Objectives

Upon completion of this module, the student will be able to:

• Discuss the role of infection control practitioners.
• Define clinical epidemiology.
• Differentiate between sensitivity and specificity. 
• Compare and contrast positive predictive value (PPV)/negative predictive value (NPV)

Infection Control

Although pioneers, including Semmelweis, Nightingale, and Farr, identified the need for such programs in healthcare, hospital epidemiology programs did not appear until the mid-1900s. Epidemics of staphylococcal infections in a variety of patients were the major reason for the development of hospital epidemiology as a discipline. Over the years, the Joint Commission (JC) has implemented infection control standards and the Occupational Health and Safety Administration (OHSA) has published documents on blood-borne pathogen protection.

Infection control as a specialty for nurses began in the 1960s. In 1970, only 10% of hospitals had Infection Control Practitioners (ICP) and only 10% had policies on intravenous line and ventilator circuit changes. It wasn’t until the 1980s that hospitals began actively employing ICPs. Components of infection control programs at that time included surveillance and analysis of nosocomial infections and the development and implementation of prevention and control measures; these remain in place today.

 Infection control has advanced and developed as a specialty. The Association for Professionals in Infection Control (APIC) is a professional organization that provides a certification examination for ICPs. The American Journal of Infection Control is its official publication.

Hand hygiene is a major way to prevent and control infections and contagious diseases among patients and healthcare personnel. Other factors in eliminating the transmission of diseases include:

• remove, eliminate or contain the source of infection
• disrupt and block the chain of disease transmission
• protect the susceptible population against infection and disease (Merrill, 2021).

In addition, controlling the environment and providing clean and safe air, water, food, and milk can prevent inadvertent exposure to environmental pathogens that result in poor patient outcomes and unhealthy workers. Using appropriate cleaners, maintaining equipment, and adhering to water quality standards will also help reduce hospital-acquired infections.

As we have learned through Covid, preventing the spread of infection involves the use of quarantine, isolation, personal protection, and chemoprophylaxis. Quarantine applies to those who have been exposed to a contagious disease but who may or may not become ill (Centers for Disease Control and Prevention (CDC, 2019; Merrill, 2021, p. 61). The CDC further applies the term to mean any situation in which a building, conveyance, cargo, or animal might be thought to have been exposed to a dangerous contagious disease agent and is kept apart from others to prevent disease spread. According to the World Health Organization, cholera, yellow fever, and plague are diseases for which a person must be quarantined. Should a case of smallpox occur, it is internationally quarantinable. The CDC made pandemic influenza a quarantinable disease and in 2020 added COVID-19 to that list. Isolation, occurring in hospitals and nursing homes, applies to persons who are known to be ill with a contagious disease (CDC, 2017). Healthcare-acquired infections (central line, bloodstream, ventilator, and urinary tract infections to name a few) are caused by a wide variety of common and unusual bacteria, fungi, and viruses. Among these are acinetobacter, clostridium difficile, enterobacter, hepatitis, influenza, klebsiella, mycobacterium, methicillin-resistant staphylococcus aureus, tuberculosis, and vancomycin-resistant enterococci are organisms that warrant isolation.

Since the introduction of mass-produced penicillin in the 1940s, there has been success in treating most infections with broad-spectrum antibiotics. Although many lives have been saved, the inappropriate use of antibiotics has led to resistant infections. Healthcare-acquired infections can be devastating and deadly, not to mention costly to treat. The overall annual direct medical costs to US hospitals can be between $28 to $45 billion. The benefits of preventing infections can range from $5.7 to $31.5.