Infectious Diseases Residency Program

Infection Control

Expectations for the rotation

1. Basic epidemiological principles
2. Principles of Outbreak Investigation
3. Basic principles of surveillance
4. General isolation procedures
5. Disinfection and sterilization
6. Role of the hospital environment
7. Handwashing and disinfection
8. Specific nosocomial agents
9. Specific health care settings
10. Occupational health

 

 

Expectations for the rotation

  1. Residents are responsible for contacting the rotation supervisor at the beginning of their Infection Control rotation to arrange for teaching during the rotation. Regular teaching will also occur with the Infection Control Practitioners.
  2. Residents should ask to be notified of outbreaks/ infection control concerns at other sites during their rotation to increase the amount of exposure they receive.
  3. Residents should attend and participate in site specific and regional Infection Control meetings during their rotation.
  4. Residents are expected to assist with educational sessions occuring during the rotation.
  5. Residents should attempt to complete a small project during their rotation (ie audit of PPE use, review the literature to answer an infection control question (ie does eradication therapy for MRSA work), answer a quality assurance or laboratory utilization question).

1. Basic epidemiological principles (Medical Expert/Scholar)

  • Know the following definitions : attack rate, case-fatality rate, endemic, epidemic, secular trends, incidence rate, prevalence rate, attack rate, index case, source, reservoir, risk factors, confounding factors, sensitivity, specificity, positive/negative predictive values (R2 MM, R4 ID/MM)
  • Know the various forms of transmission: direct, indirect, vehicleborne, airborne, vectorborne and list common etiologic agents in each category(R2 MM, R4 ID/MM)
  • Know the various epidemiological study methods (descriptive analytic, experimental) and be capable of stating advantages and disadvantages of each (R2 MM, R4 ID/MM)
  • Know the following basic quantitative measures: incidence density, relative risk, odds ratio, mean, median, variance, standard deviation(R2 MM, R4 ID/MM)
  • Know the numerator and denominator data used in infection control (eg surgical site infections, line infections, ventilator associated pneumonia) (R2 MM, R4 ID/MM)

2. Principles of Outbreak Investigation (Medical expert, Health Advocate,Communicator)

  • Know the steps involved in outbreak investigation including: creating case definitions, case finding, confirming the outbreak, data collection, descriptive epidemiology (eg line listings, epidemic curve), developing hypothesis, testing hypothesis using analytic studies, the role of environmental investigation, the use of molecular microbiology, instituting control measures, importance/methods of communication/public relations (R2 MM, R4 ID/MM)
  • Know the specific control measures needed to effectively manage outbreaks caused by organisms in each of the transmission categories (R2 MM, R4 ID/MM)
  • Know the incubation periods of organisms from each of the four transmission categories that have been implicated in hospital, daycare, or long-term care facility outbreaks(R2 MM, R4 ID/MM)
  • Know the organisms frequently associated with outbreaks in day care centres, schools, and long-term care facilities and know the specific control measures, investigations, and follow-up needed (R2 MM, R4 ID/MM)
  • Know the predisposing factors for hospital outbreaks of resistant enterobacteriaceae (including those with Bush class 1 and extended-spectrum B-lactamases), non-fermentative gram negative bacilli, MRSA, VRE (R2 MM, R4 ID/MM)
  • Know both the phenotypic and genotypic typing methodologies and the advantages and disadvantages of each (R2 MM, R4 ID/MM)
  • Know the typing method of choice for the common gram positive and gram negative organisms associated with hospital outbreaks (R2 MM, R4 ID/MM)

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3. Basic principles of surveillance (Medical Expert, Scholar, Collaborator)

  • Know the components of the NNIS system (R3-4 MM, R5 ID/MM)
  • Know the denominators used in NNIS(R3-4 MM, R5 ID/MM)
  • Know how common nosocomial infections are defined (R3-4 MM, R5 ID/MM)
  • Know what the purposes of surveillance are (R3-4 MM, R5 ID/MM)
  • Be capable of describing each of the following: active surveillance, passive surveillance, laboratory-based surveillance, patient-based surveillance, hospital-wide surveillance, targeted surveillance; know advantages and disadvantages of each (R3-4 MM, R5 ID/MM)
  • Know the definitions of incisional and organ space surgical site infections(R3-4 MM, R5 ID/MM)
  • Know the various surveillance methods for surgical site infections (R3-4 MM, R5 ID/MM)
  • Know the NNIS risk index for surgical site surveillance (R3-4 MM, R5 ID/MM)
  • Know the advantages and disadvantages of post-discharge surveillance (R3-4 MM, R5 ID/MM)
  • List interventions that may be needed to reduce SSI rates (R3-4 MM, R5 ID/MM)
  • Know how to summarize data in tabular and graphic form (R3-4 MM, R5 ID/MM)
  • Be aware of the issues of confidentiality in the dissemination of data (R3-4 MM, R5 ID/MM)

4. General isolation procedures (Medical Expert, Health Advocate, Manager)

  • Be familiar with each of the following: category specific isolation, universal precautions, body substance precautions, transmission based precautions (R2 MM, R4 ID/MM)
  • Know transmission based precautions in detail and list the organisms associated with each of the categories (standard, airborne, droplet, contact) (R2 MM, R4 ID/MM)
  • Know the special considerations for pediatric patients including precautions for each of the following: RSV, parvovirus, Pseudomonas cepacia in CF patients (R2 MM, R4 ID/MM)
  • List the components of standard precautions(R2 MM, R4 ID/MM)
  • Describe in detail precautions required for isolating patients with MRSA, VRE, C.difficile associated diarrhea, Febrile Respiratory Illness including decision making about isolation based on follow up testing(R2 MM, R4 ID/MM)
  • Know the organisms in which the environment has been implicated in transmission and justify the control measures needed. (R2 MM, R4 ID/MM)

5. Disinfection and sterilization (Medical expert, Health Advocate, Manager)

  • Define the following: disinfection, sterilization, cleaning, germicide (R2 MM, R4 ID/MM)
  • Know the Spaulding classification and give examples of critical, semi-critical, and non-critical items (R2 MM, R4 ID/MM)
  • Know the methods and controversies pertaining to the disinfection of endoscopes, laparascopes, and arthroscopes (R3-4 MM, R5 ID/MM)
  • Know how to disinfect the following: previously incubated bacterial cultures from the microbiology lab, broken blood collection tube after being dropped, corrugated ventilator tubing, implantable orthopedic devices, broken vial in open centrifuge (R2 MM, R4 ID/MM)
  • List and describe methods for sterilization (including chemical sterilization), high level disinfection, intermediate-level disinfection, low level disinfection (R2 MM, R4 ID/MM)
  • Know the specific properties of the specific agenst used for chemical sterilization, high-level disinfection, intermediate/low level disinfection and list advantages and disadvantages of each (R3-4 MM, R5 ID/MM)
  • Describe the recommendations for inactivation of Creutzfeldt-Jacob Agent (R2 MM, R4 ID/MM)
  • Discuss the factors that affect the efficacy of germicides (R2 MM, R4 ID/MM)
  • Know the specific factors that can affect the efficacy of sterilization (R2 MM, R4 ID/MM)
  • Know the limitations of flash sterilization (R2 MM, R4 ID/MM)
  • Know the physical, chemical, and biologic methods and recommendations for monitoring the sterilization process (R2 MM, R4 ID/MM)
  • Discuss the reuse of disposable devices(R3-4 MM, R5 ID/MM)

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6. Role of the hospital environment (Medical Expert, Scholar, Collaborator)

  • Understand what the role of the ventilation system and water supply is in causing certain nosocomial infections(R3-4 MM, R5 ID/MM)
  • Know the specific environmental controls needed for control of tuberculosis(R2 MM, R4 ID/MM)
  • Know the specific environmental controls needed for control of legionellosis and know the recommendations for when environmental investigation is needed(R3-4 MM, R5 ID/MM)
  • Understand how the environment is implicated in the transmission of VRE and Clostridium difficile (R2 MM, R4 ID/MM)
  • Know the survival times of HIV and other blood borne pathogens on environmental surfaces (R2 MM, R4 ID/MM)

7. Handwashing and disinfection (Medical expert, Professional, Health Advocate)

  • Be familiar with the various agents used in hand washing(R2 MM, R4 ID/MM)
  • Know the efficacy of the various agents for hand washing and surgical hand disinfection (R2 MM, R4 ID/MM)
  • Know the procedures for the surgical scrub (R2 MM, R4 ID/MM)

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8. Specific nosocomial agents (Medical Expert, Collaborator)

a) Nosocomial tuberculosis (R2 MM, R4 ID/MM)

  • Know how to assess and classify risk of nosocomial tuberculosis
  • Know how to develop a tuberculosis screening and surveillance program
  • Know the infection control management of a patient with suspected/confirmed tuberculosis
  • Know the engineering controls and personnel respiratory protection requirements

b) Legionellosis (R2 MM, R4 ID/MM)

  • Know how to proceed when nosocomial transmission of legionella is suspected
  • Know the criteria used to warrant environmental investigation
  • Know the environmental controls available and know their advantages and disadvantages

c) MRSA (R2 MM, R4 ID/MM)

  • Understand how MRSA is detected in the laboratory and know the common problems that occur in identification
  • Understand the epidemiology of MRSA (transmission patterns, infectivity rates, role of the environment)
  • Know what control measures need to be in place to prevent the spread of MRSA
  • Understand the role of screening and discuss the pros and cons of varioius strategies
  • Know about the eradication protocols available for MRSA, list the advantages and disadvantages of each
  • Understand what the concern is about preventing the spread of MRSA (includa VISA strains)

d) VRE (R2 MM, R4 ID/MM)

  • Understand how VRE is detected in the laboratory and know the common problems that occur in identification
  • Understand the epidemiology of VRE (transmission patterns, infectivity rates and patterns, role of the environment)
  • Know what control measures need to be in place to prevent the spread of VRE (including the HICPAC guidelines)
  • Understand the role of screening and discuss the pros and cons of various approaches

e) Clostridium difficile (R2 MM, R4 ID/MM)

  • Understand how Clostridium difficile is detected in the laboratory and know the limitation of current test methods
  • Understand the epidemiology of Clostridium difficile (transmission patterns, infectivity rates and patterns, role of the environment)
  • Know what control measures need to be in place to prevent the spread of Clostridium difficile (including the HICPAC guidelines)
  • Understand reporting requirements for Clostridium difficile

f) as above for MRSA’s and VRE’s, for ESBL’s and other multi-resistant gram negative bacilli, especially Pseudomonas aeruginosa, Acinetobacter baumannii complex, Serratia marcescens

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9. Specific health care settings (Medical Expert, Scholar, Health Advocate)

  • Know the specific risks associated with hospital construction with regards to patients on bone marrow transplant/hematology-oncology units and know how to monitor these risks (R3-4 MM, R5 ID/MM)
  • Know the risks associated with blood borne pathogens on renal dialysis units and know the precautions used to reduce the risks (R3-4 MM, R5 ID/MM)
  • Know the relevant infection control issues that arise in endoscopy units and know how to reduce the potential for cross transmission in this setting (R3-4 MM, R5 ID/MM)
  • Know what the evidence is for the use of scrub brush, gowns, hats, environmental cleaning of OR, shoe covers (R3-4 MM, R5 ID/MM)
  • Know the exposures/outbreaks that commonly occur in NICUs and how to manage them (R3-4 MM, R5 ID/MM)

10. Occupational health (Medical Expert, Collaborator)

g) Know how to manage illness/exposure due to chicken pox among staff (R2 MM, R4 ID/MM)

h) Know how to manage illness/exposure due to red measles among staff (R2 MM, R4 ID/MM)

i) Know how to manage needle stick exposures among staff members (R2 MM, R4 ID/MM)

j) Know how to manage staff exposures to HIV, Hepatitis B, Hepatitis C (R2 MM, R4 ID/MM)

k) Understand the significance of and know the management of the following exposures to pregnant staff: chicken pox, CMV, parvovirus, TB (R2 MM, R4 ID/MM)

 

References:

Redbook

Mayhall Hospital Epidemiology and Infection Control

Health Canada website: www.health.gov.on.ca - select information for Health Care Providers on top bar, then ID and Infection Control in lefthand column – provides PIDAC guidelines (Infection Prevention and control of resistant staphylococcus and enterococcus, surveillance of health care associated infections, febrile respiratory illness, clostridium difficile)

core competency training modules, hand hygiene improvement program

CJD Infection Control Guidelines- CCDR 2002. Vol 28S5, p1-110.

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