Organisational Structure

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Learning objectives

1. Describe how the infection prevention and control is organised in health care.

2. List the members of an infection control team.

3. Outline the topics contained in a typical infection control manual

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Time involved

• 45 minutes

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Key Points• Risk prevention for patients and staff is a concern of

everyone in the facility and must be supported at the level of senior administration

• Infection Prevention and Control Programs require an appropriate, clear, and firm organisational structure

• Infection Prevention and Control Programs in most countries are delivered through an Infection Control Team

• An infection prevention and control manual compiling recommended instructions and practices for patient care is an important tool

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Introduction • Each institution is unique and its specific needs

must be considered when developing or reorganising an infection prevention and control (IP&C) program D

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National Program National IP&C programs must:

• Set relevant objectives consistent with other national health care objectives

• Develop and continually update guidelines for health care surveillance, prevention, and practice

• Develop a national system to monitor selected infections and assess the effectiveness of interventions

• Harmonise initial and continuing training programs for health care professionals

• Facilitate access to products essential for hygiene and safety• Encourage health care establishments to monitor

healthcare-associated infections with feedback to the professionals concerned

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Health Care Facility Programs • Risk pre vention for patients and staff is a concern

of every one in the facility and must be supported by senior administration

• A yearly work plan should be developed to assess and promote • good health care, • appropriate isolation precautions, • sterilisation and other practices, • staff train ing, and • epidemiological surveillance

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Health Care Facility Programs • Appropriate arrangements must be in

place for effective IP&C practices • There is an Infection Control Committee

(ICC) and an Infection Control Team (ICT)

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Infection Control Committee (ICC) • Provides a forum for multidisciplinary input,

cooperation, and information sharing• Is responsible for the planning, implementation,

prioritisation, and resource allocation of all matters relating to IP&C

• Acts as a liaison between departments responsible for patient care and support services

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ICC Membership • Chief Executive/Administrator or nominated representative• Infection Control Officer/Doctor/Microbiologist who may

act as chairperson• Infection Control Nurse (ICN)• Infectious Disease Physician (if available)• Director of Nursing or his/her representative• Occupational Health Physician (if available)• Representatives from the major clinical specialties• Representatives of other departments may be invited as

necessary• pharmacy, central supply, maintenance, housekeeping, training

services, engineering/design, etc.

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ICC Overall Responsibility

• Holds regular meetings with minutes• Produces an annual report and an annual

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ICC Tasks - 1• To review and approve the annual plan for IP&C• To review and approve IP&C policies• To support the Infection Control Team and direct

resources to address problems as identified• To ensure availability of appropriate supplies

needed for IP&C• To review epidemiological surveillance data and

identify areas for intervention• To assess and promote improved practice at all

levels• To ensure staff training in IP&C and safety

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ICC Tasks - 2• To review infectious risks associated with new

technologies and monitor risks of new devices and products, prior to their approval for use

• To review and provide input into an outbreak investigation

• To review and approve construction/renovation projects regarding infection prevention

• To communicate and cooperate with other committees with common interests, such as Antibiotic/Pharmacy Committee, Occupational Health Committee, etc.

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Infection Control Team (ICT)

• The team should have a range of expertise covering • infection prevention and control• medical microbiology• healthcare epidemiology• infectious diseases• nursing procedures

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ICT Responsibilities• Is responsible for the day-to-day running

of Infection Prevention and Control programs

• Must have appropriate authority• 24 hour access to the ICT for advice on

IP&C issues is essential

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ICT Role - 1• To develop an annual IP&C plan with clearly defined

objectives• To develop written policies and procedures, includ ing

regular evaluation and updates• To prepare an action plan for implementation of the IP&C

program with approval from the Infection Control Committee

• To monitor and evaluate daily practices of patient care designed to prevent infection

• To identify problems in the implementation of IP&C activities which need to be solved or addressed by the Infection Control Committee

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ICT Role - 2• To organise epidemiological surveillance for

healthcare-associated infections • To investigate outbreaks and provide data (and

expert advice) that should be evaluated to allow for any change in practice or allocation of resources

• To educate all grades of staff in IP&C policy, practice, and procedures relevant to their own areas

• To provide advice to all grades of staff on all aspects of IP&C on a day-to-day basis

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ICT Role - 3

• To develop an annual training plan for healthcare workers and implement IP&C training activities

• To ensure availability of supplies and equipment needed for IP&C-related activities

• To have a scientific and technical support role in purchasing and monitoring of equipment and supplies, and in evaluation and checking the efficacy of sterilisation and disinfection measures

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ICT Role - 4• To collaborate with the pharmacy and antibiotic

committees in developing a program for supervising antibiotic use

• To support and participate in research and assessment programs

• To participate in audit activities• To obtain program approval from the Infection

Control Committee• To submit monthly reports on activities to the

Infection Control Committee

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Composition of the ICT

• Consists of • at least one physician, the Infection Control

Officer/Doctor and • at least one nurse, the Infection Control Nurse

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Infection Control Officer (ICO) - 1

• Is a medically qualified senior staff member who is interested in and who spends most of his/her time involved in IP&C

• Typically a medical microbiologist, an epidemiologist, or an infectious diseases physician

• May also be called an Infection Control Doctor or Hospital Epidemiologist

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Infection Control Officer - 2

• Serves as a specialist advisor and takes a leading role in the effective functioning of the Infection Control Team

• Should be an active member of the Infection Control Committee and may act as its Chair

• Assists the Infection Control Committee in reviewing annual plans, policies, and long-term programs for the prevention and control of infection

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Infection Control Officer - 3

• Advises the Chief Executive/Administrator directly on all aspects of IP&C and on the implementation of policies and procedures

• Participates in the preparation of tender (bid, offer) documents for support services and advises on IP&C aspects

• Must be involved in setting quality standards, surveillance, and audits with regard to infection prevention

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Infection Control Nurse (ICN)- 1• Is a registered nurse with an academic education

and practical training which enables him or her to act as a specialist advisor in all aspects relating to IP&C• Perhaps with a qualification, such as specialised

training• Is usually the only full-time practitioner on the

Infection Control Team and therefore takes the key role in day-to-day IP&C activities

• Role may be filled by someone other than a nurse in some countries. Titles vary.

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Infection Control Nurse - 2

• Contributes to the development and implementation of policies and procedures, participates in audits, and monitors tools related to IP&C and infectious diseases

• Provides specialist-nursing input in the identification, prevention, monitoring, and control of infection

• Participates in surveillance and outbreak investigation activities

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Infection Control Nurse - 3

• Identifies, investigates and monitors infections, hazardous practices and procedures

• Participates in preparing documents relating to service specifications and quality standards

• Participates in training and educational programs • Is a member of relevant committees where

Infection Prevention and Control input is required

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Infection Control Link Nurse (ICLN) - 1 • These individuals have special responsibility

for maintaining good IPC practices and education within their departments

• Is the “link” between the Infection Control Nurse and the ward

• Helps identify problems, implement solutions, and maintain communications

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Infection Control Link Nurse - 2

The ICLN is responsible for: • Monitoring hygiene, consistent with policies and good

nursing practices• Monitoring aseptic techniques, including hand hygiene

and use of isolation precautions • Reporting promptly to the attending physician any

evidence of infection in patients• Initiating patient isolation/precautions and ordering

culture specimens from any patient

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Infection Control Link Nurse - 3

The ICLN is responsible for: • Identifying signs of a communicable disease

when the physician is not available• Limiting patient exposure to infections from

visitors, staff, other patients, or equipment used for diagnosis or treatment

• Maintaining a safe and adequate supply of ward equipment, drugs, and patient care supplies

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Infection Control Manual - 1

• Establishes standards for performance• Contains recommended instructions and

practices for patient care• Topics include:

• Patient care• Hand hygiene• Isolation precautions practices• Invasive procedures (intravascular and urinary

catheterisation, mechanical ventilation, tracheostomy care, and wound management)

• Oral alimentation

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Infection Control Manual - 2• Topics include:

• Area specific procedures • Isolation precautions procedures for infectious patients• Surgical and operating theatre techniques• Obstetrical, neonatal, and intensive care techniques

• Processing of items of critical importance • Cleaning, sterilisation, and disinfection• Medication and preparation of infusions (including blood

products)

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Infection Control Manual - 3

• Topics include:• Staff health

• Immunisation• Post-exposure management for employees, patients, and

others exposed to infectious diseases within the facility• Investigation and management of patients with

specific infections • Methicillin-resistant Staphylococcus aureus (MRSA) • Diarrhoea• Human immunodeficiency virus• Tuberculosis• Multi-resistant Gram-negative bacteria

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References - 1• Ducel G, Fabry J, Nicolle L. Prevention of hospital-acquired infections;

A practical guide, 2nd ed. World Health Organization, Geneva, Switzerland; 2002; 9. http://www.who.int/csr/resources/publications/WHO_CDS_CSR_EPH_2002_12/en/

• Scheckler WE, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Infect Control Hospital Epidemiol 1998; 19: 114-124. http://www.shea-online.org/Assets/files/position_papers/IC-Infrastructure98.PDF

• Friedman C, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: A Consensus Panel report. Am J Infect Control 1999; 27(5): 418-430. http://www.ncbi.nlm.nih.gov/pubmed/10530650

• Brannigan ET, Murray E, Holmes A. Where does infection control fit into a hospital management structure? J Hosp Infect 2009: 73(4): 392-396.

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References - 2• Essential Resources for Effective Infection Prevention and

Control Programs: A Matter of Patient Safety: A Discussion Paper – 2010. Public Health Agency of Canada http://www.phac-aspc.gc.ca/nois-sinp/guide/ps-sp/index-eng.php

• Friedman C, et al. APIC/CHICA-Canada infection prevention, control and epidemiology: Professional and practice standards. Am J Infect Control 2008; 36 (6): 385-389. http://www.chica.org/pdf/08PPS.pdf

• Gordts B. Models for the organisation of hospital infection control and prevention programmes. Clin Microbiol Infect 2005; 11 Suppl 1:19-23.

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Quiz1. The infection prevention and control program is often

overseen by an Infection Control Committee. T/F?2. IC link nurses are responsible for:

a) Day-to-day activities of the IPC programb) IC education of all staffc) Monitoring local practicesd) All of the above

3. An Infection Control Manual helps a facility:a) Keep track of its infectionsb) Investigate outbreaksc) Establish standards of practiced) All of the above

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International Federation of Infection Control• IFIC’s mission is to facilitate international networking in

order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe .

• The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise.

• For more information go to http://theific.org/

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