Infection control in the hospital: Best practices

Harmful disease pathogens like bacteria, viruses, and fungi can thrive in the hospital environment if proper infection control is not practiced in the hospital. 

We would be discussing how these healthcare-associated infections can be transmitted and the various measures that can be taken to control them.

Healthcare-associated infections

When a patient is hospitalized, they become exposed to the risk of contracting infections from the healthcare environment.

Transmission could be from the hospital environment, from the equipment used for their treatment and care, or from other infectious patients, and healthcare staff present in the hospital.

These healthcare-associated infections have become a major problem for both patients and healthcare workers as it is a major cause of mortality and morbidity.  

The major infections associated with healthcare settings can manifest as bloodstream infections, ventilator-associated pneumonia, urinary tract infections, and surgical site infections.

With the right prevention and control measures,  transmission and spread of such infections can be controlled.

Implementing effective infection control measures in the hospital can help minimize the risk of healthcare-associated infections and help to maintain a safe and conducive environment for both patients and healthcare workers.  

Transmission of Infections in Hospitals 

1. Direct Contact

Transmission of infections in hospitals through direct contact is the most common type of transmission in the hospital environment.

This happens when disease pathogens are transferred directly from one person to another. This could be skin-to-skin, or via the mucous membranes of infected persons.

Also, direct contact can be through contact with contaminated surfaces in the hospital environment. 

Transmission via direct contact can be between a healthcare worker and a  patient, between two patients in the hospital, and between patients and their care providers.  

Healthcare workers sometimes act as carriers of infectious pathogens after direct encounters with infectious patients.

These pathogens are transferred from the healthcare worker to a susceptible patient that comes in contact with the worker.

In some cases, these disease pathogens are transferred from the healthcare worker to the patient without actually infecting the healthcare worker.

In such cases, the healthcare worker only played the role of the disease carrier. 

Also, infected patients sometimes contaminate surfaces by directly touching them with infectious hands. These surfaces may be touched by a  healthcare worker and subsequently carried to another patient. 

Other ways through which transmission via contact can occur include contact with body fluids such as blood, saliva, and urine; contact with shared medical equipment, contact with patient’s skin, and wound dressing and contact with other contaminated items.  

Examples of microorganisms that are commonly transmitted through contact include antibiotic-resistant strains of Staphylococcus aureus,  rotavirus, Vancomycin-resistant Enterococci [VRE], and Clostridium difficile. 

These pathogens are associated with impetigo, diarrhea, abscess, and scabies.  

2. Respiratory Droplets Transmission

When an infected person coughs,  sneezes, or talks, droplets are transmitted from the respiratory tract to their immediate surrounding. While some of these droplets settle directly on surfaces, others are inhaled by people in close proximity to the infected person. 

Common disease pathogens that can be transmitted through respiratory droplets include Neisseria meningitis, bordetella pertussis, SARS-COV-2,  and influenza.

3. Airborne Transmission

When small droplets from the respiratory tract of an infected patient are inhaled by another patient or healthcare personnel, transmission of these disease pathogens is likely.

Unlike direct transmission via respiratory droplets, in the case of airborne transmission, the infectious particles travel farther.

These particles sometimes stay suspended in the air for a long time. Some diseases which are transmitted through air include tuberculosis, chicken pox, measles, and COVID.  

Other modes of transmission of infections in healthcare settings include:  

  • Contaminated food and water 
  • Contaminated medications. 
  • Contaminated medical equipment and devices.  

While these modes of transmission of infections in the hospital help spread infections, there are certain individuals that are more prone to acquiring infections from the hospital environment when exposed to such conditions.

Such  persons include: 

  • Newborns, infants, or the elderly 
  • Individuals with weakened immune systems. A weakened immune system could be a result of disease conditions, organ transplants, or medications used to suppress the immune system.  
  • Patients with altered cellular immune functions. Some medical procedures like bone marrow transplants, treatment for autoimmune diseases, and cancer treatments can alter cellular immune functions.  
  • Patients with certain genetic disorders that impair the function of the cells of the immune system. (Phagocytes).  
  • Patients who had undergone surgery or procedures that require the insertion of medical devices into the body.  
  • Patients who have been in the hospital for longer periods. 
  • Burn patients. 

It is common to find patients in intensive care units under one or more of these categories. This is the reason why these ICU patients are more susceptible to infections in the hospital. 

Effective measures for infection control in the hospital

infection control in the hospital

Having discussed the various modes of transmission of infections in the healthcare setting, and factors that put a person more at risk of contracting these infections, it becomes necessary to implement precautionary measures to prevent the transmission and spread of infections in the hospital environment.  

The following guidelines can be followed in healthcare settings to help protect the staff, patients, caregivers, and their visitors from harmful infectious pathogens present in the hospital environment. 

1. Hand Hygiene

When we discussed the transmission of infections in the hospital, transmission through direct contact was a major mode of transmission in healthcare settings.

One of the most common vehicles of transmission through contact is the hands.

Observing hand hygiene is a very effective measure that helps prevent the spread of infections in the hospital.  Hand hygiene should be practiced by healthcare workers at different intervals during, before, and after tending to a patient.  

Guidelines for practicing hand hygiene in the hospital

  • Hands should be washed with soap and water and rubbed together for at least 15 seconds. Scrubbing and rubbing together hands should be done thoroughly, making sure all parts of the hand are covered with the hand washing product.  
  • The hands should be dried properly after washing 
  • An alcohol-based hand rub or sanitizer can be used in cases where the hands show no visible sign of dirt.  
  • Fingernails of healthcare personnel should not be kept and allowed to grow long. It should be cut often. The use of artificial nails or nail polish should not be encouraged.  
  • Hand jewelry that may serve as surfaces for pathogens to dwell on should be removed, especially during surgical hand preparation.  
  • The necessary supplies for hand hygiene should be available in strategic areas in the healthcare facility. 
  • Patients, families of patients, and visitors should be encouraged to practice hand hygiene in healthcare facilities. 

2. Sanitization and disinfection of the hospital environment 

Transmission of infection by contact is also based on some environmental factors. The environment around a patient could be contaminated with disease pathogens contained in respiratory droplets, spilled blood, the skin,  infectious cells, and fluids from the patient.

Some surfaces are more susceptible to the deposition of microorganisms from the infected patient as a  result of their close proximity with the patient, and their tendency to be in contact with different hands. Susceptible surfaces include bed rails,  bedside tables, carts, doorknobs, and faucet handles.  

These surfaces once contaminated are capable of harboring infectious pathogens for several days. These surfaces can help spread microorganisms from patients to healthcare workers or visitors even without them being in direct contact with the patient.  

It becomes necessary to ensure the frequent cleaning and disinfection of the environment with priority placed on the patient’s bed area and immediate environment.  

Cleaning products used in the hospital environment should be disinfectants with broad-spectrum efficacy against microorganisms. 

To maintain safe air quality, there should be regular checks on the ventilation systems in the hospital environment. Recirculated air should pass through appropriate filters.  

3. Proper use of PPE

Personal protective equipment used in healthcare settings include gloves, gowns, face masks, protective eyewear, face shield, shoes, and head covering.

The proper use of this protective equipment can help reduce the rate of transmission of pathogenic microbes in the hospital environment.  

It is important that healthcare workers are trained on how to properly use,  wear and remove PPE. Improper use of PPE by a healthcare worker can pose serious healthcare risks to both the healthcare worker and the patient they’re tending to.  

Potentially infectious patient care equipment should be handled carefully to prevent the transfer of infections to the environment.

Sharps should be discarded properly after each use. PPE should be changed when moving from an infected area to a clean area in the hospital.  

Safety measures like sterilization should be employed when using reusable  PPE between patients.  

4. Isolation

Isolation is an infection control measure used in healthcare settings to prevent the spread of infections from patient to patient.

Isolation can either be done for patients who have their immune system compromised, or for patients infected with a highly contagious disease. 

Isolation for immunocompromised patients is done to reduce their chances of contracting an infection from the environment.

This is because they have a greater risk of getting infected with opportunistic infections. This measure helps to protect them from infections, reducing the spread of infections in the hospital.  

Patients who are infected with highly contagious diseases are isolated because they can easily transmit infections to other patients, and healthcare workers tending to them.

During the isolation of such patients, it is important that the staff caring for this group of patients use personal protective equipment when entering the isolation centers. This would help prevent the transmission of infection from patient to staff. 

5. Vaccination and Immunization Programs 

Healthcare workers should be immunized for diseases that can be prevented with vaccines. This reduces the likelihood of patient-to-staff transmission.

This would help reduce the spread of infection in the hospital as it would become impossible for healthcare workers to contract and transmit infections to the patients they are caring for. 

Immunization of patients before admission can prevent them from contracting infections during their stay in the hospital.

This would prevent outbreaks of diseases in the hospital environment, promoting a safe environment for both patients and staff.  

7. Hospital waste disposal 

Waste produced from the hospital can serve as grounds for bacteria and a  medium of transmission of infections.

Proper disposal of medical waste is essential in the control of infections in hospitals. Medical waste includes used syringes, contaminated dressings, blades and scalpels, and other disposable materials used in the treatment of patients.

Not only does proper waste disposal help control the spread of infections in the hospital environment, but it also protects the general public from potential disease outbreaks.  

There should be strict protocols in place for the segregation, packaging,  transportation, and disposal of hospital waste. There may be a need to treat and disinfect hospital waste before disposal. 

Common methods of hospital waste management include chemical disinfection, incineration, and sterilization under high temperatures and pressure.  

7. Proper use of antibiotics 

This is essential in the control of infections both in the hospital and in the community. Antibiotic misuse can lead to antibiotic-resistant strains of infection.

These strains can be transmitted and spread to other patients in the hospital environment.  

There are guidelines that can be adhered to help prevent the emergence of these resistant strains. Some of these include: 

  • Use antibiotics only when necessary. Such usage should be after laboratory tests and clinical diagnosis. 
  • Prescription of the right dose of antibiotics for use within the correct number of days, using the correct route of administration.  
  • Monitoring of patients under antibiotic therapy to ensure that the treatment is effective. 

By adhering to the above guidelines, the spread of infections can be minimized in the hospital as treatment would be thorough and the emergence of resistant strains of diseases would be completely prevented.  

What Next? 

Healthcare workers must be conscious of infection control in the hospital environment. Proper education and training should be carried out to help healthcare workers understand the various techniques that they can implement to prevent the spread of infections.  

Although not all infections can be prevented, if there are adequate measures taken in healthcare settings to prevent the spread of infection, the transmission of hospital-acquired infections would be eliminated.

Routine surveillance by governing bodies in healthcare should be carried out to ensure that infection  control measures are being implemented by hospitals  

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Last Updated on May 17, 2023 by Our Editorial Team