Since the middle ages, people have come to realize the importance of clean water and good sanitation practice. This significant realization marks the dawn of infection control. Today, infection control is widely recognized as an integral part in the quality of service provided by the healthcare facility.

What is infection control?
Infection control is the practice of preventing and managing infection. In a healthcare facility like Normah Medical Specialist Centre (NMSC), it involves a systematic approach to minimize the effects of infection and to reduce the risk of an infectious condition and / or disease being transmitted within the hospital.

Why is it important?
Clearly, infections can be nasty. They cause suffering, longer lengths of stay at the hospital, and even death. The goal of infection control is simply to prevent the spread of infection while maintaining a focus on a high standard of patient care. Hence, it helps patients recover quickly and stay as healthy as possible. Apart from protecting the patient, good infection control also protects the healthcare staffs, visitors, and others in the healthcare environment. In the end, it ultimately saves lives, and saves a lot of money for both the patient and everyone involved.

Is there a body that works on this? Who is responsible for infection control?
Most established healthcare facilities would normally coordinate infection control activities through an infection control committee. In NMSC, the committee is headed by a senior physician, and members are from various disciplines - medical, oncology, nursing, pharmacy, and microbiology.

Infection control is not the responsibility of certain individuals only. It involves everybody, and it requires teamwork and cooperation from everyone. Therefore, it is a shared responsibility of every staff, residents and visitors.

What are the essential activities of infection control in a hospital?
There are 3 main activities of infection control:

a) Surveillance and epidemiologic investigations.

At the heart of every infection control program is surveillance. The phrase "you cannot manage what you do not know" speaks volumes of the importance and basis of surveillance.

Some examples of on-going surveillance program being done in NMSC:

• Monitoring antibiotic resistance trends in select bacteria.
• Detecting change rates and distribution of special organisms, e.g. methicillin-resistant Staphylococcus aureus (MRSA).
• Class I wound surveillance as a quality indicator on clinical and infection control practice.

b) Preventing and controlling transmission of infectious agents: Implementing isolation precautions and practices.

c) Education and training of healthcare staff.

What are bacteria? Should I be worried about them?
Bacteria are tiny, single-celled creatures. Invisible to the eye, they are so tiny that you can only see them through a microscope.

Where can you find bacteria? It is everywhere! We don't live in a sterile world, and we are certainly not meant to live in one, either. Even within ourselves and on our bodies, each of us carry a zoo of bacteria everywhere we go. Are bacteria bad? No, not all. Actually, there are good and important ones and we need them to live. For example, we have good bacteria in our intestines that help us digest food and prevent us from getting sick.

So which is good and which is bad? To distinguish them, we need to understand the relationship of bacteria to us, humans.

Relationship of Bacteria to Man
There are 3 different types of relationship:

• Contaminant: Bacteria that are deposited on our body surface from contact with the outside world. So, for example, when you do gardening, your hands become dirty from the soil that you touch. The bacteria from the soil that are transferred to your hands are known as a contaminant.
• Colonizer: Once the bacteria sit on the skin, they will start to grow and multiply. At this stage, they are known as a colonizer. Some are temporary colonizers, some others are permanent. Permanent colonizers make up our normal flora, or the zoo that we carry with us. The normal flora plays an important role in keeping us healthy.
• Pathogen: This is the term we call bad bacteria that cause infection, thus making us sick. From a bigger picture, pathogens can also include other kinds of microscopic creatures such as fungi, viruses, and parasites.

Who are at risk of getting an infection?
People with poor immunity may be particularly susceptible to infections eg.

• The very young (babies) and the elderly.
• People with certain health conditions, e.g. diabetes, kidney failure, HIV.
• Drug related therapy: immunosuppressors; prolonged antibiotics.
• Patients hospitalized for a long time.
• Patients with tubes for fluids or medications, e.g. urinary catheter, IV lines, ICU patients.

While the factors above increases the risk of infection, they do not necessarily mean that infection will surely happen. Infection has to be acquired. This link between health and sickness is dependent upon what we call, " the chain of infection".

What is the chain of infection?
The chain of infection is made up to 3 basic elements:

• Source: A place or a person harboring the pathogen in question.
• Transmission: Transfer or spread of pathogen. Just like a car is a vehicle for us to move from one place to another, so it is that pathogens require transport first before they can cause harm. There are 4 ways of nosocomial transmission: Contact, airborne, droplet, and common vehicle transmission. Contact is the most popular choice.
• A susceptible person: Someone with a special risk to get infection.

Once all three elements are there, then the link is complete, thus enabling an infection to manifest itself in the susceptible person.

The basic aim of infection control is to break this chain of infection. The way to do it: Stop transmission of the pathogen.

How do we stop transmission of infection?
Before we begin, we need to think about the following issues first:

• What pathogen is it
• What kind of infection that you want to prevent
• What are the ways that particular pathogen can be transmitted

With this understanding, we can then use certain isolation precautions to have effective prevention of transmission.

What are Isolation Precautions?
There are 2 levels of isolation precautions:

1) STANDARD PRECAUTIONS
There are precautions designed for the care of all patients regardless of their diagnosis or presumed infection status.

Infection control measures include:

• Handwashing
• The use of protective barriers, such as gloves, gown, mask, goggle where indicated
  Patient-care equipment
• Occupational health and bloodborne pathogens

Handwashing

use of protective gloves

use of protective goggles

2) TRANSMISSION-BASED PRECAUTIONS
These are the second level precautions designed for the care of patients known or suspected to be infected with certain important pathogens spread by airborne, droplet and / or contact transmission.

The three types of transmission-based precaution are:

• Airborne Precautions
• Droplet Precautions
• Contact Precautions

They may be combined together for diseases that have several ways of transmission. When used either singularly or in combination, they are to be used in addition to Standard Precautions.

More than 85% of all nosocomial infections are brought by direct contact. So what is the single most important practice to stop the spread of infection? Good hand washing!

As a healthcare worker, what is my chance of getting an infection? How can I protect myself?
Again, if you are in a reasonable state of health, you do not need to worry much about it. As part of occupational safety and health, we need to understand the basic concept of infection control, and apply infection control measures appropriately, such as standard precautions, and using personal protective equipment as necessary. That way, we can help reduce or prevent exposures and injuries to ourselves.

The infection control manual at NMSC provides a guideline on accidental injuries and occupational exposure to all our healthcare workers.

How about infection control at home? Is there something I can do about it?
Infection control is not only about hospitals and clinics. It is also a part of healthy living. We can start by cultivating good habits such as the following:

Good hand washing habits:

• Wash hands properly with soap and water:
• Before eating, drinking, handling or preparing food.
• After going to the toilet.
• Whenever hands are visibly dirty.
• After handling or playing with pets.
• Before and after changing coiled baby diapers.

Practice safe food handling practices, e.g. avoid repetitive freeze-thaw of foods, and refrigerate leftover foods promptly.

Regular cleaning of your home, e.g. sweeping, mopping.

Antibiotics: Take them according to the schedule instructed by the doctor. While you may feel better after some days of medication, it is very important to finish your medication. Never keep your leftover antibiotics for future use.

Phyllis Ting
MLT/Microbiologist

Joan Tan
RN Infection Control

Dr Gabriel Teo
Consultant Physician