INTRODUCTION

The incidence of patients developing infections as the direct result of contact during health care is
increasing. Current trends, public awareness, and rising costs of health care have increased the importance
of infection prevention and control. The Joint Commission (TJC) views this as a patient safety issue.
Infection prevention and control are essential for creating a safe health care environment for patients,
families, and staff. Nurses play a primary role in infection prevention and control. Patients in all health
care settings are at risk for acquiring infections because of lower resistance to pathogens; increased
exposure to pathogens, some of which may be resistant to most antibiotics; and invasive procedures.

Health care workers are at risk for exposure to infections as a result of contact with patient blood,
body fluids, and contaminated equipment and surfaces. Practicing basic infection prevention and control
techniques, avoids spreading pathogens to patients and sustaining an exposure when providing direct care.
Patients and their families need to be able to recognize sources of infection and understand measures used
to protect themselves.

Patient teaching must include basic information about infection, the various modes of
transmission, and appropriate methods of prevention. Health care workers protect themselves from
contact with infectious material, sharps injury, and/or exposure to a communicable disease by applying
knowledge of the infectious process and using appropriate personal protective equipment (PPE). Diseases
such as hepatitis B and C, human immunodeficiency virus (HIV) infection, acquired immunodeficiency
syndrome (AIDS), tuberculosis (TB), and multidrug-resistant organisms require a greater emphasis on
infection prevention and control techniques

NATURE OF INFECTION

An infection is the invasion of a susceptible host by pathogens or microorganisms, resulting in

disease. Colonization is the presence and growth of microorganisms within a host but without tissue
invasion or damage. Disease or infection results only if the pathogens multiply and alter normal tissue
function. Some infectious diseases such as viral meningitis and pneumonia have a low or no risk for
transmission. Although these illnesses can be serious for the patient, they do not pose a risk to others,
including caregivers. If an infectious disease can be transmitted directly from one person to another, it is
termed a communicable disease. If the pathogens multiply and cause clinical signs and symptoms, the
infection is symptomatic. If clinical signs and symptoms are not present, the illness is termed
asymptomatic. Hepatitis C is an example of a communicable disease that can be asymptomatic. It is most
efficiently transmitted through the direct passage of blood into the skin from a percutaneous exposure,
even if the source patient is asymptomatic.
DEFINITION

According to Potter and Perry,

An infection is the invasion of a susceptible host by pathogens or microorganisms, resulting in disease.

According to Kozier and Erb,

An infection is the growth of microorganisms in body tissue where they are not usually found.

According to Brar and Rawat,

Infection is the entry and multiplication of an infectious agent into the tissues of the host.

TYPES OF MICROORGANISMS THAT CAUSE INFECTIONS

Four major categories of microorganisms cause infection in humans: bacteria, viruses, fungi, and
parasites. Bacteria are by far the most common infection-causing microorganisms. Several hundred
species can cause disease in humans and can live and be transported through air, water, food, soil, body
tissues and fluids, and inanimate objects. Viruses consist primarily of nucleic acid and therefore must
enter living cells in order to reproduce. Common virus families include the rhinovirus (causes the
common cold), hepatitis, herpes, and human immunodeficiency virus. Fungi include yeasts and molds.
Candida albicans is a yeast considered to be normal flora in the human vagina. Parasites live on other
living organisms. They include protozoa such as the one that causes malaria, helminths (worms), and
arthropods (mites, fleas, ticks)

TYPES OF INFECTIONS

Colonization is the process by which strains of microorganisms become resident flora. In this state, the
microorganisms may grow and multiply but do not cause disease.

A local infection is limited to the specific part of the body where the microorganisms remain.

If the microorganisms spread and damage different parts of the body, the infection is a systemic
infection.

When a culture of the person’s blood reveals microorganisms, the condition is called bacteremia.

When bacteremia results in systemic infection, it is referred to as septicemia.

Acute infections generally appear suddenly or last a short time.

Chronic infection may occur slowly, over a very long period, and may last months or years.

Nosocomial infections are classified as infections that originate in the hospital. Nosocomial infections
can either develop during a client’s stay in a facility or manifest after discharge.
CHAIN OF INFECTION

Infection occurs in a cycle that depends on the presence of all of the following elements:

1. An infectious agent or pathogen

2. A reservoir or source for pathogen growth
3. A port of exit from the reservoir
4. A mode of transmission
5. A port of entry to a host
6. A susceptible host .

Infection can develop if this chain remains uninterrupted (Fig- 1). Preventing infections involves breaking
the chain of infection.

Fig :1 – Chain of infection

1. INFECTIOUS AGENT

Microorganisms include bacteria, viruses, fungi, and protozoa . Microorganisms on the skin are either
resident or transient flora. Resident organisms (normal flora) are permanent residents of the skin, where
they survive and multiply without causing illness.

The potential for microorganisms or parasites to cause disease depends on the following factors

 number of microorganisms present

 their virulence, or ability to produce disease
 their ability to enter and survive in the host
 susceptibility of the host.
Resident skin microorganisms are not virulent. However, they sometimes cause serious infection when
surgery or other invasive procedures allow them to enter deep tissues or when a patient is severely
immunocompromised (has an impaired immune system)

Transient microorganisms attach to the skin when a person has contact with another person or object
during normal activities. For example, when you touch a contaminated gauze dressing, transient bacteria
adhere to your skin. These organisms may be readily transmitted unless removed using hand hygiene. If
hands are visibly soiled with proteinaceous material, washing with soap and water is the preferred
practice. If hands are not visibly soiled, use of an alcohol-based hand product or handwashing with soap
and water is acceptable for disinfecting hands of health care workers

2. RESERVOIR

A reservoir is a place where microorganisms survive, multiply, and await transfer to a susceptible host.
Common reservoirs are humans and animals (hosts), insects, food, water, and organic matter on inanimate
surfaces (fomites). Frequent reservoirs for health care–associated infections (HAIs) include health care
workers, especially their hands; patients; equipment; and the environment. Human reservoirs are divided
into two types: those with acute or symptomatic disease and those who show no signs of disease but are
carriers of it. Humans can transmit microorganisms in either case. Animals, food, water, insects, and
inanimate objects can also be reservoirs for infectious organisms. To thrive, organisms require a proper
environment, including appropriate food, oxygen, water, temperature, pH, and light.

a. Food. 

Microorganisms require nourishment. Some such as Clostridium perfringens, the microbe that causes gas
gangrene, thrive on organic matter. Others such as Escherichia coli consume undigested foodstuff in the
bowel. Carbon dioxide and inorganic material such as soil provide nourishment for other organisms.

b. Oxygen

Aerobic bacteria require oxygen for survival and for multiplication sufficient to cause disease. Aerobic
organisms cause more infections in humans than anaerobic organisms. An example of an aerobic
organism is Staphylococcus aureus. Anaerobic bacteria thrive where little or no free oxygen is available.
Infections deep within the pleural cavity, in a joint, or in a deep sinus tract are typically caused by
anaerobes. An example of an anaerobic organism is Clostridium difficile, an organism that causes
antibiotic induced diarrhea.

c. Water

Most organisms require water or moisture for survival. For example, a frequent place for microorganisms
is the moist drainage from a surgical wound. Some bacteria assume a form, called a spore, which is
resistant to drying. A common spore-forming bacterium is C. difficile, an organism that causes antibiotic-
induced diarrhea.

d. Temperature

Microorganisms can live only in certain temperature ranges. Each species of bacteria has a specific
temperature at which it grows best. The ideal temperature for most human pathogens is 20° to 43° C (68°
to 109° F). For example, Legionella pneumophila grows best in water at 25° to 42° C (77° to 108° F)
(Moore, 2009; Ritter, 2005). Cold temperatures tend to prevent growth and reproduction of bacteria
(bacteriostasis). A temperature or chemical that destroys bacteria is bactericidal.

e. pH

The acidity of an environment determines the viability of microorganisms. Most microorganisms prefer
an environment within a pH range of 5.0 to 7.0. Bacteria in particular thrive in urine with an alkaline pH.

f. Light

Microorganisms thrive in dark environments such as those under dressings and within body cavities

3. PORTAL OF EXIT

After microorganisms find a site to grow and multiply, they need to find a port of exit if they are to enter
another host and cause disease. Ports of exit include sites such as blood, skin and mucous membranes,
respiratory tract, genitourinary tract, gastrointestinal tract, and transplacental (mother to fetus).

a. Skin and Mucous Membranes

The skin is considered a port of exit because any break in the integrity of the skin and mucous membranes
allows pathogens to exit the body. This may be exhibited by the creation of purulent drainage. The
presence of purulent drainage is a potential port of exit.

b. Respiratory Tract

Pathogens that infect the respiratory tract such as the influenza virus are released from the body when an
infected person sneezes or coughs.

c. Urinary Tract

Normally urine is sterile. However, when a patient has a urinary tract infection (UTI), microorganisms
exit during urination.

d. Gastrointestinal Tract

The mouth is one of the most bacterially contaminated sites of the human body, but most of the organisms
are normal floras. Organisms that are normal floras in one person can be pathogens in another. For
example, organisms exit when a person expectorates saliva. In addition, gastrointestinal ports of exit
include bowel elimination, drainage of bile via surgical wounds, or drainage tubes.

e. Reproductive Tract

Organisms such as Neisseria gonorrhoeae and HIV exit through a man’s urethral meatus or a woman’s
vaginal canal during sexual contact.

f. Blood

The blood is normally a sterile body fluid; however, in the case of communicable diseases such as
hepatitis B or C or HIV, it becomes a reservoir for pathogens.

4. MODES OF TRANSMISSION

Each disease has a specific mode of transmission. For example, varicella zoster (chickenpox) is spread by
the airborne route in droplet nuclei or by direct contact. The major route of transmission for pathogens
identified in the health care setting is the unwashed hands of the health care worker. Equipment used
within the environment (e.g., a stethoscope, blood pressure cuff, or bedside commode) often becomes a
source for the transmission of pathogens.

a. Contact

Direct

• Person-to-person (fecal, oral) physical contact between source and susceptible host (e.g., touching
patient feces and then touching your inner mouth or consuming contaminated food)

Indirect

• Personal contact of susceptible host with contaminated inanimate object (e.g., needles or sharp objects,
dressings, environment)

b. Droplet

• Large particles that travel up to 3 feet during coughing, sneezing, or talking and come in contact with
susceptible host

c. Airborne

• Droplet nuclei or residue or evaporated droplets suspended in air during coughing or sneezing or carried
on dust particles

d. Vehicles

• Contaminated items , Water , Drugs, solutions, Blood , Food (improperly handled, stored, or cooked;
fresh or thawed meats)
e. Vector

• External mechanical transfer (flies)

• Internal transmission such as parasitic conditions between vector and host such as:

• Mosquito

• Louse

• Flea

• Tick

5. PORTAL OF ENTRY

Organisms enter the body through the same routes they use for exiting. For example, when a needle
pierces a patient’s skin, organisms enter the body if proper skin preparation is not performed first. Factors
such as a depressed immune system that reduce body defenses enhance the chances of pathogens entering
the body.

6. SUSCEPTIBLE HOST

Susceptibility to an infectious agent depends on the individual’s degree of resistance to pathogens.

Although everyone is constantly in contact with large numbers of microorganisms, an infection does not
develop until an individual becomes susceptible to the strength and numbers of the microorganisms. A
person’s natural defenses against infection and certain risk factors (e.g., age, nutritional status, presence
of chronic disease, trauma, and smoking) affect susceptibility (resistance). Organisms such as S. aureus
with resistance to key antibiotics are becoming more common in all health care settings, but especially
acute care. The increased resistance is associated with the frequent and sometimes inappropriate use of
antibiotics over the years in all settings (i.e., acute care, ambulatory care, clinics, and long-term care)

DEFENSES AGAINST INFECTION

The body has natural defenses that protect against infection that protect against microorganisms
regardless of prior exposure. If any defenses fail, an infection usually occurs and leads to a serious health
problem.

1. NONSPECIFIC DEFENSES : -Normal floras, body system defenses, and inflammation

2. SPECIFIC DEFENSES : - antibody-mediated and cell mediated
NORMAL FLORAS

The body normally contains microorganisms that reside on the surface and deep layers of skin, in the
saliva and oral mucosa, and in the gastrointestinal and genitourinary tracts. A person normally excretes
trillions of microbes daily through the intestines. Normal floras do not usually cause disease when
residing in their usual area of the body but instead participate in maintaining health. Normal floras of the
large intestine exist in large numbers without causing illness. They also secrete antibacterial substances
within the walls of the intestine. The normal floras of the skin exert a protective, bactericidal action that
kills organisms landing on the skin. The mouth and pharynx are also protected by floras that impair
growth of invading microbes. Normal floras maintain a sensitive balance with other microorganisms to
prevent infection. Any factor that disrupts this balance places a person at increased risk for acquiring a
disease. For example, the use of broad-spectrum antibiotics for the treatment of infection can lead to
suprainfection. A suprainfection develops when broad-spectrum antibiotics eliminate a wide range of
normal flora organisms, not just those causing infection. When normal bacterial floras are eliminated,
body defenses are reduced, which allows for disease-producing microorganisms to multiply, causing
illness.

BODY SYSTEM DEFENSES

Normal defense mechanisms against infection

Defense mechanisms Action
Skin
Intact multilayered surface (first line of defense Provides barrier to microorganisms and
body against infection) antibacterial activity
Shedding of outer layer of skin cells Removes organisms that adhere to outer layers of
skin
Sebum Contains fatty acid that kills some bacteria
Mouth
Intact multilayered mucosa Provides mechanical barrier to microorganisms
Saliva Washes away particles containing microorganisms
Eye Provides mechanisms to reduce entry (blinking) or
Tearing and blinking assist in washing away (tearing) particles containing
pathogens, thus reducing dose of organisms
Respiratory Tract Traps inhaled microbes and sweeps them outward
Cilia lining upper airway, coated by mucus in mucus to be expectorated or swallowed
Urinary Tract Washes away microorganisms on lining of bladder
Flushing action of urine flow and urethra
Gastrointestinal Tract Prevents retention of bacterial contents
 Acidity of gastric secretions
Vagina
At puberty, normal flora causing vaginal secretions Inhibit growth of many microorganisms
to achieve low pH

INFLAMMATORY RESPONSE

Inflammation is a local and nonspecific defensive response of the tissues to an injurious or infectious
agent. It is an adaptive mechanism that destroys or dilutes the injurious agent, prevents further spread of
the injury, and promotes the repair of damaged tissue.

It is characterized by five signs: (1) pain, (2) swelling, (3) redness, (4) heat, and (5) impaired function of
the part, if the injury is severe. Commonly, words with the suffix -itis describe an inflammatory process.
For example, appendicitis means inflammation of the appendix; gastritis means inflammation of the
stomach.

Injurious agents can be categorized as physical agents, chemical agents, and microorganisms. Physical
agents include mechanical objects causing trauma to tissues, excessive heat or cold, and radiation.
Chemical agents include external irritants (e.g., strong acids, alkalis, poisons, and irritating gases) and
internal irritants (substances manufactured within the body such as excessive hydrochloric acid in the
stomach). Microorganisms include the broad groups of bacteria, viruses, fungi, and parasites.

A series of dynamic events is commonly referred to as the three stages of the inflammatory response:
First stage: vascular and cellular responses

Second stage: exudate production

Third stage: reparative phase

2.SPECIFIC DEFENSES

Specific defenses of the body involve the immune system. An antigen is a substance that induces a state
of sensitivity or immune responsiveness (immunity). If the proteins originate in a person’s own body, the
antigen is called an autoantigen. The immune response has two components: antibody-mediated defenses
and cell-mediated defenses. These two systems provide distinct but overlapping protection.

ANTIBODY-MEDIATED DEFENSES

Another name for the antibody-mediated defenses is humoral (or circulating) immunity because these
defenses reside ultimately in the B lymphocytes and are mediated by antibodies produced by B cells.
Antibodies, also called immunoglobulins, are part of the body’s plasma proteins. The antibody-mediated
responses defend primarily against the extracellular phases of bacterial and viral infections. The two
major types of immunity are active and passive .

In active immunity, the host produces antibodies in response to natural antigens (e.g., infectious
microorganisms) or artificial antigens (e.g., vaccines)

With passive (or acquired) immunity, the host receives natural (e.g., from a nursing mother) or artificial
(e.g., from an injection of immune serum) antibodies produced by another source

Type Antigen or antibody source Duration

1. Active Antibodies are produced by the body in Long
response to an antigen
a. Natural Antibodies are formed in the presence of Lifelong
active infection in the body.
b. Artificial Antigens (vaccines or toxoids) are Many years; the

administered to stimulate antibody immunity

a. production.
2. Passive (acquired) Antibodies are produced by another source, Short
animal or human.
b. Natural Antibodies are transferred naturally from an 6 months to 1 year
immune mother to her baby through the
placenta or in colostrum.
c. Artificial Immune serum (antibody) from an animal or 2–3 weeks
another human is injected.

CELL-MEDIATED DEFENSES

The cell-mediated defenses, or cellular immunity, occur through the T-cell system. On exposure to an
antigen, the lymphoid tissues release large numbers of activated T cells into the lymph system. These
T cells pass into the general circulation.

NOSOCOMIAL INFECTIONS / HEALTH CARE–ASSOCIATED INFECTIONS

Patients in health care settings, especially hospitals and long-term care facilities, have an increased risk
of acquiring infections. Health care–associated infections (HAIs), formerly called nosocomial or
health care–acquired infections, result from the delivery of health services in a health care facility. They
occur as the result of invasive procedures, antibiotic administration, the presence of multidrug-resistant
organisms, and breaks in infection prevention and control activities.

Patients who develop HAIs often have multiple illnesses, are older adults, and are poorly nourished; thus
they are more susceptible to infections. In addition, many patients have a lowered resistance to infection
because of underlying medical conditions (e.g., diabetes mellitus or malignancies) that impair or damage
the immune response of the body. Invasive treatment devices such as intravenous (IV) catheters or
indwelling urinary catheters impair or bypass the natural defenses of the body against microorganisms.
Meticulous hand hygiene practices, the use of chlorhexidine washes, and other advances in intensive care
unit (ICU) infection prevention help to prevent these infections.

IATROGENIC INFECTIONS are a type of HAI from a diagnostic or therapeutic procedure. For
example, procedures such as a bronchoscopy and treatment with broad-spectrum antibiotics increase the
risk for certain infections.

Health care–associated infections are exogenous or endogenous.

Exogenous infection comes from microorganisms found outside the individual such as Salmonella,
Clostridium tetani, and Aspergillus. They do not exist as normal floras.

Endogenous infection occurs when part of the patient’s flora becomes altered and an overgrowth results
(e.g., staphylococci, enterococci, yeasts, and streptococci). This often happens when a patient receives
broadspectrum antibiotics that alter the normal floras. When sufficient numbers of microorganisms
normally found in one body site move to another site, an endogenous infection develops. The number of
microorganisms needed to cause a health care–associated infection depends on the virulence of the
organism, the susceptibility of the host, and the body site affected.

ASEPSIS

Asepsis is the absence of pathogenic (disease-producing) microorganisms. Aseptic technique refers to

practices/procedures that help reduce the risk for infection.

The two types of aseptic technique are medical and surgical asepsis.

Medical asepsis, or clean technique, includes procedures for reducing the number of organisms present
and preventing the transfer of organisms. Hand hygiene, barrier techniques, and routine environmental
cleaning are examples of medical asepsis. Principles of medical asepsis are also commonly followed in
the home; hand hygiene with soap and water before preparing food is an example.

Surgical asepsis. Surgical asepsis includes procedures used to eliminate all microorganisms, including
pathogens and spores, from an object or area. In surgical asepsis an area or object is considered
contaminated if touched by any object that is not sterile. It demands the highest level of aseptic technique
and requires that all areas be kept free of infectious microorganisms.

Use surgical asepsis in the following situations:

• During procedures that require intentional perforation of the patient’s skin such as insertion of IV
catheters or central lines

• When the integrity of the skin is broken as a result of trauma, surgical incision, or burns

• During procedures that involve insertion of catheters or surgical instruments into sterile body cavities
such as insertion of a urinary catheter

Principles of surgical asepsis

1. A sterile object remains sterile only when touched by another sterile object.

2. Only sterile objects may be placed on a sterile field.

3. A sterile object or field out of the range of vision or an object held below a person’s waist is
contaminated.

4. A sterile object or field becomes contaminated by prolonged exposure to air

5. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field
becomes contaminated by capillary action

6. Fluid flows in the direction of gravity

7. The edges of a sterile field or container are considered to be contaminated

BREAKING THE CHAIN OF INFECTION

BREAKING THE CHAIN OF INFECTION NO. 1 (CONTROL OR ELIMINATION OF

INFECTIOUS AGENTS)

Proper cleaning, disinfection, and sterilization of contaminated objects significantly reduce and often
eliminate microorganisms.

Cleaning

Cleaning is the removal of all soil (e.g., organic and inorganic material) from objects and surfaces.
Generally cleaning involves use of water and mechanical action with detergents or enzymatic products.

The following steps ensure that an object is clean:

1. Rinse contaminated object or article with cold running water to remove organic material. Hot water
causes the protein in organic material to coagulate and stick to objects, making removal difficult.
2. After rinsing, wash the object with soap and warm water. Soap or detergent reduces the surface tension
of water and emulsifies dirt or remaining material. Rinse the object thoroughly.

3. Use a brush to remove dirt or material in grooves or seams. Friction dislodges contaminated material
for easy removal.

4. Rinse the object in warm water.

5. Dry the object and prepare it for disinfection or sterilization if indicated by classification of the item—
critical, semicritical, or noncritical.

6. The brush, gloves, and sink used to clean the equipment are considered contaminated and are cleaned
and dried according to policy.

Disinfection

Disinfection describes a process that eliminates many or all microorganisms, with the exception of
bacterial spores, from inanimate objects (Rutala and Weber, 2008, 2009). There are two types of
disinfection: the disinfection of surfaces and high-level disinfection, which is required for some patient
care items such as endoscopes and bronchoscopes. You accomplish disinfection using a chemical
disinfectant or wet pasteurization (used for respiratory therapy equipment). Examples of disinfectants are
alcohols, chlorines, glutaraldehydes, hydrogen peroxide, and phenols. Glutaraldehydes are caustic and
toxic to tissues and pose a potential health risk.

Sterilization

Sterilization is the complete elimination or destruction of all microorganisms, including spores. Steam
under pressure, ethylene oxide (ETO) gas, hydrogen peroxide plasma, and chemicals are the most
common sterilizing agents. ETO poses a potential health risk to staff processing with this agent, and
exposure must be monitored

BREAKING THE CHAIN OF INFECTION NO. 2 (CONTROL OR ELIMINATION OF

RESERVOIRS OF INFECTION)

Environmental cleaning

 Cleaning with hospital approved cleaner disinfectant, e.g. phenol.

 Thorough cleaning of bed and bedside equipments before admitting new admission.
 Separate mops should be used for cleaning of the unit (twice a day).
 Damp dusting should be done.
 Avoid brooming.
 Drains should be patent.
Handling of linen

 Keep the bed sheets dry and clean.

 Change sheets every day.
 Do not shake blankets and linen in ICU area.
 Do not throw them on floor.
 Soiled linen counting should be done in separate place.

Visitors control

 Traffic should be restricted except for doctors, nurses and supportive staff.
 Allow only one attendant (3—4 hours).
 Keep the doors and windows closed.
 Instruct the attendants about handwashing, disposal of waste, hygienic preparation of baby's feed,
etc. No personal clothing, flowers and eatables should be allowed.
 Mobile phones should not be allowed inside the area.

BREAKING THE CHAIN OF INFECTION NO. 3 (CONTROL OF PORTAL OF EXIT)

 Practice aseptic precautions.

 Avoid talking directly into the client's face to prevent droplet infections.
 Wearing of masks is important once the nurse herself has infection or deals with client's suffering
from infections.
 Careful handling of wastes like urine, faeces, emesis and blood is important
 Disposable gloves should be worn to prevent direct contact with wastes or infected materials.

BREAKING THE CHAIN OF INFECTION NO. 4 (CONTROL OF TRANSMISSION)

Contaminated hands of health care workers are a primary source of infection transmission in health care
settings.

Hand hygiene

Hand hygiene includes using an instant alcohol hand antiseptic before and after providing patient care,
washing hands with soap and water when they are visibly soiled, and performing a surgical scrub.

Handwashing is the act of washing hands with soap and water, followed by rinsing under a stream of
water for 15 seconds. The friction of rubbing hands together removes soil and transient organisms from
the hands.
The use of alcohol-based hand rubs is recommended by the CDC to improve hand hygiene practices,
protect health care worker’s hands, and reduce transmission of pathogens to patients and personnel in
health care settings. Alcohols have excellent germicidal activity and are as effective as soap and water.

The CDC (2002; WHO, 2009) recommends the following:

1. When hands are visibly dirty, when soiled with blood or other body fluids, before eating, and after
using the toilet, wash hands with water and either a non antimicrobial or antimicrobial soap.

2. Wash hands if exposed to spore-forming organisms such as Clostridium difficile or Bacillus anthracis.

3. If hands are not visibly soiled, use an alcohol based waterless antiseptic agent for routinely
decontaminating hands in the following clinical situations:

a. Before, after, and between direct patient contact (e.g., taking a pulse, lifting a patient, performing a
procedure).

b. After contact with body fluids or excretions, mucous membranes, non intact skin, or wound dressings

c. When moving from a contaminated to a clean body site during patient care.

d. After contact with inanimate surfaces or objects in the patient’s room (e.g., over-bed table, bed linen,
IV pump) .

e. Before caring for patients with severe neutropenia or other forms of severe immune suppression

f. Before putting on sterile gloves and before inserting indwelling urinary catheters, peripheral vascular
catheters, or other invasive devices .

g. After removing gloves.

BREAKING THE CHAIN OF INFECTION NO. 5 (CONTROL OF PORTAL OF ENTRY)

 Maintain integrity of skin and mucous membranes.

 proper positioning of tubings etc. may prevent injuries and skin breakdown
 Turning and positioning of debilitated clients.
 Ensure personal hygiene of clients regularly.
 Dispose of contaminated syringes and needles properly to prevent proper handling of catheters,
drainage sets etc. is essential
 Care should be taken while collecting and handling specimen.

BREAKING THE CHAIN OF INFECTION NO.6 (PROTECTING SUSCEPTIBLE HOST )

Protecting normal defence mechanisms by:

 Regular oral hygiene.

  Maintaining an adequate intake.
 Encouraging deep breathing and coughing exercises.
 Encouraging proper immunization of children and adult clients.

Maintaining healing processes: This involves:

 Promotion of intake of a well-balanced diet containing essential proteins, vitamins, fats and
carbohydrates.
 Institution of measures to improve appetite of the patient.
 Promotion of the client's comfort and sleep.
 Helping the client to identify method to relieve stress.

SUMMARY

Nurses are directly involved in providing a biologically safe environment. Microorganisms exist
everywhere: in water, in soil, and on body surfaces such as the skin, intestinal tract, and other areas open
to the outside (e.g., mouth, upper respiratory tract, vagina, and lower urinary tract). Infectious diseases are
a major cause of death worldwide. The control of the spread of microorganisms and the protection of
people from communicable diseases and infections are carried out on international, national, state,
community, and individual levels. The World Health Organization (WHO) is the major regulatory agency
at the international level. The nurse implements strategies to prevent infection. If infection cannot be
prevented, the nurse’s goal is to prevent the spread of the infection within and between individuals, and
treat the existing infection