Nursing Research: Infection Control

The infectious process depends on the interaction between an infectious agent, a susceptible host, and the environment. Essential to this interaction is a means of transmission of the agent from an infected host to a susceptible host. This occurs through direct contact, airborne droplet transmission, and indirect contact. 

Airborne transmission involves the dissemination of particles suspended in air that contain infectious microorganisms. When replication of the infectious agent occurs in the tissues of the host, causing local cellular injury, secretion of toxins, and/or an antigen-antibody reaction that produces signs and symptoms, infectious disease is present. Communicable diseases are infectious diseases that may be transmitted from one person (or animal) to another. Not all infectious diseases are communicable. Infection control occurs both in the community and within institutions. However, since 1980 increasing emphasis has been placed on hospital-acquired infections.

The CDC has long been involved in the development of guidelines for infection control programs. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) sets standards for practice and re-quires infection control committees to recommend and approve surveillance programs based on previous nosocomial infection statistics. In addition, the Occupational Safety and Health Administration (OSHA) has published a regulatory document titled The OSHA Bloodborne Pathogen Standard. This document requires that all employers of health care workers provide employees with an environment safe from exposure to blood-borne pathogens (U.S. Department of Labor, 1991). The American Public Health Association has published a classification system for reporting communicable diseases that is used by state and national public health services.
The National Nosocomial Infection Surveil-lance system collects data from a variety of hospitals nationwide. Reports of findings are published periodically. The purpose of infection control surveillance is to establish and maintain a database that describes the endemic rates of nosocomial infections. Knowledge of endemic rates allows recognition of increased rates of nosocomial infection resulting in clusters or out-breaks. These data also can be used to prioritize infection control activities and identify trends such as shifts in prevalent pathogens or outcomes of hospital-acquired infections.
The surveillance process includes definition of nosocomial infections, systematic gathering of case findings, and tabulation, analysis, interpretation, and reporting of relevant data to individuals or groups for appropriate action.
There are three major types of surveillance. Total house surveillance detects and records all nosocomial infections that occur anywhere in the hospital. It is expensive because of the time and personnel required. Priority-directed or targeted surveillance concentrates on specific areas, patient populations, or procedures, depending on the characteristics of the hospital. Problem-oriented surveillance is conducted to measure the occurrence of specific infection problems, such as outbreaks in specific areas of the hospital.
Other surveillance programs may include prevalence surveys or a focus on the identification of risk factors associated with nosocomial infections. Control of infectious diseases depends on interrupting the interaction between an infectious pathogenic agent, a susceptible person, and the characteristics of the environment.

The characteristics of transmission of the organism through direct contact, airborne droplets, and indirect contact are important considerations. Nosocomial infections are iatrogenic, costly complications of hospitalization. In order of incidence, the top four nosocomial infections are urinary tract infections, pneumonia, surgical wound infections, and bacteremia. Preventive interventions for high-risk patients are the most effective measures to prevent morbidity and mortality.