Infection Control Health Article

Description

Organized efforts at infection control began in the United States in the 1950s, along with the increase in intensive care units to care for critically ill patients and the emergence of nonsocomial staphylococcal infections. Many hospitals implemented programs in the 1960s and 1970s at the insistence of various organizations. In the 1980s, state and federal agencies, along with professional organizations, began to make recommendations for infection control and require adherence to regulations.

Infection control procedures are followed in hospitals, long term care facilities, rehabilitation units, outpatient facilities, and home care. All infection control programs should encourage actions that limit the spread of nosocomial infections. All healthcare institutions are mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to "develop specific objectives and outcome measures to determine whether or not its infection control goals have been achieved" (AJIC, 1998). Infection control programs must include the means to measure the effectiveness of procedures, policies, or programs to protect patients and health care providers and to determine if these activities are cost-effective.

Health care organizations must be in compliance with regulations and accreditation requirements by various federal and state agencies and governing bodies. JCAHO, for instance, has standards that are incorporated into many state licensing, as well as Medicare and Medicaid, regulations. The facility's administration is responsible for ensuring compliance. Ongoing education and training are an important part of an effective infection control program. Also, the monitoring of patient-care activities can identify areas of concern, and the data obtained is vital to improving the program and ensuring successes.

The Hospital Infections Program (HIP) of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), is the focus for information, surveillance, investigation, prevention, and control of nosocomial infections for the U.S. Public Health Service, state and local health departments, hospitals, and professional organizations in the United States and around the world. Studies indicate that one-third of nosocomial infections can be prevented by well-organized infection control programs, yet only 6-9% are actually prevented. The Study of Efficacy of Nosocomial Infection Control (SENIC) carried out by HIP over ten years showed that, to be effective, nosocomial infection programs must include the following: 1) organized surveillance and control activities, 2) a ratio of one infection control practitioner for every 250 acute care beds, 3) a trained hospital epidemiologist, and 4) a system for reporting surgical wound infection rates back to surgeons (NNIS, 1996). The National Nosocomial Infections Surveillance (NNIS) System has been gathering information for 20 years regarding nosocomial infections. This information is being used to assist hospitals in conducting successful surveillance of these infections.

In 1987, the Centers for Disease Control (CDC) expanded previous recommendations to prevent the spread of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. Previously, certain isolation precautions were recommended only for those patients who were known or suspected to have bloodborne infectious diseases. Because of the growing number of persons infected with HIV and the high mortality rates associated with AIDS, Universal Blood and Body Fluids Precautions were developed. Under these new recommendations, all patients are considered potentially infectious for bloodborne infections. In 1991, the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogen Standard required the use of universal precautions and dictated that all staff must be trained annually on the risk of exposure to bloodborne pathogens. Preventing exposure is the best and safest way to reduce infection.

The effectiveness of infection control programs are evaluated in several ways: lower rates of infection for the patient, shorter periods of hospital stays, decreased morbidity, and reduction of on-the-job exposure of health

care workers to infection and contamination from patients. To do this, infection control policies focus on strategies for isolation, barrier precautions, case investigation, health care worker education, immunization services, and employee health programs. When healthcare institutions are successful in their infection control programs, it decreases the cost of care and has a positive impact on the institution's image within the community.

It is the responsibility of infection control to identify problems, collect and analyze data, change policies and procedures when necessary, and monitor data. The specific functions of an infection control program should be based on the needs of the individual healthcare institution. It is most important to monitor infection activity. Data is collected and disseminated based on the principles of epidemiology to implement quality-improvement activities and improve patient outcomes. Policies and procedures of the facility must be based on scientific and valid infection control prevention and be reviewed and updated frequently to reflect practice guidelines and standards.

(Public Domain.)

Transmission of infection within a health care organization requires three elements: a source of infecting microorganisms, a susceptible host, and a means of transmission for the microorganism. The skin of patients and personnel can function as a reservoir for infectious agents and as a vehicle for transfer of infectious agents to susceptible persons. The microbial flora of the skin consists of resident and transient microorganisms. Resident microorganisms persist and multiply on the skin. Transient microorganisms are contaminants that can survive for only a limited period of time. Most resident microorganisms are found in superficial skin layers, but about 10-20% inhabit deep epidermal layers. Handwashing with plain soaps is effective in removing many transient microorganisms. Resident microorganisms in the deep layers may not be removed by hand-washing with plain soaps, but usually can be killed or inhibited by antimicrobial products. Handwashing is the single most important measure for preventing nosocomial infections.