Infection Control in Medical Practice
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A 21-year-old college student is found comatose with a fever and purple rash. Considering the immediate infection control steps, what is the FIRST action that should be taken?

  • Immediately initiate droplet and contact precautions. (correct)
  • Administer broad-spectrum antibiotics intravenously.
  • Wait for laboratory confirmation of pathogen before implementing any precautions.
  • Obtain a detailed history from the roommate and then determine the type of precautions.

    • A new Canadian from Somalia via Kenya presents with hemoptysis and a cavitary lesion on chest X-ray. What is the MOST appropriate infection control measure that should be taken?

  • Implement contact precautions, given the patient has a respiratory condition from a less developed country.
  • Initiate standard precautions only, as the patient is new to Canada.
  • Start airborne precautions with negative pressure room until TB is ruled out. (correct)
  • Start droplet precautions and obtain further travel history and wait for lab results before modifying precautions.

    • What is the overarching purpose of Infection Prevention and Control (IP&C) as discussed in the lecture?

  • To minimize pathogen spread among patients and healthcare workers. (correct)
  • To eliminate the need to use Personal Protective Equipment (PPE).
  • To create a sterile environment in all rooms of the hospital.
  • To isolate all patients with infections regardless of severity.

    • Which of the objectives was a focus of this educational lecture?

    <p>To understand appropriate PPE removal sequence, pathogen transmission, and point-of-care risk assessment. (B)</p> Signup and view all the answers

    What was an explicit area of focus for this IP&C lecture?

    <p>The historical context of infection control practices. (B)</p> Signup and view all the answers

    Which of the following best describes the contribution of Ignaz Semmelweis to infection prevention and control?

    <p>He demonstrated that hand hygiene can prevent the spread of puerperal sepsis linked to Group A Streptococcus. (C)</p> Signup and view all the answers

    Which of the following individuals is considered the 'Father' of antiseptic surgery?

    <p>Joseph Lister (D)</p> Signup and view all the answers

    What is the primary focus of 'routine practices' in healthcare settings?

    <p>Controlling the transmission of microorganisms. (A)</p> Signup and view all the answers

    Which of the following is NOT a major component of a modern infection prevention and control (IP&C) program?

    <p>Antimicrobial stewardship. (D)</p> Signup and view all the answers

    Which transmission route is primarily associated with aerosolized particles smaller than 5 microns?

    <p>Airborne transmission (B)</p> Signup and view all the answers

    What concept is central to the application of routine practices in healthcare?

    <p>Treating all blood, body fluids, secretions, and excretions as potentially infectious. (B)</p> Signup and view all the answers

    Which of the following is NOT a key element of routine practices?

    <p>Specific medication administration for common infectious diseases. (B)</p> Signup and view all the answers

    Which of the following is an example of indirect transmission of infection?

    <p>Spread through unsterile equipment. (D)</p> Signup and view all the answers

    Which of the following scenarios would MOST necessitate the use of both soap and water, rather than an alcohol based hand rub, for hand hygiene?

    <p>Caring for a patient with a confirmed <em>Clostridium difficile</em> (C diff) infection. (B)</p> Signup and view all the answers

    According to the provided guidelines, when should a gown be worn as part of personal protective equipment (PPE)?

    <p>If there is a possibility of splashing of body fluids, including blood, onto clothing. (D)</p> Signup and view all the answers

    What is the PRIMARY focus of 'source control elements' in the context of infection prevention?

    <p>To reduce the risk of infection transmission from the patient to others. (D)</p> Signup and view all the answers

    Which of the following options represents the MOST important aspect to consider for hand hygiene?

    <p>Mechanical action, which is as important as the use of antiseptic. (B)</p> Signup and view all the answers

    What is the recommended approach regarding patient flow in a healthcare setting, in the context of preventing infection transmission?

    <p>Patients need to be assessed for infectious risk, with diagnostic testing, and moved to the correct location for their needed procedures with as little movement as possible. (D)</p> Signup and view all the answers

    Besides the use of PPE, what other important element of infection control should be employed when dealing with a patient who may be producing infectious aerosols during a procedure?

    <p>Respiratory hygiene and cough etiquette, to control the source of the aerosolized particles. (C)</p> Signup and view all the answers

    Which of the following should be considered when deciding about the need for additional infection control precautions?

    <p>The patient's current symptoms and the likelihood of transmission from the patient. (D)</p> Signup and view all the answers

    What is the PRIMARY purpose of educating patients and visitors about infection prevention practices?

    <p>To inform them about the importance of measures needed to protect themselves and others. (D)</p> Signup and view all the answers

    Flashcards

    Infection Prevention and Control (IP&C)

    The process of preventing infections from spreading within healthcare settings.

    Hand Hygiene

    The practice of using clean hands before and after caring for patients, to reduce the spread of germs.

    Routine Practices

    A set of universal precautions aimed at preventing transmission of potentially infectious agents by assuming that ALL patients are infectious, ALL the time.

    Transmission of pathogens

    The transfer of pathogens from one person to another.

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    Point of care risk assessment

    Assessing the risk of transmitting infection in a specific clinical situation.

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    Sequence of PPE removal

    The proper order of removing personal protective equipment (PPE) to prevent contamination.

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    PPE (Personal Protective Equipment)

    Protective equipment worn to prevent exposure to infectious agents, including gloves, gowns, and face shields.

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    Source Control Elements

    Infection control measures that focus on the source of infection, such as respiratory hygiene, patient placement, and visitor management.

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    Aseptic Technique

    Practices that reduce the risk of contamination by microbes, including proper hand hygiene, cleaning surfaces, and handling sharps safely.

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    Clean Equipment/Environment

    Maintaining a clean and disinfected environment by cleaning equipment, surfaces, and managing waste and linen.

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    Educate Patients/Visitors

    Educating patients and visitors about infection control measures and their role in preventing the spread of infections. It involves communicating information clearly and addressing their questions.

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    Contact Precautions

    A type of infection control precaution used when dealing with specific infectious agents, such as norovirus and C. difficile, requiring hand hygiene and proper cleaning.

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    Study Notes

    Infection Prevention and Control for Medical Students

    • Course presented by Natalie Bridger, MD FRCPC DTM&H
    • Clinical Chief IP&C
    • Pediatric Infectious Diseases
    • Associate Professor MUN Pediatrics
    • Date: January 27, 2025

    Case 1

    • Patient: 21-year-old college student living in a dormitory
    • Symptoms: Headache, fever, comatose, purple rash on limbs
    • Location of incident: Bathroom floor
    • Discovered by roommate
    • Infection control precautions required: Contact and Droplet precautions (gown, gloves, mask, eye protection)

    Case 2

    • Patient: 30-year-old woman
    • Symptoms: Hemoptysis, respiratory distress, cavitary lesion on CXR
    • Recent travel: Kenya (originally from Somalia)
    • Infection control precautions required: Airborne precautions (N95 mask and negative pressure room)

    IP&C Objective

    • Reduce pathogen transmission between patients, from healthcare workers to patients, and vice versa

    Objectives for this lecture

    • Provide a historical perspective of Infection Prevention and Control (IP&C)
    • Discuss the modes of transmission of various pathogens
    • Review routine practices and point-of-care risk assessment
    • Highlight correct PPE removal sequence
    • Discuss the burden of hospital-acquired infections in Canada

    This is not new!

    • Holmes (USA, 1809-1894): Demonstrated direct transmission of infection by healthcare workers
    • Semmelweiss (Austria, 1818-1865): Demonstrated hand hygiene stops transmission of Group A Streptococcus responsible for puerperal sepsis
    • Nightingale (England, 1820-1910): Used surveillance, data collection and statistics to break the chain of infection
    • Lister (Scotland, 1827-1912): "Father" of antiseptic surgery (carbolic acid)

    Major Components of Modern IP&C Program

    • Hand hygiene
    • Cleaning, disinfection, sterilization of equipment
    • Isolation precautions
    • Occupational health
    • Vaccination
    • Surveillance
    • Outbreak investigation
    • Education
    • Policy development
    • Quality assessment and audit
    • Research

    Team of Linkages

    • Microbiology Lab
    • Antimicrobial Stewardship
    • Public Health/CDC
    • Infection Prevention and Control

    The Chain!

    • Infectious Agent
    • Reservoir
    • Portal of exit
    • Means of transmission
    • Portal of entry
    • Susceptible host

    Mechanisms of Transmission (1-4)

    • Direct (human to human)
    • Indirect (unsterile equipment, unclean environment)
    • Droplet (coughing, sneezing, suctioning procedures)
    • Airborne (aerosolized particles < 5 microns)

    What are Routine Practices?

    • System of IP&C practices to control transmission of microorganisms in healthcare settings
    • Used by all healthcare workers, ALL the time, for ALL patients, in ALL settings
    • All blood, body fluids, secretions, excretions, drainage, tissues are considered potentially infective

    List 5 Key Elements of Routine Practices

    • Hand hygiene
    • PPE control
    • Source control
    • Clean equipment/environment
    • Patient/visitor education

    But how do we know what to do?

    • Point-of-care risk assessment

    1. Hand Hygiene

    • Steps before initial patient/environment contact
    • Steps after body fluid exposure risk
    • Steps before the aseptic procedure
    • Steps after patient/environment contact

    1. Hand Hygiene (2)

    • Use soap and water or alcohol-based hand rub
    • Keep fingernails short
    • Avoid nail enhancements
    • Avoid hand jewelry (including wristwatches)
    • Roll up sleeves
    • Mechanical hand hygiene is as important as antiseptic hand hygiene

    Hand Hygiene Compliance

    • Data on compliance rates for different healthcare professionals (Clinical, Management, Nurse, Physician, Other) for 2019/20, 2020/21, 2021/22, and 2022/23

    2. PPE:

    • Exposure to Blood
    • Exposure to Secretions
    • Exposure to Excretions
    • Exposure to mucous membranes
    • Exposure to non-intact skin
    • Exposure to contaminated objects

    2. PPE (2)

    • Gloves: For potential hand contact
    • Gowns: If splashing of clothing is likely
    • Facial protection: If spraying of eyes, nose, or mouth is likely

    3. Source Control Elements

    • Respiratory hygiene (cough etiquette)
    • Patient placement/accommodation
    • Patient flow/activity
    • Aseptic technique
    • Visitor management
    • Assess need for additional precautions

    4. Clean Equipment/Environment

    • Sharps safety
    • Cleaning of equipment
    • Cleaning of environment
    • Management of waste, linen, and dishes

    5. Educate Patients/Visitors

    • What patients need to know
    • Do they know it?

    Additional Precautions

    • Used in addition to routine practices (RP)
    • Extra measures when RP alone will not interrupt transmission
    • Transmission-based precautions
    • Initiated with syndrome and/or microbiological diagnosis

    Additional Precautions (2)

    • Contact precautions: Gloves and gowns for MRSA, C. difficile, diarrhea, VRE, large wounds, other multidrug-resistant organisms (ie. ESBLs, CROS)

    Additional Precautions (3)

    • Droplet precautions: Mask and eye protection within 1m of patient for Influenza, most respiratory infections, Pertussis, Mycoplasma, Meningococcal disease

    Additional Precautions (4)

    • Airborne precautions: N95 mask, negative pressure room for TB, chickenpox, measles, and SARS-COV2 (though primarily a droplet transmission)

    What is the correct sequence of PPE removal?

    • Gloves first
    • Gown (roll inward)
    • Eyewear
    • Masks (by ties)
    • Hand hygiene

    Are Infections Acquired in Hospital a Big Deal?

    • Yes, hospital-acquired infections (HAIs), also known as "nosocomial" infections, are a significant concern

    What are 'hospital-acquired infections' (HAIs)?

    • No evidence of the infection prior to admission

    Burden of HAI Globally

    • WHO estimates > 1.4 million people affected worldwide
    • 5-15% hospitalized patients (developed countries)
    • 9-37% patients admitted to ICUs (developed countries)
    • Europe mortality 1% (50,000 deaths) annually
    • USA 2002 incidence rate 4.5%, contributing to 2.7% mortality (135,000 deaths)
    • 1.7 million affected, 99,000 deaths from HAIs in USA in 2004, $6.5 billion cost in 2004

    Burden of HAI in Canada

    • 1 in 9 patients admitted will get a HAI
    • 8,000-12,000 Canadians die from HAIs annually
    • Additional $12,000-35,000 per patient due to HAIs
    • IP&C strategies prevent HAIs and therefore reduce costs substantially
    • MRSA costs $41.7 - $58.7 million (1998 dollars)

    HAI Syndromes

    • Urinary tract infection
    • Surgical site infection
    • Pneumonia
    • Bloodstream infection
    • Gastroenteritis
    • Skin/soft tissue infections (e.g., pressure ulcers)
    • Sinusitis
    • Endometritis (following childbirth)

    The Main Players

    • MRSA (and MSSA)
    • C. difficile
    • VRE
    • ESBLs
    • Carbapenemase producing Enterobacterales
    • Coagulase negative Staphylococci, E. coli
    • Many viruses
    • Some parasites and fungi

    Risk Factors for HAIs

    • Infectious agent (increased virulence, capacity to survive, antimicrobial resistance)
    • Host (advanced age, low birthweight, immune suppression, debilitation, malnutrition)
    • Environment (ICU admission, prolonged hospitalization, invasive devices and procedures, antimicrobial therapy)

    Percutaneous Vascular Device Infections

    • During manufacture (hairline cracks or punctures)
    • Bottle-tubing junction
    • Medication port
    • Secondary infection from other side
    • Additives, Stopcock, Insertion site

    How to prevent CVC-BSI?

    • Antiseptic insertion
    • Limit duration
    • Closed system
    • Removal if infection suspected
    • Limit frequency of dressing changes
    • Antibiotic catheter for short term

    Catheter Associated UTI

    • Portals of entry (urethral meatus, catheter, drainage tubing, drainage bag outlet)

    How to Prevent CA-UTI?

    • Foley catheter insertion and use (address concerns)

    How to prevent HAP/VAP?

    • Aseptic intubation and suctioning
    • Limit duration
    • Non-invasive ventilation
    • Staff influenza vaccination
    • Sterile water for oxygen and aerosol Tx
    • Prevention of Aspergillus and Legionella during renovations
    • Head of bed elevated
    • Sedation holidays (reduce sedation)

    How to prevent SSI?

    • Clean operating environment
    • Surgical technique
    • Staff attire
    • Limit preoperative stay
    • Preoperative shower and skin prep (prophylaxis)
    • Optimal timing and choice of antibiotic prophylaxis
    • Aseptic procedure in OR
    • Surgical wound surveillance

    Does Antimicrobial Use Affect IP&C?

    • Antimicrobial use in Canada
    • Antimicrobial use in Europe

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    Infection Prevention - Jan 27 PDF

    Description

    This quiz focuses on infection prevention and control strategies relevant for medical students. It covers critical scenarios involving infectious diseases, precautions needed, and the importance of historical perspectives in infection control. Test your knowledge on managing patient care effectively while minimizing pathogen transmission.

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