Airborne Transmission: Occurs when airborne particles remain suspended in the air, travel on air currents and are then inhaled by others who are nearby or who may be some distance away from the source patient, in a different room or ward (depending on air currents) or in the same room that a patient has left, if there have been insufficient air exchanges. Microorganisms transmitted by the airborne route are Mycobacterium tuberculosis (TB), varicella virus (chicken pox virus) and measles virus.
Antibiotic-Resistant Organism (ARO): A microorganism that has developed resistance to the action of several antimicrobial agents and that is of special clinical or epidemiological significance.
Antimicrobial Impregnated Products: Antimicrobials are ubiquitous in all kinds of products on the market today, from hand soaps to building materials. Aggressively marketed to health care providers for enhanced infection control, antimicrobials are used in paint to inhibit mold and in numerous interior flooring and finish products, including carpet, privacy curtains and upholstery fabric. In some products, metals, such as silver or copper, are impregnated into fabric to provide the antimicrobial properties.
Research indicates that environmental concerns exist from the manufacturing processes associated with antimicrobials because metals may be released into our water, soil, and air—the same metals that ironically may contribute to antibiotic resistance. Silver, in particular, has been linked with antibacterial resistance. Antimicrobials can also lead to what is known as “cross-resistance,” whereby through an intricate process, bacteria become resistant to the antimicrobial itself, as well as to a whole host of other antibiotics. Serious questions are being raised, however in the industry as to whether antimicrobials serve a measurably useful function in health care fabrics at all. The efficacy of antimicrobials in fabrics in health care has been called into question by several independent studies.
The Centers for Disease Control and Prevention (CDC) concluded a 2003 comprehensive study of infection control practice with the statement that “No evidence is available to suggest that use of these [antimicrobial] products will make consumers and patients healthier or prevent disease. No data support the use of these items as part of a sound infection-control strategy.” Kaiser Permanente similarly concluded in a December 2006 position statement that “[w]e do not recommend environmental surface finishes or fabrics that contain antimicrobials for the purpose of greater infection control and the subsequent prevention of hospital acquired infections.” KP states that “No evidence that environmental surface finishes or fabrics containing antimicrobials assist in preventing infections.” Rather, the organization recommends strict hand hygiene and environmental surface cleaning and disinfection.
Canadian Association of Environmental Management (CAEM): A national, non-profit organization representing environmental management professionals within the health care sector and other industry professionals responsible for environmental cleaning.
Clostridium difficile (C. difficile or C. diff or CDAD) – is a spore forming bacteria that is a leading cause of healthcare associated diarrhea. Although C. diff has been known to cause healthcare associated diarrhea for nearly 30 years, the emergence of more virulent strains which cause seemingly greater morbidity and mortality have increased the notoriety of C.diff in recent years. It is widely distributed in the environment and colonizes up to 3-5% of adults without causing symptoms. Because C. difficile is part of the normal flora of the gastrointestinal tract, most infections with these microorganisms have been attributed to the patient’s own flora. Antibiotic exposure plays an important role in the development of C. difficile infection (CDI). Other risk factors associated with CDI include: immunosuppressive therapy post-transplant, bowel disease and bowel surgery, increased age, chemotherapy and prolonged hospitalization. C. diff can also be spread from person-to-person by direct patient-to-patient contact, or indirectly on healthcare workers’ hands, or on contaminated environmental surfaces and patient care equipment.
CHICA-Canada: The Community and Hospital Infection Control Association (CHICA) of Canada, a professional organization of persons engaged in infection prevention and control activities in health care settings. CHICA-Canada members include infection prevention and control professionals from a number of related specialties including nurses, epidemiologists, physicians, microbiology technologists, public health and industry.
Contact Precautions: Are used in addition to Routine Practices where transmission of microorganisms by the contact route is likely. Contact with contaminated environmental surfaces or contaminated intact skin is a particular consideration.
Contamination: The presence of an infectious agent on hands or on a surface such as clothes, gowns, gloves, bedding, toys, surgical instruments, patient care equipment, dressings or other inanimate objects.
Disinfectant: A product that is used on surfaces or medical equipment/devices which results in disinfection of the equipment/device. Disinfectants are applied only to inanimate objects. Some products combine a cleaner with a disinfectant.
Disinfection: The inactivation of disease-producing microorganisms. Disinfection does not destroy bacterial spores. Medical equipment/devices must be cleaned thoroughly before effective disinfection can take place. See also, Disinfectant.
Double Cleaning: Repeating a cleaning regimen immediately after it has been done once. Double cleaning is not the same as cleaning twice per day. Double cleaning must be documented.
Droplet Precautions: Are used in addition to Routine Practices for clients/patients/residents known or suspected of having an infection that can be transmitted by large respiratory droplets. Diseases such as with respiratory tract viruses (e.g. adenovirus, influenza and parainfluenza viruses, rhinovirus), rubella (German Measles), mumps and Whooping cough (Bordetella pertussis) are transmitted by this route. These droplets are propelled a short distance and may enter the host’s eyes, nose or mouth or fall onto surfaces.
Extended Spectrum Beta Lactamase (ESBL): Extended Spectrum Beta Lactamase (ESBLs) are enzymes produced by some bacteria or germs that can make them resistant to certain antibiotics, These bacteria or germs can be found in many parts of your body but are normally in your bowel.
Enzymatic Cleaner: A pre-cleaning agent which contains protease enzymes that break down proteins such as blood, body fluids, secretions and excretions from surfaces and equipment. Most enzymatic cleaners also contain a detergent. Enzymatic cleaners are used to loosen and dissolve organic substances prior to cleaning.
Fomites: Objects in the inanimate environment that may become contaminated with microorganisms and serve as vehicles of transmission.
Germs – “Germ” is an informal term for something that makes you sick, a germ is a microscopic organism that can carry disease. Other words used for germ are microorganisms, microbes, and in slang “bugs”. The term generally refers to bacteria, or viruses, but could also include fungi or protozoa.
High-Touch Surfaces: High-touch surfaces are those that have frequent contact with hands. Examples include doorknobs, call bells, bedrails, light switches, wall areas around the toilet and edges of privacy curtains.
Healthcare Associated Infection (HAI) – Also referred to as hospital aquired infections. These are infections not found to be present or incubating at the time of admission, which patients acquire during the course of receiving treatment for other conditions within a healthcare setting. It is an infection that occurs in the period beginning more that 48 to 72 hours after admission to within 10 days following discharge.
Healthcare-acquired infections are one of the top ten leading causes of death in the United States. Each year in Canada, more than 220,000 healthcare associated infections result in 8,500 – 12,000 deaths, and the rates are rising. One in nine hospital patients in Canada get a healthcare associated infection. Infections are the fourth leading cause of death in Canada. HAIs are caused by bacteria and viruses and are an increasing threat to patient safety, especially those difficult to treat organisms that are resistant to antibiotics (e.g. MRSA, VRE, and CDAD) (See also Nosocomial).
Hospital Clean: The measure of cleanliness routinely maintained in client/patient/resident care areas of the health care setting. Hospital Clean is ‘Hotel Clean’ with the addition of disinfection, increased frequency of cleaning, auditing and other infection control measures in client/patient/resident care areas.
Hospital-Grade Disinfectant: A low-level disinfectant that has a drug identification number (DIN) from Health Canada indicating its approval for use in Canadian hospitals.
Hotel Clean: A measure of cleanliness based on visual appearance that includes dust and dirt removal, waste disposal and cleaning of windows and surfaces. Hotel clean is the basic level of cleaning that takes place in all areas of a health care setting.
Infection: The entry and multiplication of an infectious agent in the tissues of the host. Asymptomatic or sub-clinical infection is an infectious process running a course similar to that of clinical disease but below the threshold of clinical symptoms. Symptomatic or clinical infection is one resulting in clinical signs and symptoms (disease).
Infection Prevention and Control: Evidence-based practices and procedures that, when applied consistently in health care settings, can prevent or reduce the risk of infection in clients/patients/residents, health care providers and visitors.
Infection Prevention and Control Program (IPAC): A health care facility or organization (e.g. hospital, long-term care, continuing complex care, home care) program responsible for meeting the recommended mandate to decrease infections in the patient, health care providers and visitors. The program is coordinated by health care providers with expertise in infection prevention and control and epidemiology.
Infection Prevention and Control Professionals (ICP): An ICP is a health care professional with specialized training and expertise in infection prevention and control. The ICP works with all hospital departments to prevent health care-associated infections. They also educate health care staff on infection prevention and control, conduct surveillance and provide expert consultation as needed. Additional titles used may include infection control nurse, infection control coordinator, nurse epidemiologist, infection control office, infection control practitioner and infection preventionists. The ICP predominately has backgrounds such as nursing, medical technology, microbiology, or public health. In Ontario an ICP must receive a minimum of 80 hours of instruction in a CHICA-Canada endorsed infection control program within six months of entering the role and must acquire and maintain Certification in Infection Control (CIC) when eligible.
Infection Prevention and Control Physician: Physician with specific training and expertise in the principles of epidemiology and infection prevention and control, and who incorporates infection prevention and control into his/her continuing professional development.
Infectious Agent: A microorganism, i.e., a bacterium, fungus, parasite, virus or prion, which is capable of invading body tissues, multiplying and causing infection.
Low-Level Disinfectant: A chemical agent that achieves low-level disinfection when applied to surfaces or items in the environment.
Low-Level Disinfection (LLD): Level of disinfection required when processing non-invasive medical equipment (i.e., non-critical equipment) and some environmental surfaces. Equipment and surfaces must be thoroughly cleaned prior to low-level disinfection.
Low-Touch Surfaces: Surfaces that have minimal contact with hands. Examples include walls, ceilings, mirrors and window sills.
Methicillin-Resistant Staphylococcus aureus (MRSA): Staphylococcus aureus, also called “staph”, can live harmlessly on the skin or in the nose of healthy people and can live on surfaces for months. But “staph” that becomes resistant to the antbiotic methicillin – methicillin-resistant Staphylococcus aureus or MRSA – can cause a wide range of infections from minor skin infections to severe surgical wound infections and bloodstream infections (bacteraemia), and in some cases, death. MRSA has been associated with health care-associated infections and outbreaks
Nosocomial infection: Also known as a hospital-acquired infection or HAI, is an infection whose development is favored by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. Such infections include fungal and bacterial infections and are aggravated by the reduced resistance of individual patients.
Routine Practices: A standard of care based on the premise that all clients/patients/residents are potentially infectious, even when asymptomatic, and that the same safe standards of practice should be used routinely with all clients/patients/residents to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin or soiled items and to prevent the spread of microorganisms.
Precautions: Interventions to reduce the risk of transmission of microorganisms (e.g., patient-to-patient, patient-to-staff, staff-to-patient, contact with the environment, contact with contaminated equipment). Additional Precautions are used in addition to Routine Practices for clients/patients/residents known or suspected to be infected or colonized with certain microorganisms to interrupt transmission.
Reservoir: Any person, animal, substance or environmental surface in or on which an infectious agent survives or multiplies, posing a risk for infection.
Staphylococcus aureus – Staphylococcus or Staph, is a type of bacteria, or large, single-cell organism. There are two common types of Staph aureus: one that is sensitive to most antibiotics and one that is resistant to many antibiotics. The form of Staph aureus that is resistant is called Methicillin-resistant Staphylococcus aureus or MRSA. ‘Resistant’ means that a specific type of antibiotic, in this case methicillin, and other related drugs, will not kill the infection. It does not mean that the infection will be harder to kill. But it may be more difficult for a patient to get well quickly if the correct antibiotic is not used first. Staph organisms are hardy and may survive for three weeks even on a dry surface, though they thrive better in moist areas like the body’s mucous membranes. As many as 30 percent of the public have Staph in their nose and nasal passages.
Superbug: An informal term for a bacterium that has become resistant to antibiotics usually used to treat it, as methicillin-resistant Staphylococcus aureus (MRSA) or any multi-resistant bacterium.
Vancomycin-Resistant Enterococci (VRE): Vancomycin-Resistant Enterococcus or VRE is a group of bacterial species that are resistant to the antibiotic Vancomycin. VREs are especially dangerous to patients and residents with compromised immune systems. Vancomycin-resistant enterococci can live on dry environmental surfaces for up to 4 months and on hands for several hours. VRE bacteria can be killed with disinfectants as long as the bacteria are in contact with the disinfectant long enough.
Virus- A microorganism smaller than a bacteria, which cannot grow or reproduce apart from a living cell. A virus invades living cells and uses their chemical machinery to keep itself alive and to replicate itself. It may reproduce with fidelity or with errors (mutations)- this ability to mutate is responsible for the ability of some viruses to change slightly in each infected person, making treatment more difficult.