Hospital Committes - Infection control committe

HOSPITAL COMMITTEES

A hospital committee is a group of healthcare professionals and/or administrative personnel within a hospital that addresses a particular aspect of patient care, hospital management, or institutional functioning.

Hospital committees may deal with:

• Patient care and clinical services
• Financial matters
• Operational management
• Drug and therapeutic management
• Infection prevention
• Research and ethics
• Quality assurance
• Biomedical waste management
• Medical records
• Blood transfusion services

Major Hospital Committees

1. Pharmacy and Therapeutics Committee (PTC)
2. Management Committee
3. Committee on Medical Services
4. Bioethics/Clinical Ethics Committee
5. Infection Control Committee (ICC)
6. Quality Assurance/Quality Control Committee
7. Waste Management Committee
8. Medical Records Committee
9. Blood Transfusion Committee
10. Research/Ethics Committee

I. INFECTION CONTROL COMMITTEE (ICC)

1. Introduction

The risk of infection is always present in a hospital. Patients may acquire infections before admission or during their stay in the hospital. Healthcare workers and visitors may also be exposed to infectious agents.

Antibiotics are among the most frequently prescribed anti-infective medicines in hospitals. However, inappropriate or unnecessary antibiotic use can contribute to adverse effects, increased healthcare costs, and the development and spread of antimicrobial resistance.

Inappropriate antibiotic use may occur because of:

• Unnecessary antibiotic therapy
• Incorrect drug selection
• Inappropriate dose
• Incorrect duration of treatment
• Unreasonable antibiotic prophylaxis
• Failure to obtain appropriate microbiological investigations when indicated

Therefore, hospitals require an effective infection prevention and control programme, supported by an Infection Control Committee and Infection Control Team.

2. Hospital-Acquired and Community-Acquired Infection

A. Community-acquired infection

An infection that is present or incubating before the patient is admitted to the hospital is generally considered a community-acquired infection.

B. Hospital-acquired infection / Nosocomial infection

A healthcare-associated infection (HAI) is an infection associated with receiving healthcare that was not present or incubating at the time of admission.

Hospital-associated infections may:

• Develop during hospitalisation
• Become apparent after a period following admission
• Become apparent after discharge when the infection was acquired during healthcare
• Include certain occupational infections among healthcare workers

Important: The commonly used 48-hour criterion is a traditional surveillance rule for some hospital-acquired infections, not a universal definition for every HAI.

3. Definition of Infection

Infection is the invasion and multiplication of pathogenic microorganisms such as bacteria, viruses, fungi, protozoa, or other infectious agents in the body, which may produce tissue injury or disease.

Infection may be:

• Localised – confined to a particular area
• Generalised/systemic – spread throughout the body

Common manifestations may include:

• Pain
• Swelling
• Redness
• Fever
• Increased pulse rate
• Functional disturbances
• Leukocytosis

4. Factors Influencing Hospital Infection

Three major factors influence the occurrence of hospital infection:

1. Microbial agent

Important characteristics include:

• Type of organism
• Virulence
• Infective dose
• Antimicrobial resistance
• Ability to survive in the environment

2. Patient susceptibility

Risk is increased by factors such as:

• Extremes of age
• Immunosuppression
• Chronic diseases
• Malnutrition
• Surgical procedures
• Invasive devices
• Prolonged hospitalisation

3. Environmental factors

Examples include:

• Contaminated equipment
• Poor hand hygiene
• Inadequate sterilisation
• Poor environmental cleaning
• Contaminated food or water
• Improper waste management
• Inadequate isolation facilities

Easy memory:

Infection risk = Agent + Host + Environment

5. Modes of Transmission

A. Endogenous infection

An endogenous infection occurs when microorganisms that are normally present in or on the patient become pathogenic or cause infection because of changes in the patient's condition.

Contributing factors may include:

• Change in normal microbial habitat
• Damage to skin or mucous membranes
• Immunosuppression
• Invasive procedures
• Inappropriate antibiotic use

Example: Normal intestinal flora causing infection following surgery or severe immunosuppression.

B. Exogenous infection / Cross-infection

An exogenous infection occurs when the infectious organism comes from an external source.

Common sources include:

• Healthcare workers
• Visitors
• Other patients
• Contaminated equipment
• Environment
• Food or water

Hands of healthcare workers are an important route of transmission, making hand hygiene a fundamental infection-prevention measure.

6. Infection Control Programme (ICP)

An effective Infection Control Programme is an important component of quality healthcare and patient safety.

The programme generally operates through two major bodies:

1. Infection Control Committee (ICC)

Advisory/policy-making body

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Develops and approves policies, reviews surveillance information and provides direction.

2. Infection Control Team (ICT)

Operational/implementation body

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Implements infection-control policies, conducts surveillance, training, audits and investigations.

Overall structure

Hospital Management

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Infection Control Committee

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Infection Control Team

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Infection Control Manual + Surveillance + Prevention + Staff Training

7. Infection Control Committee – Definition

The Infection Control Committee (ICC) is a multidisciplinary hospital committee responsible for planning, approving, monitoring, evaluating, and improving infection prevention and control activities and for recommending corrective actions.

It includes representatives from relevant clinical, nursing, microbiology, pharmacy, administrative, and support departments.

8. Constitution/Composition of ICC

The membership should reflect the clinical services and administrative structure of the hospital.

Core members

1. Chief Executive/Hospital Administrator or nominated representative
2. Hospital Microbiologist/Infection Control Doctor – often the Chairperson
3. Infection Control Nurse (ICN)
4. Infectious Disease Physician, if available
5. Director of Nursing or representative
6. Occupational Health Physician, if available
7. Representatives from major clinical specialties
8. Hospital Pharmacist/Pharmacy representative
9. CSSD representative
10. Maintenance/Engineering representative
11. Housekeeping representative
12. Biomedical waste management representative, where applicable

Important principle

The exact composition may vary according to:

• Size of hospital
• Type of services
• Available resources
• Local requirements

9. Authority of Infection Control Team

The Infection Control Team should:

• Have sufficient authority to implement the infection-control programme.
• Have a direct reporting relationship with senior hospital administration.
• Have access to necessary resources and information.
• Be responsible for day-to-day infection-control activities.
• Prepare an annual infection-control work plan.
• Have appropriate expertise and training.

10. Tasks/Functions of Infection Control Committee

1. Annual infection-control plan

• Review and approve the annual infection-control plan.
• Establish priorities and objectives.

2. Infection-control policies

• Review and approve infection-control policies.
• Ensure policies are evidence-based and periodically updated.

3. Identify areas requiring intervention

Review surveillance data to identify:

• High-risk areas
• Increased infection rates
• Problems in clinical practice
• Potential outbreaks

4. Support the Infection Control Team

• Provide institutional support.
• Direct resources towards identified problems.
• Ensure availability of appropriate supplies.

5. Surveillance

• Review epidemiological surveillance data.
• Monitor healthcare-associated infections.
• Identify trends and areas requiring intervention.

6. Promote improved practices

Assess and promote good infection-control practices at all levels of the healthcare facility.

7. Staff training

Ensure appropriate training in:

• Infection prevention
• Hand hygiene
• PPE
• Isolation precautions
• Sterilisation
• Safe clinical practices

8. Safety management

Promote safety measures for:

• Patients
• Healthcare workers
• Visitors

9. New technology and devices

Review infection-related risks associated with new technologies, procedures, and medical devices before their introduction when appropriate.

10. Outbreak investigation

Review and provide input into investigation and control of suspected outbreaks.

11. Infection-control manual

Develop, review, approve, and periodically update the hospital's Infection Control Manual.

12. Monitoring and evaluation

Monitor and evaluate the effectiveness of the infection-control programme and recommend corrective actions.

11. Role of Infection Control Team

The Infection Control Team is responsible for implementation and day-to-day activities.

Major functions

1. Develop an annual infection-control plan with clearly defined objectives.
2. Develop written infection-control policies and procedures.
3. Regularly evaluate and update policies.
4. Supervise and monitor daily patient-care practices designed to prevent infection.
5. Ensure availability of appropriate infection-control supplies.
6. Organise an epidemiological surveillance programme.
7. Pay particular attention to high-risk areas for early detection of outbreaks.
8. Educate all categories of hospital staff regarding infection-control policies and procedures.
9. Investigate suspected outbreaks.
10. Provide infection-control reports to the ICC.

12. Infection Control Manual

Every hospital should have an Infection Control Manual containing recommended infection-prevention and patient-care practices.

It should include policies/procedures relating to areas such as:

• Standard precautions
• Hand hygiene
• PPE
• Isolation precautions
• Sterilisation and disinfection
• Safe injection practices
• Biomedical waste management
• Occupational exposure
• Environmental cleaning
• Outbreak management

Development

Infection Control Team → Develops/updates manual

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Infection Control Committee → Reviews and approves

13. Scope of Infection Control

The primary aim is to prevent the spread of infection within healthcare facilities.

Standard precautions

Standard precautions should be applied to all patients, regardless of their suspected or confirmed infection status.

They are particularly important whenever healthcare workers may be exposed to:

• Blood
• Body fluids
• Non-intact skin
• Mucous membranes
• Potentially contaminated materials

Important components include:

• Hand hygiene
• Appropriate PPE
• Respiratory hygiene
• Safe injection practices
• Sharps safety
• Appropriate cleaning and disinfection

14. Antibiotic Policy and Infection Control

A hospital antibiotic policy should promote rational antimicrobial use.

Essential principles

1. Use antibiotics only when clinically indicated

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2. Identify the likely pathogen

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3. Obtain appropriate specimens for culture and susceptibility testing when indicated

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4. Select an appropriate antibiotic

Selection should consider:

• Likely/confirmed organism
• Site of infection
• Patient factors
• Safety
• Local resistance patterns
• Cost
• Ease of administration

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5. Use appropriate dose and duration

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6. Prefer oral therapy when clinically appropriate

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7. Review therapy periodically

This supports antimicrobial stewardship and helps limit antimicrobial resistance.

15. Antibiotic Use Review (AUR)

Antibiotic Use Review (AUR) is the periodic assessment of antibiotic prescribing and utilisation.

It may evaluate:

• Indication
• Drug selection
• Dose
• Route
• Duration
• Culture and susceptibility results
• Surgical prophylaxis
• De-escalation when appropriate

Periodic review meetings can be conducted to discuss findings and implement corrective measures.

16. Role of Hospital Pharmacist in Infection Control

The hospital pharmacist contributes significantly to infection prevention through antimicrobial stewardship and medication management.

Responsibilities

1. Participate in Infection Control Committee meetings.
2. Assist in developing hospital antibiotic policies.
3. Promote rational antimicrobial use.
4. Monitor antibiotic utilisation.
5. Participate in Antibiotic Use Review.
6. Provide drug information regarding antimicrobials.
7. Assist in selection of appropriate antibiotics.
8. Monitor dose, duration, interactions, and adverse effects.
9. Participate in antimicrobial stewardship activities.
10. Collaborate with microbiologists regarding antimicrobial resistance patterns.
11. Support appropriate surgical antimicrobial prophylaxis.
12. Educate healthcare professionals about rational antimicrobial use.
13. Help minimise unnecessary antibiotic exposure and antimicrobial resistance.