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Healthcare professionals have the responsibility to adhere to scientifically accepted principles and practices of infection control in all healthcare settings and to oversee and monitor those medical and ancillary personnel for whom the professional is responsible.
This course provides the information necessary for healthcare professionals to monitor, control, and prevent infection in healthcare settings. This course is designed for physicians, physician assistants, nurses, and other healthcare professionals in New York required to complete education to enhance their knowledge of infection control. This activity was planned by and for the healthcare team, and learners will receive 5 Interprofessional Continuing Education IPCE credit s for learning and change.
Physicians should claim only the credit commensurate with the extent of their participation in the activity. NetCE designates this continuing education activity for 6 hours for Alabama nurses. This activity is designed to comply with the requirements of California Assembly Bill , Cultural and Linguistic Competency. The purpose of this course is to provide a review of current infection control practices and accepted standards, with an emphasis on the application of infection control standards and practices in outpatient and ambulatory settings.
Discuss the standards of professional conduct associated with infection control in the healthcare setting. Outline the infectious disease process. Describe various practices that can result in exposure to bloodborne pathogens. Identify effective strategies to prevent or control infection, including precautions, isolation techniques, hand hygiene, standards for cleaning, and safe injection practices.
Describe the role of surveillance and reporting in an effective infection control program. Discuss the impact of communicable diseases in healthcare professionals, including the necessity for preplacement evaluations, periodic health assessments, education, and postexposure prophylaxis.
Evaluate the impact and appropriate response to sepsis. A medical writer and editor for more than 30 years, Ms. Alexander has written for both professional and lay audiences, with a focus on continuing education materials, medical meeting coverage, and educational resources for patients.
She has also earned certification as a life sciences editor and as a medical writer. Over the past thirty years she has worked in hospital nursing in various states in the areas of obstetrics, orthopedics, intensive care, surgery and general medicine. During that time, the hospital achieved Accreditation with Commendation with the Joint Commission, with a score of She worked for the Oklahoma Foundation for Medical Quality for six years.
Contributing faculty, Lori L. Contributing faculty, Carol Shenold, RN, ICP, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned. The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.
Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice. It is the policy of NetCE not to accept commercial support.
Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Supported browsers for Windows include Microsoft Internet Explorer 9. Supported browsers for Macintosh include Safari, Mozilla Firefox 3. Supported browsers must utilize the TLS encryption protocol v1. The development of formal infection control programs in hospitals and other healthcare facilities was spurred by the Joint Commission accreditation standards for infection control, published in According to the standards, accredited facilities should have a program for the surveillance, prevention, and control of healthcare-associated infections HAIs .
The most important aspect of infection control is establishing multidisciplinary programs that promote teamwork and foster an organizational culture centered on patient safety. HAIs are one of the leading causes of death and increased morbidity for hospitalized patients and are a significant problem for healthcare providers . Historically, these infections have been known as nosocomial infections or hospital-acquired infections because they develop during hospitalization.
As health care has increasingly expanded beyond hospitals into outpatient settings, nursing homes, long-term care facilities, and even home care settings, the more appropriate term has become healthcare-acquired or healthcare-associated infection. Many factors have contributed to an increase in HAIs. Advances in medical treatments have led to more patients with decreased immune function or chronic disease.
The increase in the number of these patients, coupled with a shift in health care to the outpatient setting, yields a hospital population that is both more susceptible to infection and more vulnerable once infected.
In addition, the increased use of invasive devices and procedures has contributed to higher rates of infection . According to data published in , HAIs develop in an estimated 1 in 25 hospitalized patients excluding skilled nursing facilities ; this number varies from year to year and had previously been estimated at a high of 1 in 10 [1, 4, 94, 95].
As HAIs have become a cause for increasing concern, many national organizations, state departments of health, and professional organizations have taken additional steps to prevent or control infection in the healthcare environment. The increased focus on healthcare quality over the past decade has highlighted the need to prevent HAIs as part of overall efforts to enhance patient safety. These efforts have been developed by healthcare quality agencies, professional associations, advocacy organizations, healthcare regulating bodies, and policymakers [6, 7, 8, 9, 10, 11, 12, 13].
In , the Institute for Healthcare Improvement IHI established the , Lives Campaign as a challenge to save , patient lives through six healthcare interventions, three of which were related to HAIs: Regulatory bodies have also focused on HAIs.
Perhaps the most aggressive campaign against HAIs has come from CMS, which has suspended reimbursement of hospital costs related to three categories of HAIs it considers "reasonably preventable: However, studies have shown that this policy has not been a contributor to any decrease in the rate of HAIs, and a survey indicated that adherence to only a few prevention strategies has increased as a result of the policy [97, 98].
The policy also has the potential to lead to increased unnecessary use of antimicrobials in an effort to prevent infections . The New York Codes, Rules, and Regulations require that certain healthcare professionals who may influence the control and prevention of HAIs complete training or education regarding infection control and barrier precautions . New York State has also established professional standards of conduct to ensure that infection prevention and control practices are adhered to.
According to the Rules of the Board of Regents: Part 29, "failing to use scientifically accepted infection prevention techniques appropriate to each profession for the cleaning and sterilization or disinfection of instruments, devices, materials and work surfaces, utilization of protective garb, use of covers for contamination-prone equipment and the handling of sharp instruments" is considered unprofessional conduct .
Appropriate infection control techniques include, but are not limited to, wearing appropriate personal protective equipment, adhering to recommendations for Universal and Standard Precautions, following sterilization and disinfection standards, and using the correct equipment in the correct way .
Healthcare professionals have the responsibility to adhere to scientifically accepted principles and practices of infection control in all healthcare settings and to oversee and monitor those medical and ancillary personnel for whom the professional is responsible .
Healthcare professionals are expected to use scientifically accepted infection prevention techniques appropriate to each profession for handwashing; aseptic technique; cleaning and sterilization or disinfection of instruments, devices, materials, and work surfaces; use of protective garb; use of covers for contamination-prone equipment; and handling of sharp instruments [15, 16, 17].
Evidence-based guidelines are at the heart of strategies to prevent and control HAIs and drug-resistant infections and address a wide range of issues from architectural design of hospitals to hand hygiene. Some specialty organizations and quality improvement groups have summarized the guidelines for easier use in practice [2, 17, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42].
Adherence to individual guidelines varies but, in general, is low. Decreasing the number of HAIs will require research to better understand the reasons behind lack of compliance with guidelines and to develop strategies that target those reasons. In addition, there are professional consequences for New York healthcare professionals who do not adhere to appropriate infection control efforts.
Healthcare professionals who fail to use scientifically accepted barrier precautions and state-established infection control practices may be subject to charges of professional misconduct .
The Office of Professional Medical Conduct may investigate on its own any suspected professional misconduct and is required to investigate each complaint received regardless of the source. The charges must state the substance of the alleged misconduct and the material facts but not the evidence. A hearing may be called, if warranted. The results of the hearing i. Any professional found guilty of misconduct shall be subject to penalties, including :.
A requirement that a licensee perform up to hours of public service in a manner and at a time and place as directed. The education and training of healthcare personnel are prerequisites for ensuring that Standard Precautions are understood and practiced. Education on the principles and practices for preventing transmission of infectious agents should begin during training in the health professions and be provided to anyone who has an opportunity for contact with patients or medical equipment.
Education programs for healthcare personnel have been associated with sustained improvement in adherence to best practices . Adherence to recommended infection control practices decreases transmission of infectious agents in healthcare settings; however, several observational studies have shown limited adherence to recommended practices by healthcare personnel.
Improving adherence to infection control practices requires a multifaceted approach that incorporates continuous assessment of both the individual and the work environment. A comprehensive description of the pathogenesis of infection is beyond the scope of this course. However, a broad overview of pathogen-host interaction will aid in the understanding of how infection develops in the healthcare setting. A healthy human body has several defenses against infection: The skin can effectively protect the body from most micro-organisms unless there is physical disruption.
For example, the human papillomavirus can invade the skin, and some parasites can penetrate intact skin, but bacteria and fungi cannot . Other disrupters of the natural barrier are lesions e.
In addition to breaks in the skin, other primary entry points for micro-organisms are mucosal surfaces, such as the respiratory, gastrointestinal, and genitourinary tracts . The membranes lining these tracts comprise a major internal barrier to micro-organisms due to the antimicrobial properties of their secretions.
The respiratory tract filters inhaled micro-organisms, and mucociliary epithelium in the tracheobronchial tree moves them out of the lung.
In the gastrointestinal tract, gastric acid, pancreatic enzymes, bile, and intestinal secretions destroy harmful micro-organisms. Nonpathogenic bacteria commensal bacteria make up the normal flora in the gastrointestinal tract and act as protectants against invading pathogenic bacteria.
Commensal bacteria are a source of infection only if they are transmitted to another part of the body or if they are altered by the use of antibiotics .
HAIs are commonly caused by bacteria, but can also be caused by viruses, fungi, and parasites. These types of infection occur less frequently and often do not carry the same risks of morbidity and mortality as bacterial infections.
Viral infections are more common in children than in adults and carry a high epidemic risk . Fungal infections frequently occur during prolonged treatment with antibiotics and in patients who have compromised immune systems . Various pathogens have different levels of pathogenicity, virulence, and infectivity. The transmission of infection follows the cycle the "cycle of infection" that has been described for all diseases, and humans are at the center of this cycle [2, 51].
In brief, a micro-organism requires a reservoir a human, soil, air, or water , or a host, in which to live. The micro-organism also needs an environment that supports its survival once it exits the host and a method of transmission. Inherent properties allow micro-organisms to remain viable during transmission from a reservoir to a susceptible host, another essential factor for transmission of infection.
The primary routes of transmission for infections are through the air, blood or body fluid , contact direct or indirect , fecal-oral route, food, animals, or insects.
Once inside a host, micro-organisms thrive because of adherent properties that allow them to survive against mechanisms in the body that act to flush them out.
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