PREVENTION AND

CONTROL OF
INFECTIONS
(PCI)
Dr. Clyde C. Gatpandan
How infection works
There is a close connection between microbes and humans. Experts believe
about half of all human DNA originated from viruses that infected and
embedded their nucleic acid in our ancestors’ egg and sperm cells.
Microbes occupy all of our body surfaces, including the skin, gut, and mucous
membranes. In fact, our bodies contain at least 10 times more bacterial cells than
human ones, blurring the line between where microbes end and humans begin.
Microbes in the human gastrointestinal tract alone comprise at least 10 trillion
organisms, representing more than 1,000 species, which are thought to prevent the
gut from being colonized by disease-causing organisms. Among their other beneficial
roles, microbes synthesize vitamins, break down food into absorbable nutrients, and
stimulate our immune systems.
The vast majority of microbes establish themselves as persistent “colonists,” thriving
in complex communities within and on our bodies. In many cases, the microbes
derive benefits without harming us; in other cases, both host and microbe benefit.
10/10/2021
Objectives
• At the end of the lecture, participants would be
able to:
▫ Understand the importance of Infection
Prevention and Control
▫ Demonstrate the proper way of Hand Hygiene
▫ Relate the 5 moments of Hand Hygiene and the
use of PPE in their usual practice
▫ Apply proper waste disposal and segregation.
HOW DO WE PREVENT AND
CONTROL INFECTIONS?
Know thy enemy…
 Chain of Infection
Sufficient numbers w/ high virulence

Immunocompromised

Conducive
for growth

Portal of exit
Easily accessible
from reservoir
portal

How pathogenic
microorganisms
are transferred
 PATHOGENIC MICROORGANISMS

BACTERIA VIRUSES

FUNGI PROTOZOA HELMINTH

 THE
HOSPITAL
GANG!
ESCHERICHIA COLI PSEUDOMONAS KLEBSIELLA

STAPHYLOCOCCUS
STREPTOCOCCUS PROTEUS AUREUS
 RESERVOIR
• Reservoir
▫ Animate
 Humans, Animals

▫ Inanimate
 Soil
 Water
 Feces
 IVF
 Equipment
 MEANS OF ENTRY/ MEANS OF ESCAPE

▫ Upper respiratory tract

▫ Gastrointestinal tract
▫ Urogenital tract
▫ Blood
▫ Broken skin
▫ Mucous membrane
 MEANS OF ENTRY/MEANS OF ESCAPE

Upper Respiratory Gastrointestinal

Tract Tract

Urogenital Mucous
Tract Blood Vessels Broken Skin membrane
MEANS OF ENTRY/MEANS OF ESCAPE
 MODE OF TRANSMISSION
• Mode of Transmission
▫ Airborne/Droplet
▫ Parenteral
▫ Contact
▫ Fecal-Oral
▫ Vector
MODE OF TRANSMISSION
 HOST SUSCEPTIBILITY
• Host Susceptibility
▫ Any person:
 Patient
 Health worker
 Visitor
▫ Life style
▫ Immunity
▫ Nutrition
▫ Age
▫ Underlying chronic illnesses
 HOST SUSCEPTIBILITY

• Host Susceptibility
▫ People who are in the hospital or receiving
healthcare elsewhere have an increased
vulnerability to infection.
▫ Reasons:
 Reduced immunity
 Invasive devices and procedures
 Closer proximity to other people with infectious
conditions.
Chain of Infection
 Proven Effective Infection Control Strategies
DISINFECTION & EDUCATION
STERILIZATION INFECTION
CONTROL POLICIES
HAND HYGIENE

SURVEILLANCE BUNDLES OF CARE

❑ CAUTI, VAP, CRBSI INFECTIONS
❑ MDRO ISOLATION
❑SSI PRECAUTIONS

NEEDLE STICK OUTBREAK

INJURIES CONTROL/MANAGEMENT

ANTIBIOTICS CONSTRUCTION /
RENOVATION
ENVIRONMENT OF
RESEARCH CARE
How do we participate in Infection
Prevention and Control?
• Standard Precaution
• Transmission-Based Precaution
• Reporting of notifiable diseases
Infection Prevention Control Policies

Policy III:

ALL PATIENT, STAFF, AND VISITOR

AREAS OF THE HOSPITAL ARE INCLUDED
IN THE INFECTION PREVENTION AND
CONTROL PROGRAM.
Infection Prevention and Control Policies

Intent:

Identify and reduce risks of acquiring and

transmitting infections among patients, staff,
health care professionals, contract workers,
volunteers, students and visitors.
Infection Prevention and Control
Policies

• Nurses shall observe STANDARD

PRECAUTION at all times.
Infection Prevention and Control Policies

Nurses shall strictly implement Infection

Prevention and Control Procedures in all
patient care areas, special areas and ancillary
services as indicated in the Infection Control
Manual.
Standard Precautions
• Minimum infection
prevention measures that
apply to all patient care,
regardless of suspected or confirmed infection
status
• The phrase is sometimes used interchangeably
with “Universal Precautions.”
Standard Precautions
• Hand Hygiene
• Personal Protective Equipment
• Respiratory Hygiene and Cough Etiquette
• Safe Injection Practices
• Suitably clean environment with adequately
decontaminated equipment
• Safe management of used linen
Guilty Hands…
Nurse Jackie was assessing the of Patient A
who had a (+) MRSA in the blood culture,
when suddenly she was asked to assist in
the change of dressing for Patient’s B’s
minor wound on the arm.
After 5 days, Patient B started having fever
and purulent discharges from her wound.
Wound culture was done and revealed a (+)
MRSA.
Guilty Hands…
BACTERIAL FLORA ON HANDS
RESIDENT FLORA TRANSIENT FLORA
• Normal flora • Not part of normal flora
• Found in skin surface •Acquired through contact with
objects and surroundings

• Rarely cause infection, • Commonly associated with

however may cause infection if HCAI
break in skin occurs.

• Difficult to remove with • Survives for a limited time

single hand hygiene and can be easily removed
by hand hygiene.
HAND HYGIENE
• A general term referring to any action of hand
cleansing.
• Hand hygiene substantially reduces potential
pathogens on the hands
• A primary measure for reducing the risk of
transmitting organisms to patients and health
care personnel
Hand Hygiene

The Global Response to HCAI

• Recognizing this worldwide crisis, WHO

established the campaign “SAVE LIVES:
Clean Your Hands” to address the high HCAI
rates globally.
Hand Hygiene

The Global Response to HCAI

• The primary focus of this campaign is on

improving hand hygiene compliance in all types
of healthcare facilities worldwide.
Infection Prevention and Control Policies

Nurses shall comply with the WHO Guidelines

in Hand Hygiene in Health Care.
HAND HYGIENE
• Two options for hand hygiene: Hand wash and
Hand Rub.
Hand wash vs. Hand rub
HAND WASH HAND RUB
• Uses water and soap • Uses an alcohol-based
disinfectant
• When hands are visibly soiled • When hands are visibly clean.
(After using gloves or after going
to the bathroom)
• When the sink is not accessible

Alcohol-based hand sanitizers can be used “in addition to”

hand washing, but should not be used as a substitute for
washing with soap and water.
Are you sure your hands are clean?
Now that you
know the steps,
when shall you
do it?
HAND HYGIENE
Before patient contact
Before clean/aseptic technique
After body fluid exposure risk
After touching a patient
After contact with patient’s surroundings
Standard Precautions
✓Hand Hygiene
• Personal Protective Equipment
• Respiratory Hygiene and Cough Etiquette
• Safe Injection Practices
• Suitably clean environment with adequately
decontaminated equipment
• Safe management of used linen
Infection Prevention and Control Policies

Nurses shall properly wear Personal Protective

Equipment (PPE) when attending to patients
with infectious cases and there is anticipated
blood/ body fluid contact.
Personal Protective Equipment
• “specialized clothing or equipment worn by an
employee for protection against infectious
materials” (OSHA/ Occupational Safety and
Health Administration)
• PROTECTION- for who?
• Protect mucous membrane and clothing
Type of PPE used in Healthcare Setting

• Gloves – protect the hands

• Gowns/Aprons – protect the skin and clothing
• Goggles – protect the eyes
• Face Shields – protect the entire face
• Masks/Respirators – protect the mouth and
nose
Factors Influencing PPE Selection

• Type of exposure anticipated

▫ Splash/spray versus touch
▫ Category of isolation precautions
• Durability and appropriateness for the task
• Fit
Contaminated and Clean Areas of PPE

• Contaminated – outside front

• Clean – inside, outside back, ties on head
and back
How to Safely Use PPE

• Keep gloved hands away from face

• Avoid touching or adjusting other PPE
• Remove gloves if they become torn; perform
hand hygiene before donning a new gloves
• Limit surfaces and items touched
Infection Prevention and Control Policies

IMU- Substerile; Standard Precautions

OR/DR/RR/NICU/Cath Lab- Sterile Areas
Infection Prevention and Control Policies

Nurses shall ensure that Personal Protective

Equipment (PPE) such as masks and gloves are
single use only. Nurses shall dispose used PPE
in the hazardous (yellow) trash bag.
Standard Precautions
✓Hand Hygiene
✓Personal Protective Equipment
• Respiratory Hygiene and Cough Etiquette
• Safe Injection Practices
• Suitably clean environment with adequately
decontaminated equipment
• Safe management of used linen
Prevention and Control of Infections
Prevention and Control of Infections

• WHO Five Moments of Hand Hygiene

▫ Before touching a patient
▫ Before clean/aseptic task or procedure
▫ After body fluid exposure risk
▫ After patient contact
▫ After touching patient’s surroundings
Prevention and Control of Infections

3. Nurses shall properly wear Personal Protective

Equipment (PPE) when attending to patients
with infectious cases and there is anticipated
blood/ body fluid contact.
Types of PPE used in Healthcare Setting

• Gloves – protect the hands

• Gowns/Aprons – protect the skin and clothing
• Goggles – protect the eyes
• Face Shields – protect the entire face
• Masks/Respirators – protect the mouth and
nose
Factors Influencing PPE Selection

• Type of exposure anticipated

▫ Splash/spray versus touch
▫ Category of isolation precautions
• Durability and appropriateness for the task
• Fit
Contaminated and Clean Areas of PPE

• Contaminated – outside front

➢Areas of PPE that have or are likely to have
been in contact with body sites, materials, or
environmental surfaces where the infectious
organism may reside
• Clean – inside, outside back, ties on head
and back
➢Areas of PPE that are not likely to have been
in contact with the infectious organism
How to Safely Use PPE

• Keep gloved hands away from face

• Avoid touching or adjusting other PPE
• Remove gloves if they become torn; perform
hand hygiene before donning a new gloves
• Limit surfaces and items touched
Correct Sequence for Donning PPE

• Gown
• Mask
• Eye Protection/Face Shield
• Gloves
Correct Sequence for Doffing PPE

• Gloves
• Eye Protection / Face Shield
• Gown
• Mask
Prevention and Control of Infections

4. Nurses at high risks areas such as:

Intensive Management Unit (IMU),
Neonatal Intensive Care Unit (NICU) and
Surgical Complex Unit (OR-DR-RR) shall wear
disposable caps & surgical masks and shall
observe hand hygiene.
Prevention and Control of Infections

5. Nurses shall notify the ICN/immediate nurse

manager for cases of communicable diseases
that are of Public Health Importance.
This is in compliance with Republic Act No.
3573 (Law of Reporting of Communicable
Diseases).
This is an Act providing for the prevention and
suppression of dangerous communicable
diseases.
List of Notifiable Diseases/Syndromes
IMMEDIATELY WEEKLY NOTIFIABLE
NOTIFIABLE • Acute Bloody Diarrhea
• Acute Flaccid Paralysis • Acute Encephalitis Syndrome
• Adverse Event Following • Acute Hemorrhagic Fever
Immunization • Acute Viral Hepatitis
• Anthrax • Bacterial Meningitis
• Human Avian Influenza • Cholera
• Measles • Dengue
• Meningococcal Disease • Diphtheria
• Neonatal Tetanus • Leptospirosis
• Paralytic Shellfish Poisoning • Malaria
• Rabies • Non-neonatal Tetanus
• SARS • Pertussis
• MERS-CoV • Typhoid Fever
Prevention and Control of Infections

6. Nurses shall observe STANDARD

PRECAUTION at all times.
Standard Precautions

• Represent the minimum infection prevention

measures that apply to all patient care,
regardless of suspected or confirmed infection
status of the patient, in any setting where
healthcare is delivered.
• The phrase is sometimes used interchangeably
with “Universal Precautions.”
Standard Precautions
• Standard Precautions include:
▫ Hand Hygiene
▫ The correct use of personal protective equipment
(PPE) for contact with all blood, body fluids, secretions
and excretions (except sweat)
▫ Respiratory Hygiene and Cough Etiquette
▫ Safe Injection Practices
▫ Providing care in a suitably clean environment with
adequately decontaminated equipment
▫ Safe management of used linen
▫ Safe disposal of waste
Standard Precautions
• Respiratory Hygiene and Cough Etiquette:
▫ Cover your mouth and nose with a tissue when
coughing or sneezing
▫ Dispose the used tissue in the nearest waste
receptacle.
▫ Perform hand hygiene after having contact with
respiratory secretions and contaminated
objects/materials.
Standard Precautions

• Safe Management of Infectious Linen

▫ Handle with gloves
▫ Only linen visibly contaminated with blood and/or
body fluids should be viewed as potentially
infectious.
▫ Should be segregated at point of use
▫ Place in fluid-proof bags with appropriate
biohazard label (use of color-coding)
Prevention and Control of Infections

7. Nurses shall carry out isolation procedures/

precaution and attach appropriate labels to
patient’s door and chart.
What is Isolation?

• Isolation is the practice of nursing a patient in a

single-occupancy room to reduce the risk of
spread of pathogens and to reinforce and
facilitate additional infection control
precautions.
▫ Source Isolation (Transmission-Based)
▫ Protective Isolation
Transmission-Based Precautions

• Intended to supplement Standard Precautions in

patients with known or suspected colonization
or infection of highly transmissible or
epidemiologically important pathogens.
❖Airborne Precaution
❖Droplet Precaution
❖Contact Precaution
 Airborne Precaution

❑ Standard Precaution
❑ Measles, Varicella,
PTB (SARS, AVIAN flu)
❑ Respiratory droplet
nuclei (<5 micrometers)
❑ Fitted respirator (N95
mask)
❑ Negative pressure
room
 Droplet Precaution

❑ Standard precaution
❑ Pneumonia, Diphtheria,
Pertussis, AH1N1,
Meningococcemia
❑ Large respiratory droplet
(>5 micrometers)
❑ Regular mask
❑ 3 feet apart
❑ Cough Etiquette
❑ Private room or cohorting
 Contact Precaution

❑ Standard precaution
❑ MDROs (MRSA, ESBL, VRE)
❑ Scabies, Poliomyelitis,
Decubitus Ulcer, Congenital
Rubella
❑ Use gown/apron and gloves for
any procedure involving
contact with patient or their
immediate environment
❑ Private room or cohorting
 Reverse Isolation or ❑For immunocompromised
Protective Environment patients; certain
procedures such as BMT,
Stem Cell Transplant
❑Organ transplant – observe
standard precaution only
unless otherwise ordered
by MD
❑Use of Personal Protective
Equipment (PPE) depends
on the severity of the
immunocompromised
status of patient
❑PPE maybe as simple as
mask only; mask and gown;
head to toe PPE; even
sterilized PPE
Prevention and Control of Infections

8. Nurses shall educate the patient/family on the

following: visitor control, purpose and techniques
of isolation to be used, and hand hygiene.
Prevention and Control of Infections

9. Nurses shall ensure that Personal Protective

Equipment (PPE) such as masks and gloves are
single use only. Nurses shall dispose used PPE
in the hazardous (yellow) trash bag.
Prevention and Control of Infections

1. All wastes generated by the hospital shall be

segregated and disposed properly as joint
DENR-DOH Administrative Order No. 02.
Biodegradable, non-biodegradable and
infectious wastes shall be placed in green, black
and yellow trash bags respectively
Prevention and Control of Infections

2. Nurses shall ensure that waste are properly

segregated in biodegradable, non-
biodegradable and infectious trash bins.

3. Nurses shall dispose of blood and other body

fluids at the toilet bowl.
Health Care Waste (HCW)

• Includes all waste

generated by health
care establishments,
research facilities and
laboratories.
Sharps

• Needles, syringes, scalpels, saws, blades, broken

glass, & other items that can cause a cut or
punctured wounds
• Considered as highly hazardous HCW
Sharps

• Items that can cause a cut or punctured wounds

• Considered as highly hazardous HCW
Prevention and Control of Infections

Nurses shall safely handle and dispose of used

sharps/needles in a puncture resistant
container located in every nurses station.
Proper Handling and Disposal of Sharps
• Do not recap, bend, break or hand-manipulate
used needles
• If recapping is required, use a one-handed scoop
technique
• Use safety features when available
• Discard all disposable syringes and needles,
scalpel blades and other sharps into labeled
leak-proof, puncture resistant containers
IMMEDIATELY!
Don’t Recap Like This!
Recap Like This Instead…
Proper handling and disposal of sharps
• Removing of needle will only be allowed with the
use of forceps
Proper Handling and Disposal of Sharps
• Assume there may be a sharp object in dressing
sets/other wastes being cleaned after patient
care and proceed with care.
10/10/2021
10/10/2021
 Color Coding Scheme for Containers

•Black • non-infectious dry waste

•Green • non-infectious wet waste
•Yellow • infectious & pathological waste
•Orange • radioactive waste
•Red • sharps/pressurized containers
MANILA MED’S CENTRAL GARBAGE AREA

BIO AND NON- BIO GARBAGE

stored at the basement
with enclose screen and
door
INFECTIOUS & HAZARDOUS
WASTE
stored also at the
basement with a closed
sealed plastic container
supplied by chevalier.
Prevention and Control of Infections

Policy V:

THE HOSPITAL IMPLEMENTS PRACTICES

FOR SAFE HANDLING AND DISPOSAL OF
SHARPS AND NEEDLES.
Prevention and Control of Infections

Intent:

Proper disposal of needles and sharps reduces the

risk of injury.
Prevention and Control of Infections

1. Nurses shall safely handle and dispose of used

sharps/needles in a puncture resistant
container located in every nurses station.
Standard Precautions
• Safe Injection Practices
▫ Do not recap, bend, break or hand-manipulate
used needles
▫ If recapping is required, use a one-handed scoop
technique
▫ Use safety features when available
▫ Discard all disposable syringes and needles,
scalpel blades and other sharps into labeled leak-
proof, puncture resistant containers
IMMEDIATELY!
Standard Precautions
• Safe Injection Practices
▫ Removing of needles after use is prohibited
▫ If removing of needles must be done, use
forceps
▫ Assume there may be a sharp object in dressing
sets/other wastes being cleaned after patient care
and proceed with care.
Do Not Leave Sharps Unattended
Protection of Healthcare Workers

Measures to Protect HCWs:

✓ Immunization
✓ Education and Training
✓ Reporting – HCWs must
report any accidents or illness
(e.g. needle stick injury or
blood and body fluid
exposures)
Diseases That Can Be Transmitted Through Needle
Stick Injury
INFECTIONS FROM:
❑ Human Immunodeficiency Virus (HIV)
❑ Hepatitis B Virus (HBV)
❑ Hepatitis C Virus (HCV)

Risk of infection from patients with:

HBV – 1:3 risk of transmission
HCV – 1:30
HIV – 1:300
• Review: Standard Precaution is applicable to all.
• Though, there are patients who are more at risk
to acquire infections, such as patients with
invasive devices or those who
underwent invasive procedures.
Prevention and Control of Infections
Bundles of Care

• Webster Definition: a group of things fastened

together for convenient handling.
In healthcare, bundle is:

• Group of interventions related to a disease that

when instituted together give better outcomes
than when done individually.
• A structured way of improving the processes of
care and patient outcomes.
A bundle is:

• Small and straightforward

• Set of best practices
• Scientifically grounded (evidence-based)
• Must be executed collectively and reliably
• “All or nothing” indicator
 DEFINITION:
Catheter Related Blood Stream Infections

❑ Blood stream infections that

develop among those patients with
central line placed for at least 48
hours
❑ Patient satisfies the ff criteria:
✓ fever (38 C)
✓ hypotension (systolic pressure
<90 mm)
✓ blood culture not done or no
organisms or antigen detected
by blood and no apparent
infection at another site and
physician institutes treatment
for sepsis.
FIVE COMPONENTS OF CARE

❑ HAND HYGIENE
❑ MAXIMAL BARRIER PRECAUTIONS
❑ CHLORHEXIDINE SKIN ANTISEPSIS
❑ Optimal catheter site selection, with subclavian
vein as the preferred site
❑ Daily review of central line necessity
 DEFINITION:
❑ Pneumonia among those who are
Ventilator Associated
mechanically ventilated for at least 48
Pneumonia
hours through an endotracheal or
tracheostomy tube.
❑ Patient develops any of the ff
signs/symptoms:
✓ rales (crackles) or dullness to
percussion on physical examination
of the chest
✓ new onset of purulent sputum or
change in character of sputum
✓ organisms cultured from blood
✓ isolation of an etiologic agent from a
specimen obtained by tracheal
aspirate, bronchial brushing, or
biopsy
Bundles of Care in Ventilator Associated
Pneumonia (VAP)
❑ ELEVATION OF THE HEAD OF THE BED
30-45°ANGLE
❑ DAILY “SEDATION VACATION” AND DAILY
ASSESSMENT OF READINESS TO
EXTUBATE
❑ PEPTIC ULCER DISEASE (PUD)
PROPHYLAXIS
❑ DEEP VENOUS THROMBOSIS (DVT)
PROPHYLAXIS
Head of the Bed 30-45°

Why?
• Reduces potential for aspiration
• Potential to improve ventilation
Identified Issues and Concerns
• Is it comfortable for the patient?
• Causes the patient to slide down in bed
• Potential for skin-shearing
Sedation Vacation

Why?

• Has been demonstrated to reduce overall patient sedation

• Promotes early weaning

Identified Issues and Concerns:

• Increases potential for self-extubation

• Increases potential for patient pain and anxiety
• Increases episodes of desaturation
PUD Prophylaxis

Why?

• Stress ulcerations are the most common cause

of GI bleed in ICU patients
• GI bleed due to these lesions is associated with
a five-fold increase in mortality. Applying
peptic ulcer disease prophylaxis is therefore a
necessary intervention in critically ill patients.
DVT Prophylaxis

Why?
• Reduces potential for clot formation
• Reduces potential for pulmonary emboli
Identified issues and concerns:
• May increase the risk of bleeding
“WHAP the VAP”

❑ W – Wean patient from the ventilator as

soon as possible
❑ H – Hand hygiene
❑ A – Aspiration precaution
❑ P – Prevent contamination of respiratory
therapy equipment
 DEFINITION:
Catheter Associated
Urinary Tract Infections

❑UTI among those who have urinary

catheter placed for at least 48 hours
❑ Patient develops any of the ff
signs/symptoms:
✓ fever (38 C)
✓ urgency, frequency, dysuria, or
suprapubic tenderness
✓ patient has a positive urine culture,
that is, >105 microorganisms per cm3
voided urine or urine with no more
than two species of microorganisms.
 Bundles of Care in Catheter-Associated
Urinary Tract Infections (CAUTI)
❑ FOLEY CATHETER STRAPPED TO LEG
✓ All urinary catheters must be secured to decrease
movement of catheter
❑ FOLEY BAG BELOW BED
✓ Drainage bag must be kept lower than patient’s bladder at
all times
❑ DAILY REVIEW FOR NECESSITY
✓ Can urinary catheter be removed already?
❑ CLARITY OF URINE
✓ Change catheter if patient is having symptoms of
infections
❑ STRICT HANDWASHING
❑ PERICARE DAILY AND AFTER EACH BOWEL MOVEMENT
 Surgical Site Infection (SSI)

An infection of the tissue in

or around a surgical wound.
To be considered a surgical
site infection, the infection
must occur within 30 to 90
days after surgery.
 Bundles of Care in SSI

Clippers - Hair Removal:

If hair must be removed from the surgical site, clippers
are the best option. Never use a razor.

Antibiotics Prophylactic Antibiotic:

Antibiotics consistent with national guidelines should be
administered within 1 hour of incision time and
discontinued within 24 hours, in most cases.

Temperature – Normothermia
CATS Sugar – Glucose Control
 Hypothermia

• Hypothermia reduces tissue oxygen pressure

by vasoconstriction.
• Hypothermia reduces leukocyte superoxide
production.
• Hypothermia increases bleeding and
transfusion requirement
• Hypothermia increases duration of hospital
stay even in uninfected patients.
THANK YOU!
VIDEOS FOR HANDWASHING