Evolution of Infection Prevention and Control in Healthcare
Explore the history, goals, and significance of Infection Prevention and Control (IP&C) programs in healthcare settings. Learn about the impact of IP&C initiatives on reducing healthcare-associated infections, enhancing patient safety, and optimizing healthcare delivery. Discover key milestones from Florence Nightingale's pioneering work to modern evidence-based practices in IP&C.
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Infection Prevention and Control (IP&C)
Learning objectives December 1, 2013 1. Outline the history of infection prevention and control. 2. Describe the goals of infection prevention and control programs. 3. Discuss how an IP&C program can make a positive impact in any healthcare organization. 2
Time involved December 1, 2013 35 minutes 3
What is IP&C? December 1, 2013 The discipline concerned with preventing nosocomial or healthcare-associated infections a sub-discipline of epidemiology Similar to public health activities, mainly practiced within a health-care delivery system Focuses on evidence-based practices and procedures that can prevent or reduce the risk of transmission of microorganisms to health care providers, clients/patients/residents and visitors 4
Why is IP&C Important? December 1, 2013 Infections are a leading cause of morbidity and mortality in healthcare settings Infections can cause pain, suffering and often, permanent scarring Infections cause prolonged hospital stays which has an impact on costs 5
History December 1, 2013 Pre 1800: Early efforts at wound prophylaxis 1800-1940: Nightingale, Semmelweis, Lister, Pasteur 1940-1960: Antibiotic era, S. aureus outbreaks in nurseries 1950-1970: Surveillance begins, documentation of need for infection control programs, infection control committees develop 1980: HIV issues, resistant bacteria, SENIC study and NNIS in USA 1990: Blood-borne pathogens 2000: Pandemics, patient safety 6
Florence Nightingale The first infection prevention and control champion Research into hospital sanitary problems made her a firm believer in pure air, pure water, efficient drainage, cleanliness, and light Nightingale s firm belief in preventive medicine led to an established standard of formalized cleanliness and sanitation in hospitals and the military December 1, 2013 7
Ignaz Semmelweis - 1 Demonstrated that routine hand washing could prevent the spread of puerperal fever Noted that maternity patients were dying at such an alarming rate that they begged to be sent home from the hospital to deliver with a midwife Semmelweis analysis revealed that medical students, responsible for deliveries in Division I, often performed autopsies before assisting in deliveries, while midwives, who worked in Division II, did not December 1, 2013 8
Ignaz Semmelweis - 2 December 1, 2013 Theorized that disinfecting hands could prevent transmission of infection from a diseased cadaver to a pregnant patient Required medical students to wash their hands with chlorinated lime before assisting in deliveries Resulted in a dramatic outcome - deaths on the maternity ward fell fivefold 9
Joseph Lister - 1 December 1, 2013 Troubled by high mortality rates from post-surgical sepsis First to see the connection between Pasteur's discoveries of the fermentation process and the suppuration of wounds 10
Joseph Lister - 2 December 1, 2013 In 1867 he published his paper on antisepsis, stating that "all the local inflammatory mischief and general febrile disturbance which follow severe injuries are due to the irritating and poisoning influence of decomposing blood or sloughs." He began applying carbolic acid to compound fracture wounds The wounds healed, amputation averted, and the mortality rate plummeted from 45% to 15% 11
Infection Prevention and Control Programs December 1, 2013 The earliest formal programs were in the 1950s Began as an effort to address issues like staphylococcal epidemics The first Infection Control Nurses were appointed at this time; they often had a background in bacteriology Surveillance of hospital infections was instituted and policies and procedures developed Early infection control programs focused on environmental cleanliness Antimicrobial resistant pathogens became a concern in the 1970s 12
Healthcare-Associated Infections (HAI) - 1 HAIs include urinary tract infections, pneumonia, bloodstream infections and surgical site infections The WHO states urinary tract infection is the most frequent HAI in high- income countries; surgical site infections in settings with limited resources* December 1, 2013 13 * Statistics in low resource countries are often non- standardized or incomplete
Healthcare-Associated Infections (HAI) 30% of patients in intensive care units (ICU) are affected by at least one HAI in high-income countries In low- and middle-income countries the frequency of ICU-acquired infection is at least 23 fold higher* Newborns are at higher risk of acquiring HAI in developing countries, with infection rates three to 20 times higher than in high-income countries* December 1, 2013 14 * Statistics in low resource countries are often non- standardized or incomplete
Goals of IP&C To prevent the spread of infections from patient-to-patient patients to health care providers health care providers to patients health care providers to health care providers and to visitors and others in the health care environment CONSEQUENTLY To protect patients from HAIs, resulting in improved survival rates reduced morbidity associated with infections shorter length of hospital stay a quicker return to good health December 1, 2013 15
Functions of IP&C To obtain and manage critical data and information To implement evidence-based practice, standards and guidelines through setting-specific policies and procedures To intervene directly to prevent infections To provide effective occupational health programs To educate and train healthcare workers, patients, and non-medical caregivers To provide communication of infection-related issues and relevant practices to leaders and staff to facilitate improvements To evaluate the program and improve it as necessary December 1, 2013 16
Practice of IP&C Today December 1, 2013 Surveillance Outbreak investigations Prevention through practices/guidelines hand hygiene, use of barriers, isolation/precautions, construction/renovation, sterilisation/disinfection, antibiotic resistance, blood-borne pathogens, food/water/air safety, cleaning Antibiotic use Education Occupational health Audits 17
References December 1, 2013 Cardo D, et al. Moving toward elimination of healthcare-associated infections: A call to action. Am J Infect Control 2010: 1-5. http://www.apic.org/Resource_/TinyMceFileManager/Position_Stat ements/AJIC_Elimin.pdf Friedman C, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: A Consensus Panel report. Am J Infect Control 1999; 20:695-705. Haley RW, et al. Efficacy of Nosocomlal Infection Control (SENIC Project): Summary of study. Am J Epidemiol 1980; 111: 472-485. Scheckler WE, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Am J Infect Control 1998;26:47-60. 18
Web Resources December 1, 2013 World Health Organization - http://www.who.int/csr/bioriskreduction/infection_contr ol/en/index.html Centers for Disease Control and Prevention - http://www.cdc.gov/hai/ National Institute for Health and Clinical Excellence - http://guidance.nice.org.uk/CG139 IFIC - http://www.theific.org/ International Nosocomial Infection Control Consortium - http://www.inicc.org/english/index.php National Health and Medical Research Council - http://www.nhmrc.gov.au/node/30290 19
Quiz 1. Infection prevention and control programs have been proven to be effective. T/F? IP&C is important in health care because of its: a) Focus on patient health and safety b) Focus on healthcare worker safety c) Focus on decreasing costs d) All of the above IP&C programs are relevant to all healthcare settings. T/F? December 1, 2013 2. 3. 20
International Federation of Infection Control IFIC s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe . The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise. For more information go to http://theific.org/ December 1, 2013 21
