Infection Control Program

Infectious Agents

Bacteria, viruses, fungi, prions and parasites. The organism’s increased ability to grow and multiply (virulence), to enter tissue (invasiveness), and to cause disease (pathogenicity) the greater chance the organism will have to cause an infection or disease.

Reservoir

The reservoir is the habitat where an infectious agent lives, multiplies, and grows. A reservoir can be a human, an animal, an insect, food, soil or water. Human and animal reservoirs can be colonized with an organism meaning they carry the organism as normal flora and have no signs or symptoms of infection.

Portal of Exit

The portal of exit is a way the microorganism leaves the reservoir. This could be infected blood, stool, urine, skin or respiratory secretions.

Mode of Transmission

A mode of transmission is how an organism is transferred to another person (or host). Modes of transmission can be contact, droplet or airborne. Transmission can be direct, or indirect. Direct transmission is when a susceptible host receives the infection from the reservoir. Indirect transmission is when the susceptible host gets the infection from an inanimate object. Fecal-oral transmission is usually indirect.

Susceptible Hosts

A person must be susceptible to the infectious agent for infection transmission to occur. How susceptible any host is will depend on a variety of factors: age, chronic diseases, illnesses, recent surgery, burns, or medications that make a person less able to fight off an infection.

Portal of Entry

There must be a way for the agent to enter a susceptible host. This can be through broken skin, mucous membranes, the digestive system, or the respiratory system.

The Infection Prevention and Control Plan is used to guide a facility with preventing all aspects of healthcare-associated infections and communicable disease transmission.

The Infection Prevention and Control Plan is a well-defined document that outlines the organizations philosophy and mission with infection prevention and control. The plan should be updated at least annually based on the yearly risk assessment. The plan is a living document, it should be edited and updated as conditions change in the facility or within the community. It should have planning goals and objectives that are evaluated annually.

Other Key Components:

• Antibiotic Stewardship
• Bloodborne Pathogen Exposures
• Construction
• Demographics
• Employee Illness
• Environmental Cleaning
• Equipment Cleaning
• Hand Hygiene
• Immunizations
• Linen Handling
• Organizational Structure
• Services Provided
• Standard Precautions
• Surveillance
• Transmission-based Precautions
• Tuberculosis (TB) Testing
• Water mitigation
• Vaccinations

For more information on Infection Control Program Components:

• Centers for Medicare & Medicaid Services (CMS): Infection Control Program Components >
• Centers for Disease Control and Prevention:  Infection Prevention and Control Assessment Tool for Long-term Care Facilities >

Infection control risk assessments are used to identify potential risks within the facility. An infection control risk assessment is more than just running down a list of potential hazards and informing personnel of best practice. The risk assessment is a living document that forms the foundation of a comprehensive Infection Prevention and Control Program. The document evolves over time as goals and objectives change while maintaining a framework for consistent resident safety.

• Provides a basis for infection surveillance, prevention and control activities
• Identifies at-risk populations/procedures in your facility
• Assists in focusing surveillance efforts toward targeted goals
• Aids in meeting regulatory and other requirements.

Risk assessment components:

• The probability of the event/condition occurring. The probability is determined by historical data, infection surveillance data, the scope of services provided, and the environment of the surrounding area.
• The potential impact of the event/condition on residents, visitors and/or employees. This is determined by evaluating the level of illness, injury, infection, or death that could occur. Other impacts to consider are the effects on staffing (will it cause a shortage), the organization’s ability to function (or remain open) and the financial impact.
• The organization’s preparedness to deal with the event/condition. This is determined by considering compliance with policies and procedures, staff experience, and the available services and equipment on hand.

Simply put, the risk assessment is a scoring system to prioritize infection prevention goals and objectives. Higher numbers do not reflect that a facility is doing poorly, and lower numbers do not mean there is no risk, although not having policies and processes in place can lead to a higher score. Some events/conditions on the risk assessment will be a higher risk due to the nature of the event/condition. The scoring system is only used to determine infection control goals that will lead to an increase in resident, visitor and employee safety.

• Prioritize the risk based on impact and likelihood to occur
• Take an interdisciplinary approach to collecting information
• Gain feedback from residents, visitors and employees
• Key elements to consider include geography, population served, risk for Infections, policies in place and compliance with policies
• It’s a means of stratifying to identify areas of focus & planning
• An effective Infection Prevention and Control plan begins with a risk assessment
• When in doubt, go to your resources (APIC, CDC, NJDOH, SHEA, etc.)