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| Infection
Control
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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
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5. Gregory AW, Schaalje B, Smart JD, Robison RA. (1999) The
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6. Jacobson, R. M., K. S. Zabel, and G. A. Poland. (May 2003)
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8. Kohn, W. G., A. S. Collins, J. L. Cleveland. (December
19, 2003) Guidelines for Infection Control in Dental Health-Care
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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,
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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
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14. Sehulster, L., and R. Y. Chinn. (June 6, 2003) Guidelines
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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
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16. The occupational zoonoses Health and Safety Executive
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