Part 1 — Foundations of Infection Prevention and Control
1. Introduction to Infection Prevention and Control
Infection prevention and control (IPC) is a coordinated set of evidence-based measures used to prevent the transmission of infectious agents and reduce avoidable infections in healthcare.
Its goals include protecting patients, healthcare workers, and others in healthcare environments; reducing healthcare-associated infections (HAIs); improving quality and safety; and supporting efforts to address antimicrobial resistance (AMR). WHO identifies IPC programmes as a central component of safe healthcare and places them within the broader framework of HAI prevention and AMR control.
Key concepts:
HAIs · patient safety · healthcare-worker safety · AMR · quality of care · IPC programme
2. Chain of Infection
The chain of infection describes the sequence required for an infectious agent to spread from a source to a susceptible person.
It consists of:
Infectious agent
Reservoir
Portal of exit
Mode of transmission
Portal of entry
Susceptible host
IPC interventions work by interrupting one or more links in this chain.
3. Modes of Transmission
Infectious agents can reach susceptible hosts through different transmission routes.
Contact transmission: Direct contact or contact through contaminated persons, surfaces, or equipment.
Droplet transmission: Exposure to respiratory secretions generated by an infected person, particularly at close range.
Airborne transmission: Transmission through infectious particles capable of remaining suspended in the air.
Indirect transmission: Transmission through contaminated objects, surfaces, equipment, or other intermediaries.
Blood/body-fluid exposure: Transmission through contact with blood or other potentially infectious materials.
The route of transmission determines which additional control measures are required.
Part 2 — Standard Precautions
4. Standard Precautions
Standard Precautions are the minimum infection prevention and control practices used for all patients, during all healthcare, in all settings. They are based on risk assessment and are intended to protect both patients and healthcare workers.
Core elements include:
Hand hygiene
Risk-based PPE use
Respiratory hygiene and cough etiquette
Appropriate patient placement
Aseptic technique
Safe injection practices
Sharps safety
Cleaning and disinfection of equipment and the environment
Safe handling of textiles and laundry
Appropriate waste handling
Safe management and reprocessing of reusable equipment
Standard Precautions are the foundation of everyday IPC practice.
5. Hand Hygiene
Hand hygiene is a fundamental component of infection prevention and includes alcohol-based hand rub (ABHR) and handwashing with soap and water.
Key principles
Use ABHR when hands are not visibly soiled and appropriate product access is available.
Use soap and water when hands are visibly soiled and in other situations specified by guidance.
Apply the WHO Five Moments for Hand Hygiene.
Use the correct technique and adequate duration.
Monitor compliance and provide feedback.
WHO recommends approximately 20–30 seconds for hand rubbing and 40–60 seconds for handwashing.
The five moments are:
Before touching a patient
Before a clean/aseptic procedure
After body-fluid exposure/risk
After touching a patient
After touching the patient's surroundings
6. Personal Protective Equipment (PPE)
PPE provides barrier protection when healthcare activities create a risk of exposure to infectious materials.
Selection should follow a risk assessment and may include:
Gloves
Gowns
Medical/surgical masks
Respirators
Eye protection
Face shields
PPE must be selected according to the anticipated exposure and used correctly during donning, use, removal, and disposal or reprocessing, as applicable.
7. Respiratory Hygiene and Cough Etiquette
Respiratory hygiene aims to contain respiratory secretions at the point where patients first enter the healthcare system.
Key measures include:
Source control
Covering coughs and sneezes
Hand hygiene
Tissue disposal
Masking symptomatic patients when appropriate
Spatial separation where appropriate
Early identification and triage of potentially infectious patients
CDC includes respiratory hygiene/cough etiquette within Standard Precautions.
8. Safe Injection Practices and Sharps Safety
Safe injection practice requires maintaining the sterility of medications and injection equipment.
Core principles include:
Use aseptic technique.
Use a new sterile needle and syringe for each patient.
Never reuse a syringe between patients.
Use single-dose vials for one patient only.
Handle multidose vials according to applicable guidance and manufacturer instructions.
Dispose of sharps safely.
Report and manage occupational exposures promptly.
CDC specifically identifies syringe and needle reuse as unsafe because it can transmit infectious agents.
Part 3 — Transmission-Based Precautions
9. Transmission-Based Precautions
Transmission-Based Precautions (TBPs) are additional measures used for patients with known or suspected infection or colonization when Standard Precautions alone are insufficient.
They are divided into:
Contact Precautions
Droplet Precautions
Airborne Precautions
TBPs do not replace Standard Precautions; they are applied in addition to them.
Common elements may include patient placement, PPE, transport precautions, dedicated equipment, and environmental cleaning.
10. Contact Precautions
Contact Precautions are used when transmission may occur through direct contact with the patient or indirect contact with the patient's environment.
Key measures include:
Appropriate patient placement
Gloves and gown when indicated
Dedicated or appropriately managed equipment
Limiting unnecessary patient movement
Appropriate environmental cleaning
11. Droplet Precautions
Droplet Precautions are used when infectious respiratory secretions can transmit infection through close-range exposure.
Key measures include:
Appropriate medical/surgical mask use
Appropriate patient placement
Masking and precautions during necessary transport
Hand hygiene
Environmental and equipment hygiene
The exact precautions depend on the infectious agent and the applicable guideline.
12. Airborne Precautions
Airborne Precautions are used for pathogens transmitted through the airborne route.
Key measures include:
Appropriate respiratory protection
An airborne infection isolation room (AIIR) when indicated
Limiting unnecessary transport
Source control for the patient
Appropriate ventilation and engineering controls
CDC identifies tuberculosis, measles, and varicella among examples requiring airborne precautions.
Part 4 — Asepsis and Decontamination
13. Aseptic Technique
Aseptic technique consists of practices designed to prevent contamination of sterile or susceptible sites during healthcare procedures.
It includes maintaining appropriate asepsis during:
Invasive procedures
Injection preparation and administration
Sterile procedures
Handling of sterile equipment
Procedures involving breaks in skin or mucous membranes
The precise level of asepsis depends on the procedure and its clinical risk.
14. Cleaning, Disinfection and Sterilization
These processes are distinct and should not be used interchangeably.
Cleaning: Physical removal of organic and inorganic soil and contaminants.
Decontamination: A process that makes an item safer to handle and may include cleaning, disinfection, and/or sterilization.
Disinfection: Elimination of many or all pathogenic microorganisms on inanimate objects, except bacterial spores, depending on the level of disinfection.
Low-level disinfection: Generally used for noncritical items.
Intermediate-level disinfection: Used for selected applications requiring a higher level of microbial inactivation.
High-level disinfection: Used for appropriate semicritical devices.
Sterilization: Destruction or elimination of all forms of microbial life, including bacterial spores.
Cleaning is an essential step because inadequate removal of soil can interfere with subsequent disinfection or sterilization.
15. Reprocessing of Reusable Medical Devices
Medical device reprocessing is the controlled process through which reusable devices are prepared for safe subsequent use.
A typical workflow includes:
Collection → Cleaning → Disinfection and/or Sterilization → Inspection/Packaging → Storage → Distribution
The required level of reprocessing depends on the intended use of the device under Spaulding's classification:
Category | Contact/Risk | Typical Processing |
|---|---|---|
Critical | Enters sterile tissue or vascular system | Sterilization |
Semicritical | Contacts mucous membranes or non-intact skin | High-level disinfection |
Noncritical | Contacts intact skin | Cleaning/low-level disinfection |
WHO emphasizes that decontamination and reprocessing are important components of HAI prevention and require controlled infrastructure, sequential steps, and quality control.
Part 5 — Environmental Infection Prevention
16. Environmental Cleaning and Disinfection
Environmental cleaning and disinfection reduce contamination of healthcare surfaces and equipment.
Key concepts include:
Healthcare environment
Patient-zone surfaces
Frequently touched surfaces
Cleaning frequency
Appropriate disinfectant selection
Equipment cleaning
Prevention of cross-contamination
Environmental cleaning and appropriate equipment disinfection are components of Standard Precautions.
17. Healthcare Waste Management
Healthcare waste must be appropriately segregated, collected, transported, stored, treated, and disposed of according to its type and local requirements.
Important categories may include:
Infectious waste
Sharps
Pharmaceutical waste
Chemical waste
General healthcare waste
Correct segregation at the point of generation is fundamental to safe waste management.
18. Linen and Laundry Management
Contaminated or potentially contaminated linen should be handled in a way that prevents exposure and minimizes environmental contamination.
Key principles include:
Appropriate collection
Safe containment
Controlled transportation
Proper washing and processing
Clean storage
Prevention of cross-contamination
CDC includes appropriate handling of textiles and laundry among standard precautions.
Part 6 — Healthcare-Associated Infections
19. Healthcare-Associated Infections (HAIs)
Healthcare-associated infections (HAIs) are infections acquired while or soon after receiving healthcare. They can result from microorganisms transmitted through healthcare personnel, equipment, procedures, or the healthcare environment.
HAI prevention includes:
Risk reduction
Standard and transmission-based precautions
Device and procedure safety
Environmental control
Surveillance
Outbreak response
Continuous quality improvement
20. Surgical Site Infection (SSI)
Surgical site infection (SSI) is an infection associated with a surgical procedure and may involve the incision, deeper soft tissues, or the organ/space involved in the procedure.
Prevention requires a procedure-specific, evidence-based approach covering the preoperative, intraoperative, and postoperative periods. CDC and WHO provide dedicated SSI prevention guidance.
21. Catheter-Associated Urinary Tract Infection (CAUTI)
CAUTI is a urinary tract infection associated with the presence or recent use of an indwelling urinary catheter under defined surveillance criteria.
Prevention centers on:
Appropriate catheter use
Correct insertion
Proper maintenance
Closed drainage systems
Prompt removal when no longer needed
CDC maintains dedicated CAUTI prevention guidance.
22. Central Line-Associated Bloodstream Infection (CLABSI)
CLABSI is a bloodstream infection associated with a central line under established surveillance definitions.
Prevention focuses on safe insertion, maintenance, appropriate line use, and timely removal when the line is no longer needed. CDC describes CLABSI as preventable and maintains dedicated prevention resources and surveillance protocols.
23. Ventilator-Associated Pneumonia (VAP)
VAP is a type of healthcare-associated pneumonia that develops in a patient receiving mechanical ventilation.
Prevention includes a combination of evidence-based measures addressing ventilation, patient care, oral care, aspiration risk, and timely liberation from mechanical ventilation when appropriate. CDC and SHEA provide dedicated VAP prevention guidance.
Part 7 — Surveillance and Outbreak Control
24. Infection Surveillance
Infection surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of infection-related data for action.
It may include:
Case definitions
Case finding
Data collection
Incidence
Prevalence
HAI surveillance
Data analysis
Reporting
Feedback
Intervention based on findings
WHO identifies HAI surveillance as one of the eight core components of an effective IPC programme.
25. Outbreak Investigation
An outbreak investigation is a structured response to an increase or cluster of infections above the expected level.
Core steps may include:
Recognition of the event
Establishment of a case definition
Case finding
Epidemiological investigation
Laboratory investigation
Identification of transmission pathways
Implementation of control measures
Communication
Post-outbreak evaluation
The investigation should connect epidemiological findings with immediate infection-control action.
Part 8 — Occupational Health
26. Occupational Infection Prevention
Occupational IPC protects healthcare workers from infectious hazards encountered during healthcare delivery.
Key areas include:
Healthcare-worker vaccination
Occupational exposure prevention
Needlestick and sharps injury prevention
Blood/body-fluid exposure management
Post-exposure assessment
Post-exposure prophylaxis (PEP), when indicated
Occupational health surveillance
Management of illness among healthcare personnel
WHO recognizes occupational infection risks as an important component of healthcare worker protection.
Part 9 — IPC Programme
27. IPC Programme Structure
An effective IPC programme requires defined leadership, responsibilities, resources, and systems.
Core elements include:
IPC leadership
Dedicated IPC team or focal point
Defined roles and responsibilities
Evidence-based policies and guidelines
Adequate staffing and resources
Surveillance
Monitoring and feedback
Appropriate workload and bed occupancy
Suitable built environment, materials, and equipment
WHO's framework identifies eight core components of IPC programmes, including programmes, guidelines, education and training, HAI surveillance, multimodal strategies, monitoring/audit/feedback, workload-staffing-bed occupancy, and the built environment/materials/equipment.
28. IPC Education and Training
IPC education ensures that healthcare workers have the knowledge and practical skills needed to apply infection prevention measures correctly.
It should include:
Initial training
Continuing education
Practical instruction
Competency assessment
Hand hygiene training
PPE training
Aseptic technique training
Procedure-specific IPC training
Training should be linked to monitoring and demonstrated competence, rather than relying only on attendance.
29. Monitoring, Audit and Feedback
Monitoring and audit determine whether IPC practices are being implemented as intended.
Key activities include:
Hand hygiene monitoring
PPE compliance monitoring
Audit of cleaning and reprocessing practices
HAI indicators
Process and performance indicators
Feedback to healthcare workers
Corrective action
Quality improvement
CDC's core practices specifically emphasize monitoring adherence, standardized measurement, feedback, and use of surveillance data to improve infection prevention.