Infection control (IC) is a quality of standard and is essential for the well being of the patients and the safety of both patients and staff. To accomplish a reduction in infection rates an infection control programme has to be given a firm structure.

The hospital manager or medical director should be responsible for ensuring that appropriate arrangements are in place for effective infection control and that there is an Infection Control Team (ICT) consisting of a physician, infection control officer (ICO), and an infection control nurse (ICN), and an infection control committee (ICC).

Infection Control team

The team is responsible for the day to day decisions on infection control and should meet several times a week or preferably daily. If the microbiologist is not the ICO he/she will usually be a member of the team. Consideration should be given to the local cultural and religious normalities in the country concerned and the hierarchical structure of the hospital. The team should be adequately funded to provide secretarial assistance, training material and to allow members to attend courses and professional meetings.

Infection Control Officer - duties and responsibilities

This person should preferably be a senior member of the hospital staff: a medical microbiologist, epidemiologist or infectious diseases physician, with some experience and training in infection control.  In the absence of one of these a surgeon, paediatrician or other appropriate physician with special interest in the field could be appointed. He/she should be chairman of the infection control committee and is responsible to the hospital manager or medical director for infection control in the hospital.

The main role of the ICO is to act as a liaison between the medical staff and the ICT and to promote the IC programme.

Infection control nurse - duties and responsibilities

This person should be able to function as a clinical nurse specialist. The duties of the ICN are primarily associated with IC practices with special responsibility for nursing problems and education.

Although the recommendation from the US is that one nurse or practitioner is required for 250 acute beds on a full-time basis, this is often not possible. Therefore, in a large hospital the ICN can train another ward based nurse or person to maintain infection control within his/her ward. This person would then be the "link" between the ICN and the ward in identifying problems and implementing solutions.

Basic qualifications of the ICN

Registered nurse (or equivalent qualified person) with clinical and administrative expertise. Good interpersonal and educational skills are important. Recognised training in IC is essential.

Infection control committee

The committee is an important part of good infection control practice and must be seen to function efficiently. It should be made up of key personnel from the various hospital departments. The committee should act as a liaison between departments responsible for patient care and supportive departments (EG pharmacy, maintenance). Its aim should be to improve hospital IC practice and recommend appropriate policies, which should be subject to frequent review.

The committee should be responsible to the hospital manager or medical director and should have a physician, preferably the infection control officer or hospital epidemiologist as a chairman. The hospital manager or his representative should attend meetings. The committee may be small, e.g. an executive committee or large depending on the requirements of the hospital. The representatives should be nominated by the department and if not the departmental head, the representative should be in a position to make decisions.

• The following are the most important components of infection control

  Ensure facilities are available to the hospital personnel to maintain good infection control practices.

  Establish standards (policies) for procedures or systems used within the hospital.

  Maintain an ongoing educational programme for all hospital personnel in the use of such standards.

  Establish objectives for the hospital programme by identifying problem areas and acting upon findings.

  Monitor staff health in collaboration with the occupational health department if available to prevent staff to patient spread.

  Monitor the use of antibiotics.

  Monitor the use of disinfectants, frequency of cleaning etc.

• Responsibilities of the infection control team

  Advise staff on all aspects of infection control and maintain a safe environment for patients and staff.

  Encourage participation of all hospital personnel in the programme by regular meetings and in-service education.

  Provide a manual of policies and procedures for each ward and department.

  Establish a system for case finding by means of ward rounds, chart reviews or reviews of laboratory reports.

  Advise on management of "at risk" patients relating to isolation categories and control measures.

  Investigate the spread of infection (epidemics) in collaboration with medical and nursing staff.

  Carry out targeted surveillances of nosocomial infections and act upon the data obtained.

  Other duties as required e.g. kitchen inspections, pest control, waste disposal.

  Liaise with the hospital doctors and administration (managerial and nursing),also with the community health doctors and nurses and with infection control staff in adjacent hospitals.

  Provide relevant information on infection problems to management and the ICC.

  Establish an infection control committee in collaboration with the hospital manager.

• Details of components of safe environment for patients and staff.

  Responsibility of the hospital manager

• Ensure a safe, clean environment.
• Ensure the availability of sterile water for invasive procedures.
• Ensure the availability of safe food.
• Ensure the availability of an air supply appropriate for the level of surgery provided.

Responsibility of the infection control team

• Provide advice on general architectural features (e.g. operating and isolation rooms).
• Provide advice on clean water and proper facilities for handwashing and drinking.
• Arrange for the separation of clean and dirty materials and procedures (e.g. storage of sterile supplies in a separate room to that used for reprocessing of dirty equipment or storage of waste).
• Provide written policies for critical elements of infection control.

• Topics of importance for a procedure manual

Patient care

• Handwashing
• Isolation practices
• Invasive procedures (intravascular, urinary catheterisation, mechanical ventilation, tracheostomy care and wound management).
• Oral alimentation

Ward specific procedures

• Surgical and operating theatre techniques
• Obstetrical, neonatal and intensive care techniques

  Production of items of critical importance

• Sterilisation and disinfection
• Medication and infusion preparation (including blood products)

  Staff health

• Immunization

  Investigation and management of major outbreaks

• Methicillin resistant Staphylococcus aureus (MRSA)
• Diarrhoea

• Minimal administrative requirements

• A physician and a nurse with responsibilities for control of infection.
• A manual of critical procedures.
• An educational programme for staff.