Unit 4: Infection Prevention and Control & Antibiotic Resistance | Quality and Patient Safety | 4th Semester of Bachelor of Optometry

Infection Prevention and Control

Infections are a major concern in healthcare facilities because they not only prolong illness but also increase costs, morbidity, and mortality. Healthcare-associated infections (HAIs), also known as nosocomial infections, can occur in hospitals, clinics, or even smaller practices like eye care centers. Infection prevention and control (IPC) is a scientific approach and practical solution to prevent harm caused by infections to patients and healthcare workers. Effective IPC is essential for ensuring patient safety, protecting staff, and maintaining public trust in healthcare systems.

Definition of Infection

Infection is the invasion and multiplication of microorganisms such as bacteria, viruses, fungi, or parasites in the body, which may cause disease. In healthcare, infections may spread from patient to patient, patient to staff, or staff to patient if proper precautions are not followed.

Healthcare-Associated Infections (HAIs)

HAIs are infections acquired by patients during the course of receiving treatment in a healthcare facility. Common types include:

• Urinary Tract Infections (UTIs): Often associated with catheter use.
• Surgical Site Infections: Occur at or near surgical wounds.
• Respiratory Infections: Such as ventilator-associated pneumonia.
• Bloodstream Infections: Often linked to intravenous lines or catheters.
• Ocular Infections: In eye care settings, infections may arise from contaminated instruments, contact lenses, or poor hygiene.

Chain of Infection

To understand infection control, one must understand the chain of infection, which consists of six elements:

1. Infectious Agent: The microorganism causing the infection.
2. Reservoir: The place where the microorganism lives (patients, staff, equipment, water, surfaces).
3. Portal of Exit: How the microorganism leaves the reservoir (blood, secretions, droplets).
4. Mode of Transmission: Contact, droplet, airborne, or vector-borne.
5. Portal of Entry: How the microorganism enters the new host (wounds, respiratory tract, eyes, mucous membranes).
6. Susceptible Host: Individuals with reduced immunity, chronic illness, or invasive devices.

Breaking any link in this chain is the foundation of infection control.

Modes of Transmission

• Direct Contact: Touching an infected wound or patient secretions.
• Indirect Contact: Using contaminated equipment, instruments, or surfaces.
• Droplet Transmission: Coughing, sneezing, or talking within close distance.
• Airborne Transmission: Tiny particles that remain suspended in the air (e.g., tuberculosis).
• Vector-Borne Transmission: Spread through insects such as mosquitoes.

Standard Precautions

Standard precautions are the minimum infection prevention measures applied to all patients, regardless of diagnosis. These include:

• Hand Hygiene: The single most effective method of infection control. Hands should be washed with soap and water or cleaned with alcohol-based hand rubs before and after patient contact.
• Personal Protective Equipment (PPE): Gloves, masks, gowns, and eye protection as needed.
• Respiratory Hygiene: Covering coughs and sneezes, wearing masks when appropriate.
• Safe Injection Practices: Using sterile needles and syringes, avoiding reuse.
• Environmental Cleaning: Regular disinfection of surfaces, instruments, and patient care areas.
• Waste Disposal: Proper segregation and disposal of biomedical waste.

Hand Hygiene – The Cornerstone of IPC

Hand hygiene prevents the spread of pathogens between patients and healthcare workers. The WHO recommends the “Five Moments for Hand Hygiene”:

1. Before touching a patient
2. Before a clean or aseptic procedure
3. After exposure to body fluids
4. After touching a patient
5. After touching patient surroundings

Infection Control in Eye Care Practice

Optometrists and ophthalmic professionals handle delicate instruments and come into close contact with patients, making infection control vital:

• Disinfection of trial frames, lenses, and slit lamp chin rests after each use.
• Using sterile techniques in contact lens fitting and teaching patients proper lens hygiene.
• Hand hygiene before and after examining each patient.
• Proper sterilization of surgical instruments in ophthalmic procedures.
• Educating patients about preventing eye infections, particularly in contact lens users.

Role of Vaccination in Infection Control

Healthcare workers must be vaccinated against common infections such as hepatitis B, influenza, and COVID-19 to reduce transmission risk. Vaccination of patients also prevents spread within communities and healthcare facilities.

Antimicrobial Stewardship

Overuse of antibiotics contributes to antimicrobial resistance (AMR), one of the greatest threats to infection control. Rational use of antibiotics through stewardship programs ensures that infections are treated effectively while minimizing resistance.

Infection Control Committees

Hospitals and large clinics should have infection control committees responsible for:

• Formulating policies and guidelines
• Training healthcare staff
• Conducting surveillance of infections
• Auditing infection prevention practices

Challenges in Infection Control

• Lack of Awareness: Healthcare workers may underestimate the importance of IPC.
• Resource Constraints: Limited supplies of PPE, disinfectants, or sterile equipment in smaller clinics.
• High Patient Load: Overcrowding increases infection risk.
• Non-Compliance: Staff may ignore protocols due to negligence or workload.

Strategies to Strengthen Infection Control

• Regular training programs and refresher courses.
• Visual reminders (posters) in clinics about hand hygiene and PPE.
• Audits and feedback to ensure compliance.
• Incorporating IPC in undergraduate and postgraduate medical curricula.
• Community awareness programs on hygiene and safe practices.

Conclusion

Infection prevention and control is a fundamental component of patient safety. It not only reduces the risk of healthcare-associated infections but also protects healthcare workers and the community. Hand hygiene, PPE, sterilization, vaccination, and antimicrobial stewardship are key elements of IPC. For optometrists and eye care professionals, strict adherence to infection control measures ensures safe practice and builds patient confidence. A culture of infection prevention must be ingrained in all healthcare systems to achieve the highest standards of safety and quality.

Antibiotic Resistance

Antibiotics have been one of the greatest medical discoveries, saving countless lives by effectively treating bacterial infections. However, their overuse and misuse have led to a serious global health threat known as antibiotic resistance (ABR). This occurs when bacteria evolve mechanisms to resist the effects of antibiotics, making standard treatments ineffective. As a result, infections become harder to treat, leading to longer hospital stays, higher costs, and increased mortality. For healthcare professionals, including optometrists, understanding antibiotic resistance is crucial for ensuring safe and rational use of these drugs.

What is Antibiotic Resistance?

Antibiotic resistance is the ability of bacteria to survive and multiply even in the presence of antibiotics that were previously effective against them. This resistance is not due to patients becoming resistant but because the bacteria themselves adapt and develop survival strategies.

Causes of Antibiotic Resistance

• Overuse of Antibiotics: Prescribing antibiotics unnecessarily, such as for viral infections like colds and flu.
• Incomplete Courses: Patients stopping medication early, allowing some bacteria to survive and develop resistance.
• Self-Medication: Using leftover antibiotics without medical supervision.
• Incorrect Prescribing: Wrong choice of antibiotic, incorrect dose, or duration.
• Use in Agriculture: Widespread use of antibiotics in livestock contributes to resistant bacteria entering the food chain.
• Poor Infection Control: Spread of resistant bacteria in hospitals due to inadequate hygiene and sterilization.

Mechanisms of Resistance in Bacteria

Bacteria use several strategies to resist antibiotics:

• Enzyme Production: Some bacteria produce enzymes (e.g., beta-lactamase) that destroy antibiotics before they act.
• Altered Targets: Bacteria may change their cell structures so that antibiotics can no longer bind effectively.
• Efflux Pumps: Some bacteria pump antibiotics out of their cells before damage occurs.
• Biofilm Formation: Bacteria form protective layers that antibiotics cannot easily penetrate.
• Gene Transfer: Resistant bacteria can transfer resistance genes to other bacteria through plasmids.

Examples of Resistant Bacteria

• MRSA (Methicillin-Resistant Staphylococcus aureus): A common cause of skin and wound infections resistant to many antibiotics.
• MDR-TB (Multidrug-Resistant Tuberculosis): A dangerous form of tuberculosis resistant to first-line drugs.
• VRE (Vancomycin-Resistant Enterococci): Bacteria that cause urinary and bloodstream infections.
• CRE (Carbapenem-Resistant Enterobacteriaceae): Highly resistant bacteria often found in hospital settings.
• Pseudomonas and Klebsiella: Resistant strains commonly associated with hospital-acquired infections.

Impact of Antibiotic Resistance on Healthcare

• Increased Morbidity and Mortality: Resistant infections are harder to treat and can be fatal.
• Longer Hospital Stays: Patients require prolonged care and isolation.
• Higher Costs: Expensive second-line antibiotics and longer treatments increase healthcare expenditure.
• Limited Treatment Options: Some infections become untreatable with available drugs.
• Threat to Medical Procedures: Surgeries, chemotherapy, and organ transplants become riskier due to infection risks.

Antibiotic Resistance and Eye Care

In optometry and ophthalmology, antibiotics are frequently used to treat eye infections such as conjunctivitis, keratitis, and postoperative complications. Overuse or misuse of topical antibiotics can contribute to resistance:

• Empirical use of antibiotic eye drops without culture testing.
• Patients using leftover or over-the-counter antibiotic drops for mild irritation.
• Frequent use of broad-spectrum antibiotics leading to resistant strains of Pseudomonas and Staphylococcus.
• Failure to complete prescribed treatment duration.

Resistant eye infections may result in poor healing, vision impairment, or even blindness if untreated effectively.

Prevention and Control of Antibiotic Resistance

1. Rational Prescribing

• Prescribe antibiotics only when necessary, and not for viral infections.
• Choose the correct antibiotic, dose, and duration based on guidelines.
• Avoid over-prescription of broad-spectrum antibiotics.

2. Patient Education

• Explain the importance of completing the full antibiotic course.
• Discourage self-medication and use of leftover drugs.
• Educate about the dangers of antibiotic misuse.

3. Infection Prevention

• Strict hand hygiene and sterilization in clinics and hospitals.
• Vaccination to reduce infection rates and antibiotic use.
• Isolation of patients with resistant infections to prevent spread.

4. Surveillance and Stewardship

• Antibiotic stewardship programs monitor use and promote rational prescribing.
• Regular surveillance of resistance patterns helps in choosing effective drugs.

5. Alternative Approaches

• Research into new antibiotics and treatment strategies.
• Development of phage therapy, probiotics, and immunotherapies as alternatives.
• Encouraging the use of narrow-spectrum antibiotics when appropriate.

Global and National Efforts

The World Health Organization has declared antibiotic resistance a global health emergency. Strategies include:

• Global Action Plan on Antimicrobial Resistance (WHO): Aims to improve awareness, reduce infections, and strengthen surveillance.
• National Programs: India’s National Action Plan (2017) emphasizes rational use, surveillance, and infection prevention.
• Hospital Initiatives: Many hospitals now have antimicrobial stewardship committees.

Conclusion

Antibiotic resistance is a silent but growing threat that undermines decades of medical progress. It makes common infections harder to treat and endangers routine medical procedures. The misuse of antibiotics in general healthcare and eye care contributes significantly to this problem. Preventing antibiotic resistance requires a committed effort from healthcare providers, patients, policymakers, and the community. Rational prescribing, patient education, infection prevention, and global collaboration are the cornerstones of combating this crisis. For optometrists and eye care professionals, responsible antibiotic use is not just a medical duty but also a contribution to global patient safety and public health.

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✅ Unit 1

✅ Unit 2

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✅ Unit 5