1. Organisational Structure

2. Learning objectives
Describe how the infection prevention and control is organised in health care.
List the members of an infection control team.
Outline the topics contained in a typical infection control manual
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3. Time involved
45 minutes
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4. Key Points
Risk prevention for patients and staff is a concern of everyone in the facility and must be supported at the level of senior administration
Infection Prevention and Control Programs require an appropriate, clear, and firm organisational structure
Infection Prevention and Control Programs in most countries are delivered through an Infection Control Team
An infection prevention and control manual compiling recommended instructions and practices for patient care is an important tool
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5. Introduction
Each institution is unique and its specific needs must be considered when developing or reorganising an infection prevention and control (IP&C) program
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Modern hospital infection control programs first began in the 1950s in England, where the primary focus of these programs was to prevent and control hospital-acquired staphylococcal outbreaks.
Infection prevention and control is a critical component of patient safety, as healthcare-associated infections are the most common complication affecting hospitalised patients. The human and economic burdens that healthcare-associated infections place on individuals and their health care system speak to the importance of an effective Infection Prevention and Control Program.
IP&C programs may also extend into the community through public health agencies.
Infection Prevention and Control Programs contribute to patient safety through protecting patients, healthcare workers, and visitors to health care facilities from infections.

6. National Program National IP&C programs must:
Set relevant objectives consistent with other national health care objectives
Develop and continually update guidelines for health care surveillance, prevention, and practice
Develop a national system to monitor selected infections and assess the effectiveness of interventions
Harmonise initial and continuing training programs for health care professionals
Facilitate access to products essential for hygiene and safety
Encourage health care establishments to monitor healthcare-associated infections with feedback to the professionals concerned
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The mandate of an Infection Prevention and Control Program is to prevent and control healthcare-associated infections. The responsible National Health Authority should develop a national program to support healthcare facilities in reducing the risk of healthcare-associated infections.

7. Health Care Facility Programs
Risk pre­vention for patients and staff is a concern of every­one in the facility and must be supported by senior administration
A yearly work plan should be developed to assess and promote
good health care,
appropriate isolation precautions,
sterilisation and other practices,
staff train­ing, and
epidemiological surveillance
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Evidence has been published in support of having an effective Infection Prevention and Control Program in health care facilities. The landmark Study on the Efficacy of Nosocomial Infection Control (SENIC) project estimated that one-third of healthcare-associated infections in the hospital setting could be prevented if hospitals instituted the essential components required for Infection Prevention and Control Programs. These components include surveillance with feedback of infection rates and a physician and nurse with infection prevention and control knowledge.
Reference: Haley RW, et al. Efficacy of Nosocomlal Infection Control (SENIC Project): Summary of study. Am J Epidemiol 1980; 111:
To meet its IP&C mandate, staffing, training, and infrastructure requirements are needed. Each institution is unique and its specific needs must be considered when developing or reorganising an IP&C Program. Because of these differing needs, various groups, individuals, and functions within the organisation may be responsible for the IP&C Program.

8. Health Care Facility Programs
Appropriate arrangements must be in place for effective IP&C practices
There is an Infection Control Committee (ICC) and an Infection Control Team (ICT)
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Evidence has been published in support of having an effective Infection Prevention and Control Program in health care facilities. The landmark Study on the Efficacy of Nosocomial Infection Control (SENIC) project estimated that one-third of healthcare-associated infections in the hospital setting could be prevented if hospitals instituted the essential components required for Infection Prevention and Control Programs. These components include surveillance with feedback of infection rates and a physician and nurse with infection prevention and control knowledge.
Reference: Haley RW, et al. Efficacy of Nosocomlal Infection Control (SENIC Project): Summary of study. Am J Epidemiol 1980; 111:
To meet its IP&C mandate, staffing, training, and infrastructure requirements are needed. Each institution is unique and its specific needs must be considered when developing or reorganising an IP&C Program. Because of these differing needs, various groups, individuals, and functions within the organisation may be responsible for the IP&C Program.

9. Infection Control Committee (ICC)
Provides a forum for multidisciplinary input, cooperation, and information sharing
Is responsible for the planning, implementation, prioritisation, and resource allocation of all matters relating to IP&C
Acts as a liaison between departments responsible for patient care and support services
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The ICC must report directly to either administration or the medical staff to promote program visibility and effectiveness.
An effective IP&C Program should collaborate and consult with internal (e.g., patient safety, quality assurance, reprocessing, occupational health) and external partners (e.g., other facilities and local, provincial/territorial and national health agencies) to ensure appropriate communication and sharing of information. An ICC can help foster this collaboration.
The ICC provides administrative power to the IP&C program. The ICC is generally the official route for informing administration of IP&C problems and accomplishments, such as outbreak investigations, new regulations, policy and procedures compliance, and routine data monitoring.

10. ICC Membership
Chief Executive/Administrator or nominated representative
Infection Control Officer/Doctor/Microbiologist who may act as chairperson
Infection Control Nurse (ICN)
Infectious Disease Physician (if available)
Director of Nursing or his/her representative
Occupational Health Physician (if available)
Representatives from the major clinical specialties
Representatives of other departments may be invited as necessary
pharmacy, central supply, maintenance, housekeeping, training services, engineering/design, etc.
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The ICC membership should reflect the spectrum of clinical services and administrative arrangements of the healthcare facility.

11. ICC Overall Responsibility
Holds regular meetings with minutes
Produces an annual report and an annual business plan for the program
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Minutes should be sent to the Medical Director and the Hospital/Executive Management Board as well as to departments directly involved in the subjects discussed during the meeting. The committee should produce an annual report and an annual business plan for infection prevention and control.
The annual plan is a road map for the IP&C Program. Institutional initiatives, new laws and regulatory requirements, and new information regarding infection prevention practices should be incorporated into the plan.
Components of the plan can include:
Mission, goals, and objectives of the program
Scope of the program
Specific strategies for infection prevention
Educational activities
Surveillance plan
Policy and procedure review plan

12. ICC Tasks - 1 To review and approve the annual plan for IP&C
To review and approve IP&C policies
To support the Infection Control Team and direct resources to address problems as identified
To ensure availability of appropriate supplies needed for IP&C
To review epidemiological surveillance data and identify areas for intervention
To assess and promote improved practice at all levels
To ensure staff training in IP&C and safety
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13. ICC Tasks - 2
To review infectious risks associated with new technologies and monitor risks of new devices and products, prior to their approval for use
To review and provide input into an outbreak investigation
To review and approve construction/renovation projects regarding infection prevention
To communicate and cooperate with other committees with common interests, such as Antibiotic/Pharmacy Committee, Occupational Health Committee, etc.
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14. Infection Control Team (ICT)
The team should have a range of expertise covering
infection prevention and control
medical microbiology
healthcare epidemiology
infectious diseases
nursing procedures
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The organisation of IP&C Programs varies between countries. However, in the majority of countries the IP&C program is delivered through an ICT. The ICT is responsible for all day-to-day activities of the program. It also sets priorities and advises administrators in issues related to infection prevention and control.
IP&C Programs should be staffed appropriately to meet the goals of the program.

15. ICT Responsibilities
Is responsible for the day-to-day running of Infection Prevention and Control programs
Must have appropriate authority
24 hour access to the ICT for advice on IP&C issues is essential
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The IP&C Program should be positioned within the organisational structure of the facility or agency so that the Infection Control Team has direct access to decision makers and the ability to implement critical infection prevention and control measures in a timely fashion. This support is critical for the Infection Control Team to accomplish its goals.

16. ICT Role - 1
To develop an annual IP&C plan with clearly defined objectives
To develop written policies and procedures, includ­ing regular evaluation and updates
To prepare an action plan for implementation of the IP&C program with approval from the Infection Control Committee
To monitor and evaluate daily practices of patient care designed to prevent infection
To identify problems in the implementation of IP&C activities which need to be solved or addressed by the Infection Control Committee
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17. ICT Role - 2
To organise epidemiological surveillance for healthcare-associated infections
To investigate outbreaks and provide data (and expert advice) that should be evaluated to allow for any change in practice or allocation of resources
To educate all grades of staff in IP&C policy, practice, and procedures relevant to their own areas
To provide advice to all grades of staff on all aspects of IP&C on a day-to-day basis
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Surveillance activities in high risk areas is important to detect outbreaks early.

18. ICT Role - 3
To develop an annual training plan for healthcare workers and implement IP&C training activities
To ensure availability of supplies and equipment needed for IP&C-related activities
To have a scientific and technical support role in purchasing and monitoring of equipment and supplies, and in evaluation and checking the efficacy of sterilisation and disinfection measures
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19. ICT Role - 4
To collaborate with the pharmacy and antibiotic committees in developing a program for supervising antibiotic use
To support and participate in research and assessment programs
To participate in audit activities
To obtain program approval from the Infection Control Committee
To submit monthly reports on activities to the Infection Control Committee
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20. Composition of the ICT Consists of
at least one physician, the Infection Control Officer/Doctor
and
at least one nurse, the Infection Control Nurse
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Personnel needs will be based on the size, complexity, services, and needs of the facility.
Support personnel can be useful to allow the trained ICT staff to focus on its infection prevention and control activities.
The ICT may also include a community nurse or someone from the local public health organisation. See reference – Mercier, C. Hospital and Community. Nelson Thornes, Cheltenham, UK: 1997.

21. Infection Control Officer (ICO) - 1
Is a medically qualified senior staff member who is interested in and who spends most of his/her time involved in IP&C
Typically a medical microbiologist, an epidemiologist, or an infectious diseases physician
May also be called an Infection Control Doctor or Hospital Epidemiologist
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The ICO could be a medical microbiologist, an epidemiologist, or an infectious diseases physician. If none of these are available, then a surgeon, a paediatrician, or another appropriate physician with a special interest in the field should be appointed. Irrespective of professional background, the ICO should have interest, knowledge and experience in different aspects of Infection Prevention and Control.

22. Infection Control Officer - 2
Serves as a specialist advisor and takes a leading role in the effective functioning of the Infection Control Team
Should be an active member of the Infection Control Committee and may act as its Chair
Assists the Infection Control Committee in reviewing annual plans, policies, and long-term programs for the prevention and control of infection
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23. Infection Control Officer - 3
Advises the Chief Executive/Administrator directly on all aspects of IP&C and on the implementation of policies and procedures
Participates in the preparation of tender (bid, offer) documents for support services and advises on IP&C aspects
Must be involved in setting quality standards, surveillance, and audits with regard to infection prevention
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24. Infection Control Nurse (ICN)- 1
Is a registered nurse with an academic education and practical training which enables him or her to act as a specialist advisor in all aspects relating to IP&C
Perhaps with a qualification, such as specialised training
Is usually the only full-time practitioner on the Infection Control Team and therefore takes the key role in day-to-day IP&C activities
Role may be filled by someone other than a nurse in some countries. Titles vary.
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One Infection Control Nurse (ICN) for every 250 acute beds on a full-time basis was recommended in the USA during the 1980s. However, since then, the expansion in job responsibilities necessitates that staffing requirements reflect the scope of the program, rather than bed size.
A Canadian expert panel developed a model to identify the human resources required to support an effective Infection Prevention and Control program. The model recommends, as a minimum, three full time equivalent ICNs per 500 beds in acute care hospitals and one full time equivalent ICN per 150–250 beds in long-term care facilities. Reference: Morrison J. Health Canada. Development of a resource model for infection prevention and control programs in acute, long term, and home care settings: conference proceedings of the Infection Prevention and Control Alliance. Amer J Infect Control 2004; 32(1):2-6.
A Delphi project in the USA in 2001 noted that staffing decisions should consider the facility’s size, needs, complexity, and patient population. It recommended a ratio of ICNs for every 100 occupied acute care beds. Reference: O'Boyle C, Jackson M, Henly SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project.  Amer J Infect Control 2002; 30(6):
Individuals other than nurses may fill this role in some countries. Titles may vary, e.g., infection preventionist (IP), infection control practitioner (ICP), infection control coordinator, etc.

25. Infection Control Nurse - 2
Contributes to the development and implementation of policies and procedures, participates in audits, and monitors tools related to IP&C and infectious diseases
Provides specialist-nursing input in the identification, prevention, monitoring, and control of infection
Participates in surveillance and outbreak investigation activities
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26. Infection Control Nurse - 3
Identifies, investigates and monitors infections, hazardous practices and procedures
Participates in preparing documents relating to service specifications and quality standards
Participates in training and educational programs
Is a member of relevant committees where Infection Prevention and Control input is required
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The Certification Board of Infection Control based in the USA provides a task analysis of activities for ICNs. The 2010 version is at

27. Infection Control Link Nurse (ICLN) - 1
These individuals have special responsibility for maintaining good IPC practices and education within their departments
Is the “link” between the Infection Control Nurse and the ward
Helps identify problems, implement solutions, and maintain communications
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An effective way to develop IPC education and operational support can be through a link system. In a large facility the ICN can train link nurses. Sustained, consistent senior management backing and interest are effective in supporting such link programs and essential in ensuring their success.
Competent link nurses can motivate ward staff by enabling more effective practices.
Reference: Dawson SJ. The role of the infection control link nurse. J Hosp Infect 2003: 54(4):

28. Infection Control Link Nurse - 2
The ICLN is responsible for:
Monitoring hygiene, consistent with policies and good nursing practices
Monitoring aseptic techniques, including hand hygiene and use of isolation precautions
Reporting promptly to the attending physician any evidence of infection in patients
Initiating patient isolation/precautions and ordering culture specimens from any patient
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29. Infection Control Link Nurse - 3
The ICLN is responsible for:
Identifying signs of a communicable disease when the physician is not available
Limiting patient exposure to infections from visitors, staff, other patients, or equipment used for diagnosis or treatment
Maintaining a safe and adequate supply of ward equipment, drugs, and patient care supplies
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30. Infection Control Manual - 1
Establishes standards for performance
Contains recommended instructions and practices for patient care
Topics include:
Patient care
Hand hygiene
Isolation precautions practices
Invasive procedures (intravascular and urinary catheterisation, mechanical ventilation, tracheostomy care, and wound management)
Oral alimentation
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Infection Prevention and Control Programs must oversee the on-going review and evaluation of written policies and procedures outlining prevention and control mechanisms in all patient care and service areas. The policies and procedures should be based on recognised guidelines and applicable laws and regulations. The policies should address the prevention of infection transmission among patients, employees, medical staff, contractors, volunteers, visitors, and environmental issues. Policies must be reviewed and approved routinely. The infection control manual must reflect what is actual practice in the institution.
An infection control manual, containing recommended instructions and practices for patient care, is an important tool. The manual should be developed and updated by the Infection Control Team, with review and approval by the committee. It must be made readily available for patient care staff, and updated regularly.

31. Infection Control Manual - 2
Topics include:
Area specific procedures
Isolation precautions procedures for infectious patients
Surgical and operating theatre techniques
Obstetrical, neonatal, and intensive care techniques
Processing of items of critical importance
Cleaning, sterilisation, and disinfection
Medication and preparation of infusions (including blood products)
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32. Infection Control Manual - 3
Topics include:
Staff health
Immunisation
Post-exposure management for employees, patients, and others exposed to infectious diseases within the facility
Investigation and management of patients with specific infections
Methicillin-resistant Staphylococcus aureus (MRSA)
Diarrhoea
Human immunodeficiency virus
Tuberculosis
Multi-resistant Gram-negative bacteria
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33. References - 1
Ducel G, Fabry J, Nicolle L. Prevention of hospital-acquired infections; A practical guide, 2nd ed. World Health Organization, Geneva, Switzerland; 2002; 9.
Scheckler WE, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: a consensus panel report. Infect Control Hospital Epidemiol 1998; 19:
Friedman C, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: A Consensus Panel report. Am J Infect Control 1999; 27(5):
Brannigan ET, Murray E, Holmes A. Where does infection control fit into a hospital management structure? J Hosp Infect 2009: 73(4):
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34. References - 2
Essential Resources for Effective Infection Prevention and Control Programs: A Matter of Patient Safety: A Discussion Paper – Public Health Agency of Canada
Friedman C, et al. APIC/CHICA-Canada infection prevention, control and epidemiology: Professional and practice standards. Am J Infect Control 2008; 36 (6):
Gordts B. Models for the organisation of hospital infection control and prevention programmes. Clin Microbiol Infect 2005; 11 Suppl 1:19-23.
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35. Quiz
The infection prevention and control program is often overseen by an Infection Control Committee. T/F?
IC link nurses are responsible for:
Day-to-day activities of the IPC program
IC education of all staff
Monitoring local practices
All of the above
An Infection Control Manual helps a facility:
Keep track of its infections
Investigate outbreaks
Establish standards of practice
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True C
3. C

36. International Federation of Infection Control
IFIC’s mission is to facilitate international networking in order to improve the prevention and control of healthcare associated infections worldwide. It is an umbrella organisation of societies and associations of healthcare professionals in infection control and related fields across the globe .
The goal of IFIC is to minimise the risk of infection within healthcare settings through development of a network of infection control organisations for communication, consensus building, education and sharing expertise.
For more information go to
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