MICROBIOLOGY AND PARASITOLOGY BSCI 106

CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

CHAPTER 12: HEALTH CARE EPIDEMIOLOGY

o infections that are acquired outside health care
AND INFECTION PREVENTION
facilities (community-acquired infections)
AND CONTROL
➢ Community-acquired infections are those
that are present or incubating at the time of
CHAPTER 12 OUTLINE:
hospital admission.
− A hospitalized patient could have either type of
12.1 Health Care–Associated Infections infection.
IATROGENIC INFECTION
12.2 Infection Prevention and Control − term “health care–associated infection” (HAI)
should not be confused with the term
12.3 Conclusions “iatrogenic infection” (iatrogenic literally
meaning “physician induced”)
− Iatrogenic infection is an infection that results
from medical or surgical treatment (an infection
HEALTH CARE EPIDEMIOLOGY that is caused by a surgeon, another physician,
− Can be defined as the study of the occurrence, or some other health care worker)
determinants, and distribution of health and − Iatrogenic infections are a type of HAI, but not
disease within health care settings. all HAIs are iatrogenic infections.
− Health and disease are the result of complex Examples:
interactions between pathogens, patients, and ➢ surgical site infections
the health care environment. ➢ urinary tract infections (UTIs) that result from
− Primary focus of health care epidemiology is on urinary catheterization of patients.
infection control and preventing health care– FREQUENCY OF HEALTH CARE–
associated infections (HAIs) ASSOCIATED INFECTIONS
▪ Activities include - surveillance, risk reduction ▪ In the United States, approximately 4% of
programs, policy development, and education hospitalized patients develop HAIs.
of health care personnel ▪ Of these, the greatest number of deaths was
− The importance of microbiology to those who caused by pneumonia.
work in health-related occupations can never ▪ HAIs cause significant increases in excess
be overemphasized. hospital stays and costs for additional
HEALTH CARE–ASSOCIATED INFECTIONS treatment.
Infectious diseases (infections) can be divided into PATHOGENS MOST OFTEN INVOLVED IN
two categories: HEALTH CARE–ASSOCIATED INFECTIONS
o infections that are acquired within hospitals or − Hospital environment hosts various pathogens,
other health care facilities (health care– including drug-resistant strains
associated infections HAIs) Four most prevalent causes of HAIs in U.S.
➢ All other infections are considered HAIs, hospitals:
including those that erupt within 14 days of − Clostridium difficile
hospital discharge. − Staphylococcus aureus
− Klebsiella pneumoniae and Klebsiella oxytoca
− Escherichia coli

ADRIAN H MALLORCA, BS N 1H CHAPTER 12 1

 MICROBIOLOGY AND PARASITOLOGY BSCI 106
CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

− HAIs often originate from patients' own MODES OF TRANSMISSION

indigenous microbiota; enter a surgical incision three principal routes by which pathogens
or otherwise gain entrance to areas of the body involved in HAIs are transmitted are:
other than those where they normally reside • contact
− For C. difficile, the organism may have been • droplet
part of the patient’s indigenous microbiota but • airborne
was allowed to overgrow after antibiotic usage. Contact Transmission
− Approximately 70% of HAIs involve drug- two types of contact transmission:
resistant bacteria due to selective pressure − Direct contact transmission, pathogens are
from antimicrobial agents transferred from one infected person to another
− HAIs caused by certain pathogens, like person without a contaminated intermediate object
Pseudomonas and multidrug-resistant bacteria, or person.
are challenging to treat. − Indirect contact transmission, happens when
− Fungi, such as Candida spp., are also pathogens are transferred via a contaminated
becoming more resistant to antifungal agents. intermediate object or person.
− CDC launched a campaign in 2001 to prevent Droplet Transmission
antimicrobial resistance in health care settings. − respiratory droplets carrying pathogens
CDC recommended 12 steps to prevent
transmit infection when they travel from the
antimicrobial resistance among hospitalized adults.
respiratory tract of an infectious individual (e.g.,
by sneezing or coughing) to susceptible
mucosal surfaces of a recipient.
− Droplets traditionally have been defined as
being larger than 5 μm in size.
Airborne Transmission
− Airborne transmission occurs with
dissemination of either airborne droplet nuclei
or small particles containing pathogens.
− airborne droplets are defined as being less than
or equal to 5 μm in size.
MOST COMMON TYPES OF HEALTH CARE–
ASSOCIATED INFECTIONS
Most common types of HAIs in U.S. hospitals are
the following:
1. C. difficile–associated gastrointestinal disease
(antibiotic-associated diarrhea [AAD])
2. UTIs, most of which are catheter related
3. Surgical site infections
4. Lower respiratory tract infections (primarily
pneumonia)
5. Bloodstream infections (septicemia)

ADRIAN H MALLORCA, BS N 1H CHAPTER 12 2

 MICROBIOLOGY AND PARASITOLOGY BSCI 106
CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

Most common organism causing HAI is C. Three major contributing factors in health care–
difficile associated infections.
➢ Anaerobic, spore-forming, Gram-positive 1. An ever-increasing number of drug-resistant
bacillus. pathogens
➢ Part of indigenous colon microbiota in small 2. The failure of health care personnel to follow
numbers. infection control guidelines
➢ produces two types of toxins (an enterotoxin 3. An increased number of immunocompromised
and a cytotoxin) patients.
➢ Toxins cause antibiotic-associated diarrhea Additional contributing factors:
(AAD) and severe form of the disease is known • Indiscriminate use of antimicrobial agents.
as pseudomembranous colitis • False sense of security regarding antimicrobial
pseudomembranous colitis (PMC). agents, leading to neglect of aseptic techniques
➢ PMC results in sections of colon lining and infection control procedures.
sloughing off, leading to bloody stools. • Lengthy, complicated surgeries.
➢ C. difficile, which is resistant to many orally
• Hospital overcrowding and staff shortages.
administered antibiotics
• Increased reliance on less trained health care
Zoonoses - diseases that are transmissible from
workers who may lack awareness of infection
animals to humans.
control.
PATIENTS MOST LIKELY TO DEVELOP
• Increased use of anti-inflammatory and
HEALTH CARE- ASSOCIATED INFECTIONS
immunosuppressant agents.
Immunosuppressed patients- patients whose
• Overuse and improper use of indwelling
immune systems have been weakened by age,
medical devices.
underlying diseases, or medical or surgical
What can be done to reduce the number of
treatments.
health care–associated infections?
− Contributing factors include an aging
− The primary way to reduce the number of HAIs
population; increasingly aggressive medical
is strict compliance with infection control
and therapeutic interventions
guidelines.
− The highest infection rates are in intensive care
− Handwashing is the single most important
unit (ICU) patients
measure to reduce the risks of transmitting
− HAI rates are three times higher in adult and
pathogens from one patient to another
pediatric ICUs than elsewhere in the hospital.
“Standard Precautions.”
The following are the most vulnerable patients Handwashing guidelines:
in a hospital setting: Before:
elderly patients,women in labor and delivery,
premature infants and newborns, − Prepare or eat food
surgical and burn patients, − Treat a cut or wound or tend to someone who
patients with diabetes or cancer, is sick
patients with cystic fibrosis,
patients having an organ transplant, − Insert or remove contact lenses
patients receiving treatment with steroids, anticancer After:
drugs, antilymphocyte serum, or radiation,
immunosuppressed patients (i.e., patients whose − Use the restroom
immune systems are not functioning properly), − Handle uncooked foods, especially raw meat,
patients who are paralyzed or are undergoing renal
dialysis or urinary catheterization, poultry, or fish
patients with indwelling devices, such as endotracheal
tubes, central venous and arterial catheters, and synthetic
implants.

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 MICROBIOLOGY AND PARASITOLOGY BSCI 106
CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

− Change a diaper DISINFECTION

− Cough, sneeze, or blow your nose Categories of disinfectants:
− Touch a pet, particularly reptiles and exotic • Chemical sterilants: Kill bacterial spores with
animals prolonged exposure times (3–12 hours).
− Handle garbage • High-level disinfectants: Kill all microbes,
− Tend to someone who is sick or injured including viruses, except large numbers of
Handwashing procedure: bacterial spores.
Following manner: • Intermediate-level disinfectants: Might kill
− Use warm or hot running water and soap. mycobacteria, vegetative bacteria, most
− Wash all surfaces thoroughly, including wrists, viruses, and most fungi, but do not necessarily
palms, back of hands, fingers, and under kill bacterial spores.
fingernails. • Low-level disinfectants: Kill most vegetative
− Rub hands together for at least 10 to 15 bacteria, some fungi, and some viruses within
seconds. 10 minutes of exposure.
− When drying, start with forearms and work Spaulding System for Classification of
toward hands and fingertips, patting skin Instruments
instead of rubbing to avoid chapping and Critical items
cracking. − Critical items confer a high risk for infection if
INFECTION PREVENTION AND CONTROL they are contaminated with any microbe.
− Pertains to the numerous measures that are − Critical items include surgical instruments,
taken to prevent infections from occurring cardiac and urinary catheters, implants, and
within health care settings. ultrasound probes used in sterile body cavities.
− Infection control measures are designed to Semicritical items
break various links in the chain of infection. − Semicritical items contact mucous membranes
− Joseph Lister and Ignaz Semmelweis or nonintact skin and require high-level
discovered in the 19th century that wound disinfection.
contamination can be prevented, leading to the − include respiratory therapy and anesthesia
concept of asepsis. equipment, some endoscopes, laryngoscope
− Asepsis, which literally means without infection blades, esophageal manometry probes,
− Aseptic techniques include general cleanliness, cytoscopes, anorectal manometry catheters,
frequent and thorough handwashing, isolation and diaphragm fitting rings
of infected patients, disinfection, and − minimally require high-level disinfection
sterilization. Noncritical items
− There are two main types or categories of − Noncritical items are those that
asepsis: medical asepsis and surgical asepsis. come in contact with intact skin, but not mucous
Medical Asepsis membranes.
• Medical asepsis is a clean technique. Its goal is − Such items are divided into two
to exclude pathogens. subcategories: noncritical patient-care items (
• It involves measures to prevent direct transfer bedpans, blood pressure cuffs, crutches, and
of pathogens from person to person and computers) and noncritical environmental surfaces
indirect transfer through air or objects (fomites) (bed rails, some food utensils, and floors).

ADRIAN H MALLORCA, BS N 1H CHAPTER 12 4

 MICROBIOLOGY AND PARASITOLOGY BSCI 106
CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

SURGICAL ASEPSIS − Standard Precautions are to be applied to the

− Or sterile technique, includes practices used to care of all patients in all health care settings,
render and keep objects and areas sterile. regardless of the suspected or confirmed
following points are differences between presence of an infectious agent.
medical and surgical asepsis: − Based on the principle that all blood, body
• Medical asepsis is a clean technique, whereas fluids, secretions, excretions except sweat,
surgical asepsis is a sterile technique. nonintact skin, and mucous membranes may
• The goal of medical asepsis is to exclude contain transmissible infectious agents
pathogens, whereas the goal of surgical − Implementation of Standard Precautions
asepsis is to exclude all microbes. constitutes the primary strategy for the
Surgical aseptic techniques are practiced in prevention of health care–associated
operating rooms, in labor and delivery areas, and transmission of infectious agents between
during invasive procedures. patients and health care personnel.
For example, invasive procedures, such as VACCINATIONS
drawing blood, injecting medications, urinary The Immunization Action Coalition
catheter insertion recommends healthcare personnel
❖ Other surgical aseptic techniques include receive the following vaccines:
surgical scrubbing of hands and fingernails • Hepatitis B vaccine
before entering the operating room; wearing • Influenza (annually)
sterile masks • Measles–mumps–rubella
• Varicella (chickenpox)
Regulations pertaining to health care • Tetanus–diphtheria–pertussis
epidemiology and infection control • Meningococcal vaccine (for microbiologists
❖ Regulations pertaining to health care who are
epidemiology and infection control in the United • routinely exposed to isolates of Neisseria
States, particularly the Bloodborne Pathogen meningitidis)
Standard (29 CFR 1910.1030): PERSONAL PROTECTIVE EQUIPMENT
There are many components of personal
• Published by the Occupational Safety and protective equipment (PPE). The most common
Health Administration (OSHA) in 2001. are listed here:
• Requires facilities with employees having Glove
occupational exposure to blood or other − Gloves can protect both patients and health
potentially infectious materials to prepare and care personnel from exposure to infectious
update a written plan called the Exposure materials that may be carried on hands.
Control Plan. − must be changed between tasks and
STANDARD PRECAUTIONS procedures on the same patient whenever
− To prevent transmission of pathogens within there is risk of transferring microorganisms
health care settings, two levels of safety from one body site to another.
precautions have been developed by the CDC: − hygiene should be performed prior to
Standard Precautions and Transmission-Based putting on gloves.
Precautions.

ADRIAN H MALLORCA, BS N 1H CHAPTER 12 5

 MICROBIOLOGY AND PARASITOLOGY BSCI 106
CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

Isolation Gowns Linens

− Isolation gowns are worn in conjunction with
− Textiles, such as bedding, towels, and patient
gloves and with other PPE when indicated.
gowns, that have become soiled with blood,
Gowns are usually the first piece of PPE to be
body fluids, secretions, or excretions must be
donned. handled, transported, and laundered in a safe
− They protect the health care worker’s arms manner
and exposed body areas and prevent
contamination of clothing with blood, fluids, and Disposal of Sharps
other potentially infectious material. − Needlestick injuries and injuries resulting from
Masks broken glass and other sharps are the primary
− They are worn by health care personnel to manner in which health care workers become
protect them from contact with infectious infected with pathogens, such as HIV, HBV,
material from patients and HCV.
− They are worn by health care personnel
Transmission-Based Precautions
when engaged in procedures requiring
sterile technique to protect patients from • Contact Precautions: Used for patients
exposure to pathogens that may be present known or suspected to be infected or
in a health care worker’s mouth or nose. colonized with pathogens spread by direct or
Respiratory Protection indirect contact.
− Respiratory protection requires the use of a • Contact Enteric Precautions: Specifically for
respirator with N95 or higher filtration to prevent pathogens spread by fecal-oral route. is the
inhalation of infectious particles. most frequent mode of transmission of HAIs.
Eye Protection. • Droplet Precautions: For pathogens
transmitted by respiratory droplets produced
− Types of eye protection include goggles and by coughing, sneezing, or talking. Droplet
disposable or non-disposable face shields. Precautions are used for particles that are
Masks may be used in combination with larger han 5 μm in diameter.
goggles, or a face shield may be used instead • Airborne Precautions: For pathogens that
of a mask and goggles remain suspended in the air for long periods or
Environmental Control can be disseminated over long distances.
Airborne Precautions are used when particles
− The hospital must have, and employees are 5 μm or less in diameter.
must comply with, adequate procedures for the
routine care, cleaning, and disinfection of It's important to use Transmission-Based
environmental surfaces, such as bedrails, Precautions in addition to Standard Precautions.
bedside tables, commodes, doorknobs, sinks, Patient Placement
and any other surfaces and equipment, in close
proximity to patients. • Single-patient rooms are preferred for
patients who might contaminate the hospital
environment or who cannot maintain
appropriate hygiene.
• Single rooms are always indicated for
patients on Airborne Precautions and

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 MICROBIOLOGY AND PARASITOLOGY BSCI 106
CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

preferred for those requiring Contact or Handling Fomites

Droplet Precautions.
Fomites are nonliving objects that may harbor and
Airborne infection isolation rooms (aiir) transmit microbes. Examples in health care
settings include patients' gowns, bedding, towels,
• Preferred placement for patients infected with eating and drinking utensils, and various hospital
pathogens spread via airborne droplet nuclei, equipment.
requiring Airborne Precautions.
• AIIRs are single-patient rooms equipped with − Transmission of pathogens by fomites can be
special air handling and ventilation systems. prevented by:
• Under negative pressure to prevent room air − Using disposable equipment and supplies
from entering the corridor when the door is whenever possible.
opened. − Disinfecting or sterilizing equipment promptly
• Air evacuated from AIIRs passes through high- after use.
efficiency particulate air (HEPA) filters to − Using individual equipment for each patient.
remove pathogens. − Using electronic or glass thermometers with
• Standard and Airborne Precautions are strictly disposable covers or single-use thermometers.
followed in AIIRs. − Emptying bedpans and urinals, washing them
in hot water, and storing them in a clean
Protective Environment
cabinet between uses.
• Patients vulnerable to infection, particularly − Placing bed linen and soiled clothing in bags to
invasive environmental fungal infections, be sent to the laundry.
include those with severe burns, leukemia,
Medical Waste Disposal
hematopoietic stem cell transplant recipients,
immunosuppressed individuals, those − Materials harmful to health are called
undergoing radiation treatments, leukopenic biohazards and must be identified by a
patients, and premature infants. biohazard symbol.
• These patients can be protected by placing − According to OSHA standards, medical wastes
them in a Protective Environment, also known must be disposed of properly.
as protective isolation or positive pressure
isolation. Standards include:
• The Protective Environment is a well-sealed • Receptacles for decomposable solid or liquid
single-patient room where vented air passes waste must not leak and must be kept sanitary,
through HEPA filters and is under positive with a solid, tight-fitting cover if needed.
pressure to prevent corridor air from entering • Sweepings, solid or liquid wastes, refuse, and
when the door is opened. garbage must be removed promptly to maintain
Handling Food and Eating Utensils a sanitary environment.
• The medical facility's infection control program
− Contaminated food provides an excellent must address the handling and disposal of
environment for potentially contaminated items.
− the growth of pathogens. Most often, human
carelessness, especially neglecting the practice
of handwashing, is responsible for this
contamination.

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 MICROBIOLOGY AND PARASITOLOGY BSCI 106
CHAPTER 12: Health Care Epidemiology and Infection Prevention and Control
SECOND SEMESTER | 2023-2024 | PROF: ELIJAH JOY SULADAY
BSN 1H: ADRIAN H. MALLORCA

Infection Prevention and Control

Committees and Infection Control
Preventionists
− A hospital’s infection control and prevention
program is usually under the jurisdiction of the
hospital’s IPCC or Epidemiology Service.

ADRIAN H MALLORCA, BS N 1H CHAPTER 12 8