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Topics: Infection, Infectious disease, Bacteria Pages: 6 (1784 words) Published: October 29, 2014
Breaking the Chain of InfectionBreaking the Chain of Infection By Kelly M. Pyrek

One of the basic infection control principles is the chain of infection. Transmission of infection in a hospital requires at least three elements: a source of infecting microorganisms, a susceptible host and a means of transmission for bacteria and viruses.1

"An example of the most simple chain of infection is an infected patient cared for by a healthcare worker (HCW) who doesn't wash his or her hands before caring for another patient," says Richard Wenzel, MD, MSc, of the Department of Internal Medicine of Virginia Commonwealth University in Richmond, Va. Wenzel adds that contaminated hands are one of the most likely means of transmission of bacteria in hospitals.

Breaking the Chain of Infection
By Kelly M. Pyrek

One of the basic infection control principles is the chain of infection. Transmission of infection in a hospital requires at least three elements: a source of infecting microorganisms, a susceptible host and a means of transmission for bacteria and viruses.1

"An example of the most simple chain of infection is an infected patient cared for by a healthcare worker (HCW) who doesn't wash his or her hands before caring for another patient," says Richard Wenzel, MD, MSc, of the Department of Internal Medicine of Virginia Commonwealth University in Richmond, Va. Wenzel adds that contaminated hands are one of the most likely means of transmission of bacteria in hospitals.

"When you talk about the chain of infection, you must acknowledge Ignaz Semmelweis, who in the mid-1800s, noted how bacteria travel from caregiver to patient." In a chapter on handwashing for A Guide to Infection Control in the Hospital, Wenzel describes how, as an obstetrician, Semmelweiss noticed the practice of physicians and medical students examining women who died of puerperal sepsis (later linked to infection by Streptococcus pyogenes) and then going directly to the wards where they examined women in labor. Wenzel writes, "Semmelweis noted that on wards where midwives delivered babies, few mothers died of puerperal sepsis. He knew that midwives did not witness autopsies. Semmelweis reasoned that something was carried from the autopsy room to the wards on the hands of physicians and students. He introduced a simple handwashing regimen and rates of death due to puerperal sepsis fell."2

"Obviously hands are important agents in the transmission of infection and a number of studies demonstrate this," Wenzel says. "In the 1970s, Katherine Sprunt's work with newborns showed that if you washed your hands after changing a baby's diaper, you get rid of the coliforms, the transient gram-negative rods. Then it turns out that gram-positive bacteria are not so easily washed off the hands. In the 1980s, Ojajarvi of Finland showed us that medicated soaps worked better than plain soap and water for gram-positive bacteria, particularly methicillin-resistant Staph aureus (MRSA). It still stands to reason, however, that a careful 10- to 15-second handwash with any soap and water is effective in reducing the transmission of bacteria."

Wenzel continues, "In the 1960s, one study of newborn units looked at how Staph aureus was transmitted. Physicians, nurses and babies were cohorted in one area while another colonized group was cohorted where the only transmission of bacteria would have occurred by an airborne route. Nobody crossed the magic line between the two groups, and at the end of the study it was shown that about 15 percent of the transmission of Staph aureus could have been by the airborne route. There was no other explanation, so at least 85 percent of the transmission was via hands. The concept of the chain of infection started with initial studies on the importance of handwashing and was confirmed in subsequent decades."

The specific links in the chain of infection are: reservoir, infectious agent, susceptible host, portal of entry, mode of...
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