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Infection Control


Infection control is an important issue which stays in the focus of attention for many years. Since ancient time infectious diseases brought danger to people. Modern medicine can provide a lot of means to control infectious disease but this problem is not completely overcome yet. That is the reason infection control is a subject of great concern of scientists, medical workers and ordinary people.
Under infection control we usually understand policies and procedures, which are used to reduce the risk of spreading infections. Special attention to this measure should be paid in health care organizations and hospitals.
Infectious diseases are kind of diseases, which are transmitted by human to human contact, animal to human contact or human contact with an infected surface. These diseases can be also be spread by airborne transmission. Even smallest droplets from infectious agents, which get to the air can cause the spread of disease. Sometimes diseases are classified according to the way of transmission. For example, diseases which are transmitted from animals to humans are called zoonosaes and animals, which carry infections are called vectors. There is a big problem with infection spread inside of the health care institution. Very often people, who come to the hospital with one disease, become infected with another disease. This results in additional time patients have to spend in the hospital and can result in different complications and even death. Infections, which are contracted in hospitals, are called nosocomial infections. Statistics state that they occur to more than 5% of hospital patients (NIAID). Such high rates can be explained by the fact that in many case patients have weakened immune system and this puts them in danger to become victims of infections (Lee, 2002).
Infection Control has become especially widespread in the United States since the 1950s, after great spread of staphylococcal infections in the hospitals. Centers of Disease Control and Prevention have been created all over the country in order to control the situation with infectious diseases. These centers initiated the appliance of different infection control procedures and they present standard precautions for infection control. “To lower the risk of nosocomial infections, the CDC began a national program of hospital inspection in 1970 known as the National Nosocomial Infections Surveillance system, or NNIS. The CDC reported that over 300 hospitals participate in the NNIS system as of the early 2000s.” (Jarvis, 2003) Infection control will be effective if it is followed not only in the hospitals, but also in clinics, child care centers, public places and at homes of people. All there preventive measure taken together can provide the best infection control. Latest researches show that infection control programs can be an effective means, which helps to reduce the rates of infection.
Infectious diseases are hard to cure because newer and newer types of infectious diseases appear constantly. There are several causes of such a phenomenon. Environmental pollution and changes in the lifestyles are among the main reasons of the appearance of new kinds of infectious diseases. This factor makes the question about the defense from infectious diseases of paramount importance. During last three years there have been uncovered a big number of infectious diseases. AIDS, Ebola and Hantavirus are only the most well known ones. There are a lot of new viruses, which are not as widespread as the ones mentioned above but at the same time they are not less dangerous.
It is also necessary to take into account that a lot of infectious diseases have strong resistance to modern treatments. Another case of this phenomenon is so-called Globalization. On the one hand it gives people a possibility to travel all over the world; on the other hand it became the reason of the appearance of SARS epidemic (the severe acute respiratory syndrome) in Asia in February 2003. It was an example of quick spread of this epidemic because of frequent intercontinental travels. Another great problem is the fact that medical workers are vulnerable to infectious diseases. “Clusters of cases within hospitals occurred in the early weeks of the epidemic when the disease had not yet been recognized and the first SARS patients were admitted without isolation precautions” (Gostin, 2003).
The main purpose of infection control is reducing the number of infectious diseases. There are several types of infection control. They are: immunization, screening, hand washing, surface disinfection and wearing respirators. Immunity is the body’s ability to protect organism from certain kinds of diseases, to which the organism has developed a resistance. In order to develop immunity it is necessary to inject a small portion of infectious agent into the body to activate its potential. This process is called immunization or vaccination. Vaccination or immunization can be made against diphtheria, influenza, pheunococcal pneumonia, hepatitis and some other diseases. Elderly people have greater risk of acquiring diphtheria, so it is necessary to make vaccination against it every ten years. Influenza can have serious complications and it is possible to avoid them making vaccination. Pneumococcal pneumonia is one of the most spread causes of mortality, especially among elderly population. “All residents less than 65 years old should receive pneumococcal vaccine (0.5 ml IM) if they have not had the vaccine in the past 5 years, have not already had two pneumococcal vaccinations and have no contraindication to the vaccine. More than one revaccination in adults is not recommended” (Subramanian, 2003). Vaccination against Hepatitis B is strongly recommended for hospital workers who are engaged in collecting blood, or performing wound debridement or administering injectiable medications, because there is high risk of getting this infection.
So, the standard precautions for infection control may be the following: to make vaccination for people and their pets against certain diseases, for which there is a vaccine; avoid places with a lot of insects; wash hands often and thoroughly; cook food in a proper way; use antibiotics only according to the doctor’s prescription; go to hospital for general medical examination; be careful with wild and aggressive animals; not to take wild animals as pets and not to be engaged in unprotected sex or drugs used intravenously. When people are going to travel it is necessary to find out information about possible infectious diseases in the country. Vaccination recommendations can be available on the CDC site.
The goals of infection control presuppose immunization of vaccination against certain diseases, descriptions of standard precautions, which can help to prevent infectious diseases and reduction of exposure of care workers’ health to these infections. Infection control problems are overseen by infection control practitioners, who are usually thoroughly trained professionals of this sphere.
As it was mentioned above there is a great risk that infectious diseases could be spread in hospitals and among doctors, so there should be taken serious precautions. Doctors have to wear special glasses with all patients. Patients with infectious diseases have to be isolated in order not to transmit this disease. Health care workers who are in contiguous contact with infectious patients have to wear gloves and gowns to decrease the risk of transmitting the infectious agent to another patient. Patients with weak immunity should be isolated from other patients because their organism is very susceptible to diseases. Hospital worker with any kind of infectious disease, including a cold, should not be allowed to work until his recovery. “All articles of equipment that are used in an isolation room are decontaminated before reuse” (Kohn, 2003). It is well know that infections can be transmitted through air, so it is necessary to provide good ventilation system to prevent the circulation of the air contaminated. Hospital workers should also take this fact into account while working with infected materials.
If the person already has an infectious disease different methods of disinfection are used. “Disinfection is the use of a chemical to remove most forms of life on an instrument, device, or environmental surface (operatory surface). This is done either because it cannot be processed in a sterilizer due to its ability to withstand high temperatures or due to its size” (Rutala, 1996). Disinfectants in accordance with disinfection capabilities can be sterile, high level, intermediate level, hospital level or low level. Sterilant disinfectants kill all forms of microbes, including spores. High level disinfectants are capable to kill microorganisms. They are used to disinfect shade guides and are utilized only by the Dispensary staff. Hospital level disinfectant destroys such types of tested bacteria: Salmonella choleraesuis, Staphylococcus aureus and Pseudomonas aeruginosa, while intermediate level one presents hospital level of tuberculocidal activity. In Hospital level disinfectant “caution must be used when evaluating disinfectants to ensure that an intermediate level or Tuberculocidal standard is used. If the claim is only termed hospital level, then it is inadequate for use in the dental operatory” (Rutala, 1999). Intermediate level disinfectant is widely used to disinfect surfaces in dentistry. Low level disinfectant is responsible for household cleaners.
Latest methods of disinfection are the following: a high-level disinfectant with reduced exposure time (so-called ortho-phthalaldehyde), a persistent antimicrobial-drug coating, used for both, animate and inanimate objects (so-called Surfacine) and antimicrobial drug, which can also be applied to inanimate and animate objects (so-called superoxidered water). (Fraise, 1999)
There are a lot of complications caused by infections. The situation with infectious diseases is complicated by the fact that bacteria have an ability to develop a resistance to antibiotics, which are used to treat certain infections. Antibiotic resistance is usually defined as an ability of infectious agents to adapt to antibiotics making their use ineffective. Infectious diseases can affect liver, kidneys, heart and other organs. After the infection of Pneumococcal pneumonia person can have problems with locomotor apparatus because due to infection ligamental cells mortify and they are replaced by the conjunctive tissue. Hepatitis can have complications on liver, as well as on heart, while influenza weakens all the immunity. Different social mobilization campaigns are created in order to help to control viruses.
The doctors have to look for new antibiotics to treat same infections and this makes the process of treatment more and more difficult. There are multiple cases when antibiotics are used outside medical sphere and this also adds to the better resistance of viruses. This situation can be corrected by well-controlled use of antibiotics only in the situations when they are really necessary. (Price-Smith, 2001)
These social companies can be applied during serious dangerous situations caused by the spread of viruses. They usually have both, preventive and practical functions. They help to inform the population about possible dangers of virus infections timely. They give all necessary information about preventive measures, which can help to prevent infections. “The campaigns were designed to inform the general public about the risk of exposure to, and mode of transmission of infectious diseases” (Ashford, 2003).
Health Care Team is a group of medical workers, who work with the patients, who have life-limiting illnesses. These teams can consist of different health professional groups. Different specialists provide different kinds of services to the sick person. Their role is very important as they do not only help patients giving them medical service, but provide psychological help, social help and even nutrition. Health care team may include social workers, pastoral care workers, volunteer workers, psychologists, diversional therapists, message therapists, speech therapists, psychiatrics, nurses, nutritionists, medical practitioner, physiotherapist and occupational therapist. Social workers help the person and his or her family to perceive a thought about illness. Their role becomes especially important for the family, which have infectious patient. Social workers can explain potential risks and dangers and give the list of standard precautious measures necessary for the family members. Pastoral care workers can help patients to understand the meaning and purpose of their illness in the religious framework. Volunteer support members can give additional emotional support. Nurses, who work as a part of health team not only provide nursing care but also coordinate the work of all other members of the group. Psychologists usually provide psychological assistance and help the patient and the members of his or her family to come in terms with incurable disease. Psychiatrist’s task is somewhat alike. He also helps the patient to perceive his illness and continue his life. Diversional therapists or recreational therapists help to establish new goals after finding out about disease. These therapists are especially important for people with infectious diseases as they usually have limited opportunities to for work and leisure and should know about their rights. A nutritionist helps to pick up the best menu for the patient. Balanced and nutritious food is a very important factor for keeping a good physical state. Physiotherapist must prepare his patient for physical challenges he is going to meet because of his illness. Physiotherapist’s goal is also to inform a patient about the course of an illness. He may also teach some breathing techniques and give a set of physical exercise. Occupational therapists in many cases act as social therapists. They help the patients to find occupations suitable for them. It is hard to overestimate the role of health care team for the infected patients. These cases should be treated separately as not only patient’s life is under thereat but also the life of his family members. Health care team members provide not only medical service, but also help the patient and his patient perceives a new reality, caused by an illness.

References:
1. Antimicrobial Resistance: A Challenge for Global Health Governance. (2002) Globalization and Health: Case Studies (Kelley Lee, Ed.). London: Macmillan.
2. Beers, Mark H., MD, and Robert Berkow, MD, editors. (2004) Immunizations for Adults. Section 13, Chapter 152. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories.
3. Fraise A. P. (1999) Choosing disinfectants. J Hosp Infect; 43: 255-64.
4. Gostin, L. O., R. Bayer, and A. L. Fairchild. (December 24, 2003) Ethical and Legal Challenges Posed by Severe Acute Respiratory Syndrome: Implications for the Control of Severe Infectious Disease Threats. Journal of the American Medical Association 290: 3229-3237.
5. Gregory AW, Schaalje B, Smart JD, Robison RA. (1999) The mycobactericidal efficacy of ortho-phthalaldehyde and the comparative resistances of Mycobacterium bovis, Mycobacterium terrae, and Mycobacterium chelonae. Infect Control HospEpidemiol: 20:324-30.
6. Jacobson, R. M., K. S. Zabel, and G. A. Poland. (May 2003) The Overall Safety Profile of Currently Available Vaccines Directed Against Infectious Diseases. Expert Opinion on Drug Safety 2: 215-223. 7. Jarvis, W. R. (December 2003) Benchmarking for Prevention: the Centers for Disease Control and Prevention’s National Nosocomial Infections Surveillance (NNIS) System Experience. Infection 31, Supplement 2: 44-48.
8. Kohn, W. G., A. S. Collins, J. L. Cleveland. (December 19, 2003) Guidelines for Infection Control in Dental Health-Care Settings-2003. Morbidity and Mortality Weekly Reports: Reports and Recommendations 52, RR-17: 1-61.
9. National Institute of Allergy and Infectious Diseases (NIAID). 31 Center Drive, Room 7A50 MSC 2520, Bethesda, MD, 20892. (301) 496-5717. http://www.niaid.nih.gov.
10. Peng, P. W., D. T. Wong, D. Bevan, and M. Gardam.(December, 2003) Infection Control and Anesthesia: Lessons Learned from the Toronto SARS Outbreak. Canadian Journal of Anaesthesiology 50: 989-997.
11. Price-Smith Andrew. (2001) Public Health and International Law: The Impact of Infectious Diseases on the Formation of International Legal Regimes, 1800-2000, Plagues and Politics: Infectious Disease in International Policy, London: Macmillan.
12. Rutala WA. (1996) APIC Guidelines Committee. APIC guideline for selection and use of disinfectants. Am J Infect Control. 24:313-42. 13. Rutala WA, Weber DJ. (1999) Disinfection of endoscopes: review of new chemical sterilants used for high-level disinfection. Infect Control Hosp Epidemiol;20:69-76.
14. Sehulster, L., and R. Y. Chinn. (June 6, 2003) Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Morbidity and Mortality Recommendations and Reports 52, RR-10: 1-42.
15. Subramanian, D., J. A. Sandoe, V. Keer, and M. H. Wilcox. (June 2003) Rapid Spread of Penicillin-Resistant Streptococcus pneumoniae Among High-Risk Hospital Inpatients and the Role of Molecular Typing in Outbreak Confirmation. Journal of Hospital Infection 54: 99-103.
16. The occupational zoonoses Health and Safety Executive (1993) HMSO Books, P.O. Box 276, London SW8 5DT, United Kingdom, p. 32.

 

 
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