🧼 Chapter 99: Infection Prevention and Control

Hand hygiene · Sterilization · Disinfection · Transmission-based precautions (Contact/Droplet/Airborne) · PPE · Isolation · Terminal cleaning · Vaccination of HCW · Post-exposure prophylaxis

🔍 Core Concepts: Infection Prevention & Control in PICU

🧴 Hand Hygiene
Single most important measure. Alcohol-based rub (60-95%) preferred unless hands soiled or C. difficile. Soap & water required for spore-forming organisms.
⚙️ Sterilization & Disinfection
Autoclave (steam), EtO, dry heat. Disinfection: hypochlorite (1000 ppm) for terminal cleaning. Fumigation no longer recommended.
🛡️ Standard Precautions
Apply to all patients: hand hygiene, PPE (gloves, gown, mask, eye protection) based on anticipated exposure.
📌 Contact Precautions
For C. difficile, MDROs, draining wounds. Private room or cohort. Gloves, gown, dedicated equipment. Hypochlorite cleaning.
💧 Droplet Precautions
Influenza, pertussis, meningococcus. Surgical mask within 3 ft of patient. Private room, door closed.
🌬️ Airborne Precautions
TB, measles, varicella. N95 respirator, negative-pressure AIIR (≥6-12 ACH).
💉 Healthcare Worker Protection
Vaccination: HepB, influenza, MMR, varicella, Tdap. Post-exposure prophylaxis (PEP) for HIV within 72h.
🧹 Terminal Cleaning & Bundles
After patient discharge: NaDCC or bleach (1000 ppm). VAP/CLABSI bundles reduce HAI by 30-40%.

🩺 Stepwise Approach: Infection Prevention & Control

1
Perform hand hygiene before and after every patient contact
Use alcohol-based rub (≥60% alcohol) for routine, soap and water for C. diff or visibly soiled hands. Ensure availability at bedside.
2
Apply Standard Precautions universally
Assume every patient is potentially infectious. Use PPE (gloves, gown, mask, eye protection) based on anticipated exposure to blood/body fluids.
3
Identify additional transmission-based precautions
Contact (MDRO, C. difficile, draining wounds) → gown + gloves + dedicated equipment. Droplet (flu, pertussis) → surgical mask within 3 ft. Airborne (TB, measles, varicella) → N95 respirator, negative-pressure room.
4
Environmental cleaning & sterilization
Terminal cleaning: hypochlorite 1000 ppm or NaDCC. For C. difficile: sporicidal bleach. Avoid fumigation.
5
Healthcare worker protection & surveillance
Vaccinate HCWs (HepB, influenza, MMR, varicella). Implement PEP program (HIV, HBV). Use infection control surveillance to track CLABSI, CAUTI, VAP rates.
6
Isolation & cohorting when needed
Single room for airborne/droplet/contact. Cohort same pathogens. Reverse isolation for immunocompromised (HEPA filter).