Principles of Infection Prevention and Control

This document discusses the principles of infection prevention and control, including the nature of microorganisms, the impact of infections, and measures to prevent and control them. It also explores the role of nursing and public health practice in infection prevention, as well as audit, surveillance, and risk management in infection control.

Running head: PRINCIPLES OF INFECTION PREVENTION AND CONTROL
PRINCIPLES OF INFECTION PREVENTION AND CONTROL
Name of the Student
Name of the university
Author’s note

1PRINCIPLES OF INFECTION PREVENTION AND CONTROL
TABLE OF CONTENTS
Introduction......................................................................................................................................2
Nature of the microorganism...........................................................................................................2
Impact of the infection.....................................................................................................................3
Infection prevention and control measures involved.......................................................................4
Effect of the nursing and public health practice on the prevention of infection..............................5
Audit, surveillance and risk management to prevent the control of infection.................................7
Principles of risk management.........................................................................................................8
Organisation of infection control in the workplace and by the Hong Kong government................9
Recommendations..........................................................................................................................10
Conclusion.....................................................................................................................................11
References......................................................................................................................................12

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Introduction
Surgical site infection are some of the potential complications, linked with any kind of
surgical procedures. Although SSIs are among the most preventable form of hospital acquired
infections, but they still represent a significant burden on patient mortality and morbidity (Miah
2018). They also incurs additional cost to the health systems and as a result to the entire service
payers worldwide. According to recent study by WHO , SSI has been found to be the most
surveyed and the frequent type of Hospital acquired infection in the low income countries. In
2014, a total of about 15600 cases of surgical site infections has been found at Hong Kong,
associated with the inpatient surgeries.
Nature of the microorganism
Three different types of surgical site infection has been identified by the Centre for Disease
Control and Prevention. They are: superficial infections, deep incisional infections and infections
involving body organs. The severity of the surgical site infection depends upon the location of
the infection and the type of microorganisms involved in the infection. Staphylococcus aureus is
the main microorganism that is found to be responsible for the most common type of surgical site
infection (Bhattacharya et al. 2016). Some of the other organisms that are involved in are
coagulase-negative staphylococci (CONS), Escherichia coli, Pseudomonas aeruginosa,
Enterococcus spp., and Escherichia coli. Methicillin resistant Staphylococcus aureus (MRSA) is
one of the most common and dangerous pathogen, that is responsible for the occurrence of most
of the surgical site reaction (Bhattacharya et al. 2016).
Surgical site infections are formed due to the interaction of the microorganisms in a health care
environment, a host who is vulnerable to infection and the chain of transmission. Infection is

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caused by the exposure to an infectious agent, multiplying within a susceptible host. There are
five components in the chain of reaction- The pathogen, Reservoir of the agent, Mode of escape
from the reservoir, mode of transmission, a portal of entry.
The reservoir is the place where infectious agent lives, from where it passes to the
susceptible host. Most of the SSI occurs from the body of the patients and also from
contaminated surgical instruments. Some of the inanimate reservoirs are bed rails, medical
equipments. The transmission of the harmful microorganisms occurs on direct contact with the
hospital workers or an environment. Pathogens colonies in the moist and the warm portions of
the body like axilla, perineal area and the trunk. There are certain microorganisms that can form
biofilms around the catheter like Pseudomonas species, Acinetobacterbaumannii and
Stenotrophomonasmaltophila. In case of the central line blood stream infection, Extraluminal
migration is the main route of infection. For the SSIs, urinary catheter, punctures due to IV
procedures and incisions acts as the portals of entry. They can also act as the portal of exit. Some
of the other factors responsible for the entry of the microorganism includes the perioperative
temperature of the body. Unplanned hypothermia in patients impairs the function of immune
system necessary for fighting infections.
Impact of the infection
The development of surgical site infection causes an added burden, besides the huge surgical
costs. The economic burden is increased due to the direct cost increases due to prolonged
hospitalization of the clients, screening tests and treatments. Certain cases might also require
reoperation after the client has contracted with hospital acquired infection that is an additional
cost beyond the normal surgical cost. Furthermore, the length of the hospitalization is also
increased due to this. According to Badia et al. (2017) surgical site infections possess a negative

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effect on both the physical and the mental health of the patient. Apart from mortality, morbidity
and the loss of earnings, patients also have to bear certain intangible costs like anxiety and pain.
Due to SSI, there can be a delay on the wound healing and extreme conditions like bacteremia
can occur. Hospital readmissions and prolonged wound healing increases the number of absent
days.
Infection prevention and control measures involved
Nowadays at Hon Kong, large number of open surgeries are replaced by Laparoscopic
surgeries, thus lowering down the occurrence of surgical site infection. Again, judicious use of
antibiotics and an organised wound surveillance system has been found to be the most effective
means of reducing the rate of wound infection. Kreem, Hamza and Branch (2019) have stated the
importance of using prophylactic antibiotics at the time of surgery. It has been found that the
prophylaxis can prevent morbidity in patients, shortened hospital stay and have reduced the
overall cost responsible for the infection. The infection control nurses make it sure that the
antimicrobial dosage modifications are suitable to the elderly patients (Dodson et al. 2018). The
department of Health of Hong Kong is structured and the protocols allow the scope and the
objective of the surveillance to be followed clearly. The effectiveness of the surveillance lies in
the fact that the feedback of the findings to specific surgeons in lowering the rate of SSI has been
successful in controlling SSI. Among some of the well accepted measures for preventing the
surgical site infection, the Department of health have taken up several imperatives, which is
called bundle of care, consisting of fur evidence based components. Although they are four
components, they are grouped as a single intervention and standard of care for the clients who

5PRINCIPLES OF INFECTION PREVENTION AND CONTROL
have undergone surgical procedures. The components involve appropriate hair removal, glucose
control in diabetic patients and those who have undergone major cardiac surgery.
The infection controlling department of the hospital includes a multidisciplinary team
work for the successful implementation of the preventive measures and the improvement in
surgical site infection. The team should include anybody who has some role in the surgical care
process. All the health care workers are educated of the risk of the surgical site infections and the
preventive measures. The infection control team maintain operative surgical hand preparation,
before the conduction of any invasive procedures. Furthermore, the laboratories present at Hong
Kong are equipped with infrastructure to identify the bacteria responsible for the infection
(Sridhar et al. 2018). The ventilation and the ambience in a hospital are made such that they exert
traffic control of the operating room by restricting the number of people allowed in the operating
room, with automatic closing doors for the prevention of the in and out traffic and limiting the
unnecessary movement and talking in an operating room. Maintaining positive pressure
ventilations for the operating rooms with respect to the corridors and the adjacent areas (Kreem,
Hamza and Branch 2019). There are devices that require a least amount of differential pressure
for indicating the direction of the airflow. There are Laminar flow ventilation system. The health
care workers are knowledgeable about the use of personal protective equipment and process of
disinfection during any surgical procedure. Hong Kong department of Health have also taken up
certain policies and procedures in order to prevent surgical site infection.
Effect of the nursing and public health practice on the prevention of infection
SSIs are one of the major causes of death and morbidity in the hospital patients having a
loss of financial burden. They are also major causes of several deaths and morbidity in hospitals
with a lot of financial burdens associated with infections such as surgical wound infections

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(Cardoso et al. 2014). Measures that are universally accepted and applied such as aseptic hands
washing among health care staff has immensely helped in reducing surgical site infections.
Infection control nurses help eliminate or reduce the bacteria implicated in surgical site infection
by creating awareness among other staff members on the strategies that can be used to achieve
the goal of minimizing surgical site infection (Kreem, Hamza and Branch 2019). Public health
practice which is committed to enhancing the health of the people by averting diseases before
they happen through offering education and promoting lifestyles that are healthy (Musmar and
Baba, 2014). Nurses have a critical role to play in prevention and control of surgical site
infections by observing the preoperative and postoperative measures that ensure surgical patients
are clear of bacterial infections implicated in surgical site infections. Health care personnel
actively involved in surgery significantly contribute to the reduction of surgical site infections by
practicing aseptic measures outlined before entering the operating room (Spampinato and
Leonardi, 2013). It has been found that the risk factors for the occurrence of surgical site
infection include prolonged invasive procedures and inadequacies in the surgical scrub or the
antiseptic preparation on the skin. It has been stated that some of the Physiologic states that
increase the risk of surgical site infection are trauma, blood transfusion, hypothermia,
hyperglycaemia and hypoxia. Some of the other risk factors that has been found to be associated
are the body mass index, video assisted procedures, non –performance of perioperative bath and
presence of pre-existing disease. Here lies the role of the infection control nurses to the mitigate
the risk factors. While management of the theatre ventilation system and Ultra clean air system
are the duty of the infection control team, nurse are more in to proper skin preparation, provision
of proper dosage of antibiotics, using proper personal protective equipment as per the protocol
and ensure cleanliness at the hospital ward. Surgical masks are sometimes the source of

7PRINCIPLES OF INFECTION PREVENTION AND CONTROL
controversy. Although their primary purpose is to prevent the blood or the body fluid
contaminating the mucous membrane of the wearer’s nose and the mouth, but they definitely
does not give protection against the inhalation of the airborne particles. Some of the other
measurements that are taken up by the control nurses involve proper dressing of the wound as
well as the timely removal and redressing, timely removal of urinary catheter. Proper
antimicrobial sutures like triclosan-coated polyglactin 910 shall be used for the stitch. It is the
duty of the surgical nurses to make sure that a normothermia is maintained throughout the
surgery as body temperature less than 36 degree makes the body more prone to intraoperative
blood loss. Hence the risk of developing hypothermia has to be identified.
Audit, surveillance and risk management to prevent the control of infection
Clinical audit can be defined as a quality improvement process that seeks to improve
patient care and outcomes by the help of systematic review of care against some explicit criteria
and change implementation. Audit of infection prevention and control aids in the identification
of areas that have been diligently executed and those areas that need improvement for a better
outcome in the fight against surgical site infections (Bish et al. 2016). While clinical surveillance
is necessary for the early identification of the high risk patients. According to the researchers the
health system involved in the clinical surveillance technology for helping the doctors, nurses and
the other members of the team to better monitor the patients who are vulnerable to life
threatening conditions (Manivannan et al. 2018).
Promotion of awareness about surgical site infection among the staffs by the development
of an active surveillance system has been found to be effective for mitigating SSIs. Furthermore,
in order to implement the “care bundle”, auditing and feedback is necessary for a high quality of
patient care. Multidisciplinary teams has to be involved for the evaluation of the surveillance

8PRINCIPLES OF INFECTION PREVENTION AND CONTROL
system of the hospital. A periodic update is required for the adherence to the best practice
guidelines (Yang et al. 2016). According to Centers for Disease Control despite the advances
made towards prevention and control of surgical site infections such as making sure that
ventilation in the operating room is improved, application of several methods of sterilization to
surgical equipment and use of antimicrobial prophylaxis, surgical site infections are still a cause
of deaths and extended hospital stay to surgical patients in hospitals. There are several questions
that need to be answered in the audit of surgical site infections to see if the patients and the
health care staff followed the laid out guidelines that need to be observed before, during and after
the surgery. The audit needs to ask and get answers to measures such as the patient needing to
take a bath using the antiseptic agent before the operation, did the patient adhere to this?
Prophylactic antibiotics need to be administered to the patient before the operation is done and
later be discontinued, did the nurses ensure that the patient received this medication and was the
prophylactic medication later discontinued? Intact skin needs to be cleaned using a specific
solution during the intra-operative stage, was this done? The protocols for the surveillance of
surgical site infection is mainly designed by the World Health organization. Locally, they are
done by the Department of Health, infection control, Honk Kong and their specialized IPC team
(Fan et al. 2014). At the organizational level, they looked after by the local senior managers,
national organizations.
Principles of risk management
Principles of risk management in infection prevention and control aid in the
identification, evaluation, and reduction of dangers associated with healthcare (Melaine et al.
2017). Risk management is a fundamental aspect that needs to be followed towards the
achievement of quality management of surgical patients in hospitals (Melaine et al. 2017). There

9PRINCIPLES OF INFECTION PREVENTION AND CONTROL
are basic five steps of the risk management, which begins with the identification of the risks,
analyzing the risk, prioritization of the risk, implementation of the solution and finally the
monitoring of the risk. Different risk assessment tools are there for the identification of the risks,
such as The Socio-Technical Probabilistic Risk Assessment, which is a proactive risk assessment
tool, used for the assessment of SSIs (Bish et al. 2016). This tool can assess the possible risks
like risk of infection in the perioperative period. After the patients who are prone to risks are
identified, and the risk factors have been identified, now it is necessary to identify reason for
which the condition has arrived, for example untidy hospital premises or non-adherence to hand
washing techniques (Dodson et al. 2019). This is followed by the intervention as per the
organizational protocol of infection control or the Global protocol published by WHO.
The infection control policies and the procedures provides a crucial set of the control
practices that might provide chances for the mitigation of the potential risks. Reanalysis of the
data and the associated risks are carried. Clinical audit and surveillance are an important part of
the risk assessment.
Organisation of infection control in the workplace and by the Hong Kong government
The public health policies
The health care system of Hong Kong is not sufficient to address the need of controlling SSIs.
The rules and regulations and the health care policies needs to be stringent to address the issue.
The policy procedures and guidelines have provided several approaches as follows:
Showering of patients using antiseptic agents before the surgical procedure is done helps
in reduction of bacterial load on the skin of the patient known as normal flora that may a source
of infection during or after the surgery to cause surgical site infection (Yeung et al. 2013). Hair

10PRINCIPLES OF INFECTION PREVENTION AND CONTROL
removal from a patient should be absolutely avoided unless it is thought to be an interference to
the operation in which then it should be removed before the operation through clipping.
Staphylococcus aureus screening and decolonization should be done before the operation
especially in orthopedic and cardiothoracic procedures whereby mupirocin two percent can be
used preoperatively. Surgical antibiotic prophylaxis is a very important guideline and should be
applied only when indicated before the patient undergoes the surgical procedure preferably one
hour before so as to increase the antibiotic concentration at the surgical site (Ayele and Taye,
2018). Surgical hand scrub which is an intraoperative guideline is performed using antibiotic
soap and water wearing the sterile gloves. Skin antiseptic preparation is an intraoperative
guideline is done using a solution that is an alcohol-based antiseptic especially those based on
chlorhexidine gluconate to prepare the skin on the surgical site (Gandaglia et al. 2014). hese
guidelines are majorly followed in most Hong Kong hospitals and this has immensely
contributed to the lowering of cases of healthcare-associated infections specifically those relating
to surgical site infections
Recommendations
To help improve the care of surgical patients in hospitals in order to minimize or do away
with surgical site infections there are several recommendations like, the hospital management
can organize monthly seminars for its healthcare staff especially the nurses dealing with patients
needing surgery (Gokani et al. 2016). These seminars will help the nurses update their skills with
the currently available information on how to deal with bacterial implicated mainly in surgical
sites infection. Armed with this information the nurses will help the hospital provide quality care
to its surgical patients and this will help minimize the infections of the surgical site reported in
Hong Kong hospitals. Patients centered care approach can be applied to patients who need

11PRINCIPLES OF INFECTION PREVENTION AND CONTROL
surgery in Hong Kong hospitals to help them appreciate the care being provided by the nurses so
that they can be motivated to join in the provision of their own care (Shearer et al. 2015).
Patients being involved in the decision-making process for their own care helps them understand
the importance of their contribution in reducing the risks that are associated with surgical site
infection occurring to them after the surgery. Hong Kong government can supply all its hospitals
with antiseptic hand washing solutions that are placed on all hospital corridors and patients
rooms. The antiseptic solutions placed strategically ensure that nurses can always practice hand
hygiene which is integral in the prevention and control of surgical site infections (Rogers 2015).
The practice of hand washing hygiene ensures that bacterial transmission from nurses to surgical
patients is greatly minimized and therefore reducing the surgical site related infections (Khan
and Nausheen, 2017). Antibiotic stewardship can be used by hospital management in Hong Kong
hospitals to help the nurses clearly understand the risks posed to patients due to antibiotic
overuse. Equipped with this information nurses will understand and apply the guidelines that
pertain antibiotics and this goes on to reduce the development of antimicrobial resistance that is
related to surgical site infections.
Conclusion
Surgical site infection prevention and control is a complex issue that needs the interplay
of healthcare management, healthcare staff, and the Hong Kong government to be achieved. The
hospitals in Hong Kong have to be organized in a way that they are able to deal with the
prevention and control of surgical site related infections. Nurses have a critical role to play in
prevention and control of surgical site infections and therefore it is important that they are
equipped with the skills and knowledge that is needed to help fight the burden of surgical site
infections suffered by surgical patients in hospitals. A lot of money is spent on offering care to

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patients undergoing treatment due to surgical site infections and this can be reduced if measures
are put in place to ensure that hospitals in Hong Kong are able to reduce the incidences of
surgical site infections in their respective hospitals. The recommendations discussed can help the
hospitals achieve the goal of reducing the rates of surgical site infections in their hospitals if well
applied.

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