 Infection Control Nurse (ICN).
 Infectious Disease Physician (if available).
 Director of Nursing or his/her representative.
 Occupational Health Physician (if available).
 Representatives from the major clinical specialties.
 Representatives of other departments may be invited as necessary
(e.g., pharmacy, central supply, maintenance, housekeeping, and training
services).
The committee should hold regular meetings with minutes containing
assigned and completed dates for action items determined by the
ICC. Minutes should be sent to the Medical Director and the
facility’s Management Board as well as to departments directly
involved in the subjects discussed during the meeting. It should
produce an annual report and an annual business plan for IPC.
The ICC has the following tasks:
 To review and approve the annual plan for IPC.
 To review and approve IPC policies.
 To support the ICT and direct resources to address problems as identified.
To ensure availability of appropriate supplies needed for IPC.
 To review epidemiological surveillance data and identify areas for intervention.
To assess and promote improved practice at all levels of the facility.
To ensure staff training in IPC and safety.
To review infectious risks associated with new technologies and monitor risks of new
devices and products, prior to their approval for use.
To review and provide input into the process of conducting an outbreak investigation.
To review and approve construction/renovation projects regarding infection prevention.
 To communicate and cooperate with other committees with common interests, such as
Antibiotic Committee, Occupational Health Committee, etc.
 INFECTION CONTROL
TEAM
The ICT should have a range of expertise covering IPC, medical microbiology,
infectious diseases, and nursing procedures.
The team should have a close liaison with the microbiology laboratory and, ideally,
a microbiologist should be a member.
The team should consist of at least one physician, the ICO, and at least one nurse,
the ICN.
The ICT is responsible for the day-to-day running of IPC programs. All healthcare
organisations should have an ICT.
If this is not practical, arrangements for IPC services should be made with a nearby
hospital. The optimal structure will vary with the type, needs, and resources of the
facility.
The ICT must have appropriate authority; in large facilities, this usually means a
direct reporting relationship with senior administration. The ICT must ensure that an
effective IPC program has been planned, coordinate its implementation, and
evaluate its impact. Twenty-four hour access to the ICT for advice (both medical and
nursing) on IPC is essential.
The team should meet regularly (several times a week or, preferably, daily) to
discuss relevant issues.
A standing agenda may include updates on surveillance, observations of IPC
practice, policy review, revision of education and training, and follow-up of
identified problems. Minutes should be prepared for all meetings. Any
regulations, rules, or recommendations should be widely distributed
throughout the facility. Feedback from the ward staff should be encouraged
The role of the ICT can be summarised as follows:
To develop an annual IPC plan with clearly defined objectives.
 To develop written policies and procedures, includ-ing regular
evaluation and updates.
 To prepare an action plan for implementation of the IPC program with
approval from the ICC.
 To monitor and evaluate daily practices of patient care designed to
prevent infection.
 To identify problems in the implementation of IPC activities which need
to be solved or addressed by the ICC.
 To organise epidemiological surveillance for HAIs (particularly in high-
risk areas to detect outbreaks early).
To investigate outbreaks and provide data (and expert advice) that should
be evaluated to allow for any change in practice or allocation of resources.
 To educate all grades of staff in IPC policy, practice, and procedures
relevant to their own areas.

To provide advice to all grades of staff on all aspects of IPC on a
day-to-day basis.
 To develop an annual training plan for healthcare workers and
implement IPC training activities.
 To ensure availability of supplies and equipment needed for IPC.
 To have a scientific and technical support role in purchasing and
monitoring of equipment and supplies, and in evaluation and
checking the efficacy of sterilisation and disinfection measures.
To collaborate with the pharmacy and antibiotic committees in
developing a program for supervising antibiotic use.
 To support and participate in research and assessment programs.
To participate in audit activities.
 To obtain program approval from the ICC.
 To submit monthly reports on activities to the ICC.
INFECTION CONTROL OFFICER:
DUTIES AND RESPONSIBILITIES
The ICO should be a medically qualified senior staff member who is
interested in and who spends most of his/her time involved in IPC.
The ICO could be a medical microbiologist, an epidemiologist, or an
infectious diseases physician. If none of these individuals are
available, then a surgeon, a pediatrician, or another appropriate
physician with a special interest in the field should be appointed.
Irrespective of professional background, the ICO should have
interest, knowledge, and experience in different aspects of IPC.
The role and responsibilities of the ICO are summarized as follows:
 Serves as a specialist advisor and takes a leading role in the
effective functioning of the ICT.
 Should be an active member of the ICC and may act as its Chair.
Assists the ICC in reviewing annual plans, policies, and long-term
programs for the prevention and control of infection.
Advises the Chief Executive/Administrator directly on all aspects of
IPC and on the implementation of policies and procedures.
Participates in the preparation of procedural documents for support
services and advises on IPC aspects.
Must be involved in setting quality standards, surveillance, and
audit with regard to infection prevention
INFECTION CONTROL NURSE:
DUTIES AND RESPONSIBILITIES
An ICN is a registered nurse with an academic education.
The ICN is usually the only full-time practitioner, key role in day-to-day IPC activities, with
the ICO providing the leading role.
Some countries may have non-nurses functioning in this role. They may be called Infection
Control Practitioners or Infection Perfectionists.
One ICN for 250 acute beds on a full-time basis was recommended in the United States
during the 1980s. However, since then, the expansion in job responsibilities necessitates that
staffing requirements reflect the scope of the program, rather than bed size.
The role and responsibilities of the ICN are summarized as follows:
1. Contributes to the development and implementation of policies and procedures, participates
in audits, and monitors activities related to IPC and infectious diseases.
2. Provides specialist input in the identification, prevention, monitoring, and control of
infection.
3. Participates in surveillance and outbreak investigation activities.
4. Identifies, investigates, and monitors infections, hazardous practices, and procedures. 5.
Participates in preparing documents relating to service specifications and quality standards.
6. Participates in training and educational programs and in membership on relevant
committees where IPC input is required.
INFECTION CONTROL
LINK NURSE:
An effective way to develop IPC education and operational support
can be through a link system. In a large facility the ICN can train link
nurses; these individuals have special responsibility for maintaining
good IPC practices and education within their departments. The
Infection Control Link Nurse (ICLN) is the “link” between the ICN
and the ward and helps identify problems, implement solutions, and
maintain communications.
A competent ICLN can motivate ward staff by enabling more
effective practice. Sustained, consistent senior management backing
and interest are effective in supporting such link programs and
essential in ensuring their success.
INFECTION CONTROL
MANUAL
A HAI manual, containing recommended instructions and practices for patient care, is
an important tool.
The manual should be developed and updated by the ICT, with review and approval by
the ICC. It must be made readily available for patient care staff and updated regularly.
Topics of importance for a procedure manual include:
Patient care
Hand hygiene
 Isolation precautions practices
 Invasive procedures (intravascular and urinary catheterisation, mechanical
ventilation, tracheostomy care, and wound management)
Oral alimentation Area specific procedures
Isolation precautions procedures for infectious patients
Surgical and operating theatre techniques
Obstetrical, neonatal, and intensive care techniques Processing of items of critical
importance
 Cleaning, sterilisation, and disinfection
Minimal Requirements The IPC program must include:
A physician and a nurse with responsibilities for IPC.
A manual of dated critical IPC policies with valid citations of
evidence for these policies.
An educational program for staff.
 Importance of infection control

HAI’s rises the cost of health care

studies have shown that 2/3 of developing countries
spend more than 50% of their health care budgets on
hospitals

Effective IC programs are beneficial

They decrease spread of nosocomial infections,
morbidity, mortality, and health care costs
Anti Microbial Resistance

Poor or absent IC practices, especially in intensive care units,

results in cross-transmission of antibiotic-resistant bacteria.

Resistant bacteria prompts even greater antibiotic use by

physicians.

Perception of knowledge by physicians of poor sterilization,

disinfection, or patient care practices prompts increased
antibiotic use (e.g., broad spectrum and prolonged surgical
prophylaxis in an effort to prevent infections).
Epidemiology of Nosocomial Infections

Most common sites for nosocomial infections

SSI’s (Surgical site infections)
UTI’s (CAUTI catheter associated Urinary tract infection)
Lower respiratory tract
BSI (Blood Stream Infection i.e., catheter-related)
Epidemiology of Nosocomial Infections:

Common microorganisms
Aerobic gram-positive cocci
 (Staphylococcus aureaus [MRSA],
Enterococci
 (vancomycin-resistant)
Aerobic gram-negative bacilli
(Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiella pneumoniae)
Epidemiology of Nosocomial Infections:

Nosocomial transmission of community

acquired, multidrug-resistant organisms
Mycobacterium tuberculosis
Salmonella spp.
Shigella spp.
Vibrio cholera
Root Causes of Nosocomial Infections:

Lack of training in basic IC

Lack of an IC infrastructure and poor IC practices
(procedures)
Inadequate facilities and techniques for hand hygiene
Lack of isolation precautions and procedures
Root Causes of Nosocomial Infections:
Use of advanced and complex treatments without adequate
training and supporting infrastructure, including

Invasive devices and procedures

Complex surgical procedures
Interventional obstetric practices
Intravenous catheters, fluids, and medications
Urinary catheters
Mechanical ventilators
Inadequate sterilization and disinfection practices and
inadequate cleaning of hospital
USE FULL LINKS:
www.cdc.gov
www.who.int
www.shea-online.org
www.apic.org
www.parn.org.pk
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