How can infections be prevented and managed?

Infection Prevention and Control Strategies

The most effective approach to prevent and manage infections is implementing a comprehensive infection prevention and control bundle that includes hand hygiene, standard precautions, environmental cleaning, antimicrobial stewardship, and appropriate isolation measures. 1

Core Prevention Strategies

Hand Hygiene

• Perform hand hygiene using alcohol-based hand rub or handwashing with soap (plain or antimicrobial) and water before and after every patient contact or contact with the patient's environment 1
• Hand hygiene is the single most important measure to prevent transmission of infectious agents 2
• Healthcare workers' hands are the primary vehicle for transmission of healthcare-associated pathogens 2

Standard Precautions

• Use standard precautions for all patient interactions, including:
  • Appropriate use of personal protective equipment (gloves, gowns, masks) based on anticipated exposure 1
  • Safe handling and disposal of needles and sharp instruments 1
  • Proper respiratory hygiene/cough etiquette 1

Environmental Cleaning and Disinfection

• Implement regular cleaning and disinfection of surfaces and equipment 1
• Use appropriate disinfectants (e.g., 0.5% hypochlorite solutions for surface cleaning during outbreaks) 1, 3
• Ensure proper sterilization of critical items that contact sterile tissue and high-level disinfection for items contacting mucous membranes 3
• Clearly define responsibility for cleaning medical equipment 1

Antimicrobial Stewardship

• Implement judicious use of antimicrobial agents to prevent emergence of resistant organisms 1
• Develop and enforce antibiotic stewardship programs that ensure appropriate antibiotic selection, dosing, and duration 1, 4
• Target reduction of cephalosporins and quinolones to reduce Clostridioides difficile infections 1

Isolation and Patient Placement

• Promptly identify and isolate patients with potentially contagious diseases 1
• Implement contact precautions for patients with known colonization or infection with multidrug-resistant organisms 1
• Minimize contact between contagious and uninfected patients, especially immunocompromised individuals 1

Special Considerations for Different Settings

Healthcare Facilities

• Develop written infection prevention and control policies that are reviewed at least every 2 years 1
• Implement educational programs for staff regarding infection prevention and control 1
• Ensure healthcare workers receive appropriate immunizations (influenza annually, plus pertussis, measles, mumps, rubella, varicella, and hepatitis B) 1
• Conduct active surveillance for high-risk pathogens in endemic or outbreak situations 1

Ambulatory Settings

• Implement respiratory hygiene/cough etiquette strategies in waiting areas 1
• Use alcohol for skin antisepsis before routine procedures; use 2% chlorhexidine gluconate/70% isopropyl alcohol for more invasive procedures in patients older than 2 months 1
• Establish protocols for handling patients with highly contagious infections 1

Immunocompromised Patients

• Implement more aggressive prophylactic strategies for high-risk patients (e.g., cancer patients, transplant recipients) 1
• Consider antimicrobial prophylaxis and pre-emptive therapy based on individual risk factors 1
• Provide prophylaxis for Pneumocystis jirovecii pneumonia (PJP) for patients receiving CAR T-cell therapy and other high-risk immunosuppressive treatments 1

Management of Infections

Early Detection

• Implement active surveillance for infections in high-risk settings 1
• Use appropriate diagnostic testing to identify causative pathogens 1, 5
• Consider use of chromogenic media for rapid identification of multidrug-resistant organisms during outbreaks 1

Treatment Approach

• Select appropriate antimicrobial therapy based on likely pathogens and local resistance patterns 5, 4
• For surgical site infections and abscesses, combine incision and drainage with appropriate antimicrobial coverage 1, 5
• Adjust therapy based on culture results and clinical response 5

Outbreak Management

• Implement multifaceted interventions including reinforced education, hand hygiene, contact precautions, environmental cleaning, and active surveillance 1
• Screen all patients at least weekly during outbreaks for colonization with the outbreak organism 1
• Obtain institutional and administrative support for outbreak control measures 1

Common Pitfalls and Challenges

• Lack of adherence to guidelines due to ambiguity, constant changes, or increased workload 6
• Insufficient training on proper use of personal protective equipment 6
• Inadequate supplies of appropriate personal protective equipment 6
• Failure to include all staff (including cleaning staff, porters, and support staff) in infection control initiatives 6
• Lack of physical space for proper isolation of infected patients 6
• Inconsistent communication about infection prevention guidelines 6

By implementing these evidence-based strategies systematically, healthcare facilities can significantly reduce the risk of infections and effectively manage them when they occur.