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Infection Control and

Infection Control
- intact and active public health system
- universal immunizations
- optimal nutrition
- use of specific methods to prevent transmission of infection

Nosocomial Infection acquired during hospitalization

- 3.5% of children admitted to hospitals
- higher rates in intensive care units
- also acquired in emergency departments, physicians offices, and long
term care settings
- increased use of medical devices at home education of home health
care providers

Determinants of Infection
1. Host Factors-
- anatomic abnormalities
- damage to skin
- organ dysfunction
- malnutrition
- underlying disease or comorbidities
2. Prior invasive procedures
- may introduce pathogens, and damage anatomic host defences
3. Use of catheters
- bypass host defences, provide direct access to sterile sites,
provide adherence sites for microbes, and may occlude normal
ostia, eg. Eustachian tube
4. Use of antibiotics
- alter normal bowel flora and encourage colonization by
resistant flora, and may suppress hematopoiesis
5. Exposure to other patients, visitors, or other health care providers with
contagious disease, and damage host

Routes of Transmission of Infection

1. via the hands most common and most important route
2. through fomites
3. by airborne transmission
4. food and water contamination
Common causes of nosocomial infection in children:

1. Seasonal viruses
2. Staphylococcus
3. Gram negative bacilli
4. Fungi and resistant bacteria in immunocompromised children, those
who require intensive care, and prolonged hospitalization
Common sites of infection-
1. respiratory tract
2. gastrointestinal tract
3. blood stream
4. skin
5. urinary tract
I. Prevention
1. Hand hygiene
- the most important measure in any infection control progam
- 15 sec. scrub removes the majority of transient flora but does not
alter the permanent flora

- In child care settings and schools hand washing can be taught to children
- The rates of infection are decreased when children and care givers
regularly clean their hands
II. Standard Precautions
- Universal Precautions
- intended to protect health care workers from blood and body fluids
- should be used whenever providing care
- involve the use of barriers gloves, gowns, masks, googles, and
face-shields as needed to prevent transmission of organisms,
associated with contact with blood and body fluids
III. Isolation
- decreases the risk of nosocomial infection
- depends on the infecting agent and route of transmission
- contact transmission most frequent mode
> direct contact
> contact with contaminated intermediate object
- droplet transmission by droplets propelled a short distance through
the air and deposited on mucous membranes
- airborne transmission dissemination of droplet nuclei (5 m) of
evaporated droplets or dust particles carrying the infectious agents
- Standard precautions indicated for all patients
- Contact precautions include gowns and gloves and single room isolation
- Droplet precautions include masks for close contact (<3 ft.) and
single room isolation
- Cohorting of children infected with the same pathogen
- Airborne precautions include masks and single room isolation with
negative pressure ventilation
Outpatient Setting
-separate waiting areas for well and sick children
- triage of patients is essential to ensure that contagious children or
adults are not present in waiting areas
- toys and items that are shared between patients should be cleaned
between uses soap and water is enough
- complete disinfection or sterilization for items that encounter mucus
and for all reusable items used for body fluid sampling
Additional Measures:
1. Aseptic technique
2. Catheter care
3. Prudent use of antibiotics
4. Isolation of contagious patients
5. Cleaning of the environment
6. Disinfection and sterilization of medical equipments
7. Reporting of infections
8. Safe handling of needles and other sharp instruments
9. Establishment of employee health services
Surgical Prophylaxis
- is appropriate when there is high risk of postoperative infection or
when the consequences of infection are catastrophic

Four categories of wounds based on risk having/becoming infected

1. Clean wounds-uninfected operative wounds, with no inflammation
- respiratory, alimentary, genitourinary tracts, and the oropharynx are not
- elective procedures eg. Operative incisional wounds after non-
penetrating trauma
- prophylactic antimicrobial therapy is not recommended
2. Clean contaminated wounds
- operative wounds in which the respiratory, alimentary or genitourinary
tract is entered under controlled conditions and does not have unusual
contamination preoperatively
- operations that involve the biliary tract, appendix, vagina, and oropha-
rynx with no evidence of infection or break through in technique
- antimicrobial prophylaxis is recommended
3. Contaminated Wounds
- open fresh and accidental wounds
- major breaks in otherwise sterile operative technique
- gross spillage from the gastrointestinal tract
- penetrating trauma occurring <4H earlier
- incisions in which acute nonpurulent inflammation is encountered
IV. Dirty and infected wounds
- penetrating traumatic wounds longer than 4H earlier
- those with retained devitalized tissue
- those in which infection is apparent
- viscera have been perforated
- antimicrobial therapy is indicated and may need to be given for
5 to 10 days
Employee Health
- Employees are at risk for acquiring infections from patients
- Minimized by use of standard precautions and hand hygiene before and
after all patient contacts
- Infected employees also pose a risk to patients
- All health workers should be immune to measles, varicella, and
- health workers who might be exposed to blood or body fluids should
be immunized against Hepatitis B
- annual influenza immunization
- lessens staff illness and absenteeism and reduces nosocomial infections
- hospital policies on immunization of employees, exclusion of infected
- Regular educational sessions on infection control methods and policies