The prevalence of Healthcare Associated Infections (HCAI) has increased and this triggers different organizations and governments to set policies, guidelines and programmes to minimise its occurrence. However, these activities to be effective and fulfil its objectives it need management, organisational, and components factors (NAO, 2000).
In this essay I will describe the principles of infection control service, its structure and liaising with the different agencies involved to prevent the transmission of (HCAI).
Infection control is a collection of different actions aiming to prevent the spread of communicable infections e.g. (HCAI), and the scope not just the medical professionals, but also patient safety, occupational safety etc (WHO, 2010).
Healthcare Associated Infection (HCAI) refers to the infection that developed in patients or healthcare workers in hospitals (POST, 2005). Worldwide there are 1.4 million patients with (HCAI) (Weinestein, 1998 cited by Pittet e.t.al, 2008); in UK there are 9% infections of (HCAI) at any time, and 100,000 per a year (NAO, 2000). Usually these are urinary tract infections, surgical wounds, and lower respiratory infections (WHO, 2002).
The importance of infection control service can be recognised from the impact of these infections on public health and governments. They cause stress, disability, and affect quality of life (WHO, 2002). In UK there is an estimate that it causes 5000 deaths and contributes to 15,000 deaths yearly (NAO, 2004). The cost for treating these cases is 1 billion, and by implementing infection control activity 150 millions can be saved (NAO, 2000). From this background infection control becomes priority for WHO which create World Alliance for Patient Safety (Pittet e.t.al, 2008) and in UK the priority is raised through different initiatives by Department of Health (NAO, 2004).
Aims and objectives of hospital infection control service
There should be a programme in every hospital for infection control having the aim of preventing and controlling the (HCAI) among health service consumers and providers (ICS, 2007a). This programme has effective components which reflect the objectives and the functions of the service and these are recommended by department of health (DH, 95 cited by NAO, 2000);
Surveillance of infection; this is aiming to detect outbreak early, assessing the rate of infection, and evaluating the preventive and control measures in the hospital.
There are some methods of surveillance;
Alert organism; e.g. MRSA, if the microbiology report is positive, the patient is isolated or discharged, and other carriers are searched (ICS, 2007b).
Alert condition; e.g. chicken box, is an indication of high infection risk, measures of source isolation can be implemented (ICS, 2007b).
Targeted surveillance; this refers to specific areas surveillance e.g. urinary tract infection surveillance (ISC, 2007b).
Education and training of the stuff; this is to increase their awareness of the importance of infection control measures, and to keep them updated about these measures.
Evaluating, and formulating of existing policies and guidelines.
Hospital hygiene monitoring; this include sterilising, cleaning, kitchen hygiene, disposal of clinical waste, etc.
Setting auditing system; for standards and procedures within the service and other services to ensure they are in line with the infection control guidelines.
Participation in decisions; e.g. building extension plans, buying equipments.
Controlling and management of outbreak; if more than expected cases of infection developed, then the ward nurse should collect data about the cases, e.g. time of onset and date of admission, infection control team should be informed, source isolation measures applied, and specimen for microbiology should be taken (ICS, 2007c). When outbreak confirmed, actions will be taken, e.g. restricted movement of both stuff and patients in the ward, no visiting, and stuff and patient screening by microbiologist. These all depends on the nature of the outbreak and require cooperation between different members and organisations of infection control service (ICS, 2007c).
Antibiotic prescription; there should be monitoring policy of antibiotic use to reduce antibiotic resistance (WHO, 2006).
Structure and organisations of hospital infection control service
Because these components represent different areas then to be effective it requires an organisational structure to deliver it and not just the responsibility of an expert or a team (Brannigan e.t.al, 2009). Thereby, there is a management framework of different organisations through which roles, responsibilities and leadership styles are described to manage the infection and fit the programme in the management structure of the hospital (NAO, 2000), and these are;
Chief executive officer/ Head of Hospital; responsible for setting different organisations, effective arrangements are practiced, and availability of resources for the programme, e.g. technical (e.g. IT) and human resources for surveillance system (WHO, 2006).
Infection Control Officer (ICO); usually microbiologist, work as a member of (ICC) and head of (ICT), involved in surveillance, analysing and providing data of antibiotic resistance, involved in management of outbreaks ( WHO, 2006).
Infection Control Committee (ICC); formed by representatives of different departments, e.g. infection control team, occupational health and infectious disease physicians and nurses, consultant of communicable diseases, it is responsible for using and applying policies, procedures and guidelines in the hospital, cooperating with infection control team of developing annual programme (NAO, 2000).
Infection Control Team (ICT); this include infection control nurse and doctor. Responsible for day to day availability and applications of infection principles, updating programme manuals, education training to all stuff (NAO, 2000).
Clinical governance; this is a system through which infection control service is linked to the management structure of the hospital to improve its effectiveness (QH, 2008). It is a framework of accountabilities; policies, performance and standards to improve quality of services delivered by hospitals and this include infection control service, done for example by auditing, and evidence base approach of the different procedures of infection control programme (Mastertone and Teare, 2001).
Liaising with other services and agencies
To minimise the transmission of the infection the infection control service has to liaise with other services within and outside the hospital. These include for example the occupational health service to implement measures that keeps staff safe and avoiding spreading the infection, catering services to fulfil the legislation of food safety (NAO, 2000).
The service has to report about out breaks to agencies like Health and Safety Agency in UK (NAO, 2000), and to local public health and public through media (WHO, 2002).
