Infection control is a broad topic in itself but I think it will benefit us greatly if we educate ourselves even by just knowing the basics. This blog is written in such a way that it will also cover how infection control is applied to the household environment. One must understand that the measures vary from setting to setting with the hospital set-up being very strict with this because of the high level of risk.
Nowadays, the concept of infection control has been very well highlighted especially that we are currently living in the middle of a pandemic (as of this writing). Hand hygiene has been the talk of the towns during the covid-19 era. Infection control measures should therefore be considered essential by everyone and healthcare providers have been very meticulous with this ever since.
Pathogens
Pathogens are microorganisms or viruses that are capable of causing disease especially when they can invade and infect our body. There are several types of pathogens. Bacteria, viruses, fungi and protozoa are the most common.
Infections occur when pathogens start to invade and multiply in our body causing damage to cells and tissues. While our body is capable of fighting so many of these microbes and viruses, there are instances when the body’s immune system can be weak to defend against particular pathogens. Also, a break in the line of defences (such as a wound on the skin) can provide an opportunity for some pathogens to infect.
Bacteria and Virus
The Difference Between Bacteria and Viruses
Bacteria and viruses differ in a way that bacteria are single-celled organisms that contain bacterial structural components like capsule, cell wall and a flagella for some. Viruses are smaller than bacteria. Viruses are non –living particles which contains a genetic material in the form of RNA or DNA, also called the viral genome. The genetic materials are wrapped in envelopes of proteins and viruses need host cells in order to replicate.
The Chain of Infection
The Chain Of Infection
The chain of infection illustrates how one can get infected from pathogens referred to as causative agents. They usually start from a source such as a contaminated object or an infected person (referred as the reservoir) until it finds its way to infect another susceptible host. Infections are spread in various ways. Depending on the type of pathogen and disease involved, transmissions can either be through direct contact, droplets, or by air (as in the case of airborne pathogens). Microorganisms are everywhere and it is impossible to get rid of them 100% in our life. However, the chain of infection has a weakest link and that is the mode of transmission. We can implement measures to prevent the spread of infection through handwashing, avoiding contact with contaminated objects, disinfection and other infection control procedures.
Handwashing
Handwashing has been considered as the single most important procedure in reducing the spread of microorganisms. However, when the procedure is done incorrectly, it will not be effective in breaking the chain of infection. The World Health Organisation (WHO) introduces the 5 Moments of Hand Hygiene to guide healthcare workers in washing their hands.
Hand washing must be performed for the following “5 Moments”:
before touching a patient,
before clean/aseptic procedures
after body fluid exposure/risk
after touching a patient, and
after touching patient surroundings.
Even if you are not a healthcare worker, it is still important to practice good hand hygiene. You must wash your hands whenever it gets dirty, before and after eating, or whenever it is contaminated. In some instances, we may not be really aware if our hands are contaminated or not because we are not conscious about them all the time 24/7. So if you are in doubt if whether you’ve touched something that would contaminate your hands or not, it is best to just wash your hands.
“When in doubt, just wash your hands”
The Hand Hygiene Procedure
Hand hygiene can either be performed using soap and clean running water or through the use of hand hygiene gels and products. If soap and water is available and accessible, then this should be considered as the better option because the washing of hands with soap and water is more effective in removing dirt. Hand gels can also vary in the concentration of sanitizing ingredients however they can still be used in many settings like if you are outside in public and soap and water is not accessible.
The hand hygiene procedure must be in such a way that the cleaning covers all the areas of the hands, from the palms to the back of the hand, between the fingers and nails, and the wrist. Soap must be applied in all of these areas through rubbing or friction. This can sometimes take a minute to complete. The video below shows the handwashing procedure using the World Health Organization technique:
How to wash your hands with soap & water. Video from WHO (2020a)
In the use of hand sanitizers, same principles also apply in that all areas must be covered. The video below shows the hand hygiene procedure using an alcohol based gel.
How to wash your hand with hand sanitizers. Video from WHO Africa Region (2020)
The Use of Personal Protective Equipment (PPE)
Wearing of face mask used to be only common in work places but because of covid-19, wearing them in public has now been highly recommended in most countries. It has now become the “new normal”. There are several studies that show that masks are effective in reducing the spread of diseases. However, for this to be true, several principles must also be followed. The WHO (2020) outlines the following basics when wearing a mask:
Your hands must be clean when you put your mask on. Therefore, wash your hands before putting a mask, as well as wash your hands after taking it off.
Masks should be worn in such a way that it covers your nose, mouth and chin.
“When you take off a mask, store it in a clean plastic bag, and every day either wash it if it’s a fabric mask, or dispose of a medical mask in a trash bin.”
Avoid using masks with valves
Clinical grade masks are used in clinical settings and they come in different types such as surgical and N95 masks. It is important to follow the guidelines and policies that pertains to which mask or PPE (e.g. face shield & gowns) to wear as this may differ from the work settings and the risks involved. Health care providers must conduct a risk assessment in order for their patients to be safe and most importantly to keep oneself also safe and be protected from possible transmissions.
Different types of masks. Video by WHO (2020b)
In clinical settings, the use of PPE’s involve putting on gloves, aprons, gowns, masks, and eye/face shields, depending on the situation. There are specific techniques that apply in the use and removal of PPE’s. If you are a healthcare worker, it is important to follow applicable guidelines (check what applies to your country) and the policies of your workplace. Several factors need to be considered such as the type of material used (disposable or reusable), is it a clean or of a sterile type, and the availability of resources. In general though, the techniques in the application and removal of PPE’s must be in such a way that you prevent yourself and your patient from being contaminated. The ultimate focus should be on safety, and that also involves the proper disposal of PPE’s as well as the cleaning, disinfecting and sterilization of PPE’s if applicable. One rule is that if the PPE is for single use only, then it should be disposed of immediately (and properly) after using.
The WHO has provided useful infographics regarding the putting on and removal of PPE’s for health care workers. Links are below:
· HOW TO GUIDE -PUTTING ON PPE FOR CONTACT/DROPLET PRECAUTION
· CONTACT AND DROPLET PRECAUTIONS - COVID-19 PERSONAL PROTECTIVE EQUIPMENT (PPE)
Through time, it is possible that the wearing of masks in public won’t be recommended anymore especially if getting an infection from covid-19 is no longer a threat. It is important to keep yourself updated of the current guidelines all the time as they can be fast changing. As of this writing, the wearing of mask in public such as when in trains and inside stores or shops is still recommended in many countries.
3 Levels of Decontamination: Cleaning, Disinfection and Sterilisation
There may be variations in terms of how cleaning and disinfecting can be done in household and hospital settings. Clinical settings will always involve the use of clinical grade equipment and solutions, and in some cases, sterilisation may be necessary.
For household settings, there are a lot of over-the-counter products that can be bought for cleaning and disinfecting. It is important to read the manufacturer’s description and instruction of the products. Everyone must exercise good judgement in the use of these such as finding out if they are effective against bacteria only or both bacteria and viruses, does it kill 99% of the microorganisms, should gloves be used when cleaning because the chemicals are harmful to the skin, and so forth.
The video below from the famous Dr Oz of the Doctor Oz Show shows “The Do's And Don'ts Of Disinfecting Your Home”. This was made during the time when covid-19 was just beginning to spread across America. I personally find this useful as it makes one aware of some of the little things and areas in our home that needs disinfecting but are likely to be forgotten.
The Do's & Don'ts of Disinfecting Your Home. Video from DoctorOz (2020).
For clinical settings, the process of decontamination is a broad topic in itself covering the type of wipes and solutions used to handling spillages, the technique in sterilising instruments as well as risk assessments involved. It is essential for clinical staff to be trained with infection control, which includes some of the concepts of decontamination. The level of training is usually based on your scope of practice and job responsibilities. Not everyone may be involved with some of the decontamination techniques (for example, sterilising instruments) thus training is provided in accordance to what’s applicable to the job. Clinical facilities will also have their own infection control policies and it is imperative that staff familiarize with these as well.
Cough Etiquette
Cough etiquette should always be a part of infection control. Infected persons with respiratory symptoms must ensure that they implement the measures that help prevent the passing of disease to someone else.
The nose and mouth must be covered with tissue when sneezing or coughing
In some instances, a tissue may not be available and therefore the crux of the elbow (space between upper and lower arm) can be used when sneezing or coughing
Used tissues must be disposed properly in the disposal bin. They must not be left lying around.
Hands must be washed properly after coughing or sneezing to prevent transferring the microbes to items touched.
Make sure to self-isolate when advised to do so. Instructions provided by the health care adviser relating to this must be followed properly. This is very applicable at present especially that we are still living in the middle of the covid-19 pandemic (as of this writing).
Disposal of Wastes
Again, this is a broad topic in itself and also varies from different settings. It is important to check the laws that apply to your country as sometimes waste disposal rules may be very specific (e.g. colour coding of waste disposal bags). In clinical environments, waste disposal is even broadened for the fact that different techniques are applied when disposing clinical and non-clinical wastes, and hazardous and non-hazardous wastes. In addition, the disposal of sharps (e.g. needles in syringes) are also done differently as this involves the use of “sharps containers” with a biohazard symbol to prevent injuries. If you work in a clinical facility, it is important to check the applicable policies.
Below is the “How to Safely Dispose of Medical Waste – Caregiver tips” video from the Care Channel which you might find useful.
How to Safely Dispose of Medical Waste – Caregiver tips. Video from CareChannel (2019).
For those involved in health care, the WHO has a useful document on the safe management of wastes.
WHO Safe management of wastes from health‑care activities: A summary
Time and time again, infection control measures when done properly have proven to be effective in preventing the transmission of infectious diseases. We must understand that microorganisms are always everywhere and it is very hard to eliminate them all. We actually co-exist with them. It’s just that for some of these bacteria, viruses and other pathogens, they are capable of causing harm. However, going back to the concept of the chain of infection, we should always remember that there’s that weakest link in that chain. We must therefore do our best to control infections by educating ourselves about how particular microorganisms can be transmitted and spread, as well as what measures can be employed to control them.
Disclaimer:
The content in this blog is for informational purposes only and should not be taken as medical advice. It is always best to consult your doctor for medical questions.
If you are a healthcare provider, the content here should not be used to make any diagnosis, give advice or prescribe treatment as this blog is for informational and educational purposes only. Healthcare is an everchanging field and each patient is unique. It is your responsibility as a healthcare provider to always refer to current care standards and practices.
References:
CareChannel. (2019). How To Safely Dispose Of Medical Waste - Caregiver Tips. [video] Available at: <https://www.youtube.com/watch?v=yJIJfgRwMgU> [Accessed 6 December 2020].
DoctorOz. (2020). The Do's And Don'ts Of Disinfecting Your Home. [video] Available at: <https://www.youtube.com/watch?v=vjxJMSvulyc> [Accessed 6 December 2020].
Gillespie,S and Bamford, K. ( 2007 ) Medical Microbiology and Infection at a Glance ( 3rd edn ). Blackwell Publishing : Oxford.
Peate, I. (2019) Learning to Care:The Nursing Associate, Elselvier:London
Stone, V. (2017). Safe Management Of Wastes From Health‑Care Activities: A Summary. [ebook] World Health Organization. Available at: <https://apps.who.int/iris/bitstream/handle/10665/259491
/WHO-FWC-WSH-17.05-eng.pdf> [Accessed 6 December 2020].
World Health Organization African Region. (2020). How To Wash Your Hands With Hand Gel. [video] Available at: <https://www.youtube.com/watch?v=PMYrcKbvUgo> [Accessed 6 December 2020].
World Health Organization. (2015). GB 0:00 / 1:26 WHO: How To Handwash? With Soap And Water. [video] Available at: <https://www.youtube.com/watch?v=3PmVJQUCm4E> [Accessed 6 December 2020].
World Health Organization. (2020a). Infecton Control And Prevention. [online] Available at: <https://www.who.int/teams/integrated-health-services/infection-prevention-control/> [Accessed 6 December 2020].
World Health Organization. (2020b). Medical And Fabric Masks: Who Wears What When?. [video] Available at: <https://www.youtube.com/watch?v=esM_ePHn0aw&feature=emb_title> [Accessed 6 December 2020].
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