Healthcare-associated infections (HAIs) - infections patients can get while receiving medical treatment in a healthcare facility, are a major, yet often preventable, threat to patient safety. Together with health care and public health partners, CDC is working to bring increased attention to HAIs and prevention.

The Centers for Disease Control and Prevention (CDC) is a federal agency that conducts and supports health promotion, prevention and preparedness activities in the United States, with the goal of improving overall public health.

According to the CDC, the most common pathogens that cause nosocomial infections are Staphylococcus aureus, Pseudomonas aeruginosa, and E. coli. Some of the common nosocomial infections are urinary tract infections, respiratory pneumonia, surgical site wound infections, bacteremia, gastrointestinal and skin infections.

Infections caught in the hospital

A nosocomial infection is contracted because of an infection or toxin that exists in a certain location, such as a hospital. People now use nosocomial infections interchangeably with the terms health-care associated infections (HAIs) and hospital-acquired infections. For a HAI, the infection must not be present before someone has been under medical care.

One of the most common wards where HAIs occur is the intensive care unit (ICU), where doctors treat serious diseases. About 1 in 10 of the people admitted to a hospital will contract a HAI. They are also associated with significant morbidity, mortality, and hospital costs.

As medical care becomes more complex and antibiotic resistance increases, the cases of HAIs will grow. The good news is that HAIs can be prevented in a lot of healthcare situations.

Nosocomial infections are often caused by breaches of infection control practices and procedures, unclean and non-sterile environmental surfaces, and/or ill hospital staff. Prevention of nosocomial infections includes proper personal hygiene and hand washing on the part of the hospital staff, complete sterilization of medical equipment, and providing a clean, sanitary environment in the health care facilities coupled with an very effective decontaminating or disinfecting protocol.

Hospital cleanliness is the first impression that any patient or relative makes while entering a hospital.

A clean and hygienic environment has a tremendous psychological impact on the patients and the family members, and speaks volumes about the quality of service the hospital provides. Since it is difficult for people to judge the clinical services in a hospital due to lack of medical knowledge, opinion about a hospital is often formed on the basis of its appearance and cleanliness.

Housekeeping services in a hospital has a major role in controlling the infection rate as well as minimizing the Hospital acquired infections to the patients. Effective housekeeping prevents diseases and spread of infections reducing medical costs and the amount of sickness among patients and other visitors.

The task of fighting and preventing cross-contamination of infectious agents has become harder for the infection control staff because of the emergence of strains of multi-resistant organisms, increasing antibiotic resistance and an increase in the number of outbreaks such as Norovirus, MRSA, and Clostridium difficile.

The increased throughput of patients to meet hospital performance targets has resulted in higher bed occupancy. The lack of suitable isolation facilities also remains a concern, as does the increase in frequency of moving patients.

Good hospital hygiene and cleanliness is an integral component of a strategy for preventing health-care associated infections in hospitals.

Healthcare-associated infections are preventable

There are around 200,000 healthcare acquired infections (HAI's) in Australian healthcare facilities each year. This makes HAI's the most common complication affecting patients in our hospitals. These infection are becoming more common in Aged Care facilities.

Any person working in or entering a healthcare facility is at risk of transmitting infection or being infected.

Infection acquired in hospitals and other healthcare facilities are preventable.

Classification of hospital areas for antimicrobial treatment:

Areas without increased risk of infection: staircases, halls, administration offices, dining rooms, teaching facilities and other non technical areas.

Areas with increased risk of infection: Normal wards, Ambulances, Laboratories, Radiology, Physical therapy, Sanitary facilities

Areas with immuno-compromised patients: Operating theatres, Surgery (operative and interventional), Intensive medicine units, Transplantation units (BMT, stem cells) Haemato-oncology units, Burn injury units, Invasive functional diagnostics, endoscopy units, Dialysis units

Areas with patients who carry pathogens: Infection wards/care, Dialysis units, Intensive care areas, Paediatrics, Out Patient departments.

In these areas, all surfaces close to patients and surfaces with frequent hand contact should be treated with antimicrobial solutions, as often as possible.

Bacteria, fungus, and viruses can cause HAIs. Bacteria alone cause about 90 percent of these cases. Many people have compromised immune systems during their hospital stay, so they are more likely to contract an infection. 

Clinical evidence suggests an association between poor environmental hygiene and the transmission of micro-organisms causing HAIs in hospitals.

Transmission of micro-organisms may occur through direct contact with contaminated surfaces, equipment or hands. MRSA and other pathogens have been recovered from a range of surfaces commonly touched, such as door handles, computer keyboards, soap dispensers and sink taps.

Contaminated surfaces, bedding, clothing and food can also spread the illness.

Influenza is a highly infectious and potentially dangerous disease. Flu is spread by droplets from coughing or sneezing. Flu is often called 'seasonal' as it tends to occur in the colder, winter months.

Elderly people living in aged care facilities are particularly vulnerable to flu. It can lead to complications such as pneumonia, which in turn can result in death in the elderly and others whose health may put them at risk.

Microbes such as the flu virus, are highly contagious. This means they can spread very easily from one person to another. You do not have to be in contact with the virus for very long to catch it and get sick.

All patients admitted to hospital are at some risk of contracting a Hospital Acquired Infection (HAI). If you are very sick or have had surgery, you have an increased risk of infection.

People with low immunity - people with diseases or are on treatments that lower their immunity such as people who are being treated with chemotherapy or steroids.

Doctors, nurses, support staff and workers, clients and others may be exposed to infection, during personal care tasks, when handling food or soiled clothing or linen, or by just being near people with infections.

Infection can also be present without any visible signs or symptoms of illness. Therefore, you should assume that everyone is potentially infectious and treat everyone in the same way by practicing infection control procedures.

Also, remember that a person may be infectious before they become unwell (i.e. during the incubation period). With some infections, people can become carriers and remain infectious.

Being with people who are infectious increases your risk of infection. For example, if someone who has a cold or the flu, coughs or sneezes on you, their infection might pass to you. If a person who has a skin infection holds your hand when you have an uncovered cut, their infection might be passed on to you.

Anyone admitted to a healthcare facility is at risk for contracting a HAI. For some bacteria, your risks may also depend on:
  • your hospital roommate
  • age, especially if you’re more than 70 years old
  • how long you’ve been using antibiotics
  • whether or not you have a urinary catheter
  • prolonged ICU stay
  • if you’ve been in a coma
  • if you’ve experienced shock
  • any trauma you’ve experienced
  • your compromised immune system
Your risk also increases if you are admitted to the ICU. The chance of contracting a HAI in pediatric ICUs is 6.1 to 29.6 percent. A study found that nearly 11 percent of roughly 300 people who underwent operations contracted a HAI. Contaminated areas can increase your risk for HAIs by almost 10 percent.

HAIs are also more common in developing countries. Studies show that five to 10 percent of hospitalizations in Europe and North America result in HAIs. In areas such as Latin America, Sub-Saharan Africa, and Asia, it is more than 40 percent.

Health care facilities - whether hospitals, nursing homes, or outpatient facilities - can be dangerous places for the acquisition of infections. The most common type of nosocomial infections are surgical wound infections, respiratory infections, genitourinary infections, as well as gastrointestinal infections.

These infections are often caused by breaches of infection control practices and procedures, unclean and non-sterile environmental surfaces, and/or ill employees. We have the experience to understand and ascertain the facts behind these hospital acquired nosocomial infections.

Chemical antimicrobial solutions or disinfectants are chemical substances used to control, prevent, or destroy harmful microbes. Workers in hospitals, healthcare facilities, poultry facilities, abattoirs, food products manufacturing plants, sanitary and similar services, households, etc. frequently use chemical disinfectants to eradicate the diseases causing microbes.

Chemical antimicrobial solutions or disinfectants could be hazardous to all. Some of the chemical disinfectants are flammable and explosive. They may react with incompatible chemicals violently and generate toxic gases.

All chemical antimicrobial solutions or disinfectants are, by their very nature, potentially harmful or toxic.

Like other toxic substances, the chemical antimicrobial solutions or disinfectants could be harmful to humans and the environment.

Some of the chemical antimicrobial solutions or disinfectants are irritating to the skin, eyes, and respiratory system. The highly corrosive chemical antimicrobial solutions or disinfectants could inflict serious damage if they come into contact with the skin or eyes. The airborne chemical antimicrobial solutions or disinfectants would also cause respiratory problems.

Flammability is one of the potential dangers when chemical antimicrobial solutions or disinfectants are used.
  • Alcohols are flammable liquids that could be ignited if used near a flame, spark or any ignition source particularly when the alcohols are applied by spraying as mist.
  • Ethylene oxide is a highly flammable and explosive gas that has an explosive concentration range of 3% to 100% by volume.
  • Formaldehyde gas, which is given off by either liquid formalin or paraformaldehyde powder, has a characteristic pungent odour and is highly flammable. It forms explosive mixtures with air and the explosive concentrations range from 7% to 73% by volume.
  • Hydrogen peroxide possesses strong oxidizing properties and spilling high concentration peroxide solutions on flammable substance can cause an immediate fire.
  • Sodium hypochlorite in aqueous solutions is not explosive but the anhydrous sodium hypochlorite becomes an explosive substance.
  • Calcium hypochlorite is not flammable. However, it acts as an oxidizer with combustible materials.
Mixing chemical antimicrobial solutions or disinfectants with other chemical substances could be hazardous.
  • Chlorine, which is a toxic gas, is rapidly released from sodium hypochlorite solutions (bleaching solutions) if mixed with acids for example, the acidic cleaning agents. In such circumstances, workers would be exposed to high concentrations of chlorine that could be fatal.
  • Calcium hypochlorite decomposes readily in water or when heated, releasing oxygen and toxic chlorine. It may react explosively with ammonia, amines, or reducing agents.
  • When formaldehyde is mixed with strong oxidizers, violent reactions could occur. Mixing formaldehyde solution (formalin) with potassium permanganate could cause an explosion.
Health hazards involved in using chemical antimicrobial solutions or disinfectants.
  • Formaldehyde is an effective disinfectant. It is a toxic and carcinogenic chemical and can cause eye irritation, cough, shortness of breath, skin irritation, chronic bronchitis and exacerbation of asthma. It can also react with chlorine to form another carcinogen.
  • Ethylene oxide is toxic by inhalation. It is also an irritant to the skin, eyes, and the respiratory tract. Ethylene oxide may damage the nervous system, and the chemical is also a carcinogen.
  • Glutaraldehyde is a strong irritant to the skin, eyes, and respiratory system. Contact with the chemical can cause skin sensitisation, leading to allergic contact dermatitis. Exposure to the chemical may exacerbate asthma.
  • High concentrations of hypochlorite are irritating to the mucous membranes, eyes and skin.
  • Concentrated hydrogen peroxide solution is corrosive and the domestic-strength peroxide solutions could cause local burns, irritation of the mucous membranes, eyes and the skin.
  • Quaternary ammonium compounds might cause mild to severe irritation of the skin and mucous membranes depending on the chemical properties and the concentration.
  • Allergic reactions can occur to workers handling iodine solutions and iodophors. Concentrated iodine compounds can be irritating to skin.
  • Phenols disinfectants may cause irritation of the skin, local burns, headache, vomiting, diarrhoea, and damage to the kidneys in severe cases.
  • Alcohol disinfectants can be irritating to the injured skin. Inhalation of concentrated alcohol vapour may cause irritation of the respiratory tract and have effects on the central nervous system.
Many factors can influence the risk of hazards associated with use of chemical antimicrobial solutions or disinfectants. These include physical, chemical and toxic properties of the substances used in their preparation, usage protocols and practices, the nature and duration of the exposure, the effects of combined exposures, the routes of entry into the human body, and the susceptibility of the worker.

It should be noted that many of the chemical antimicrobial solutions or disinfectants are proprietary prepared formulations and their chemical components may not be shown in detail on the containers.

There are occasions where a hazardous chemical antimicrobial solutions or disinfectants  could be substituted by using other less or non-harmful chemical antimicrobial solutions or disinfectants to minimize or eliminate risks, for example, ortho-phthalaldehyde (OPA) has been used as glutaraldehyde alternative.

In addition, the one and only best alternative to chemical antimicrobial solutions or disinfectants, is our 100% natural and organic antimicrobial solution used to reduce or eliminate microbes.

It is also very important to note that, when chemical antimicrobial solutions or disinfectants are used, researchers have found that they actually make certain microorganisms stronger and resistant to antibiotic treatment. This is true even in hospital settings.

While building up antibiotic-resistance and thereby contributing to the creation of superbugs,  chemical antimicrobial solutions or disinfectants disrupt the balance of bacteria, both good and bad, making it much easier for the bad bacteria to flourish.

Some of the common chemical disinfectants and their characteristics are described in the following paragraphs. Each of the chemical disinfectants has its characteristics, hazards and efficacy against various microorganisms.

1. Ammonium hydroxide is a colourless liquid that is commonly found as household ammonia. It has a strong irritating odour and is corrosive at high concentrations. Ammonium hydroxide is an alkali. Alkalis have been used as disinfectant against a wide range of pathogens including most bacteria and viruses. The disinfection activity of alkalis is slow but increases with higher temperature. Alkalis are ineffective against the non-enveloped viruses and bacterial spores.

2. Benzalkonium chloride and cetylpyridinium chloride are quaternary ammonium compounds that are widely used as disinfectants. They are cationic detergents. Benzalkonium chloride and cetylpyridinium chloride are reported non-toxic at use-dilution concentrations. However, prolonged contact with the disinfectants at high concentrations can irritate the skin. They are effective against bacteria, fungi and enveloped viruses. The disinfectants have residual effect, keeping surfaces bacteriostatic for a brief time. Benzalkonium chloride and cetylpyridinium chloride are the active ingredients in disinfectants for homes, farms, hospitals, offices, etc. The compounds are considered stable in storage but are easily inactivated by organic matters, anionic detergents, soaps and hard water.

3. Calcium hypochlorite is a widely used chlorine compound that is highly effective against bacteria, algae, fungi and other microorganisms. Calcium hypochlorite is adopted primarily to chlorinate swimming pool and to treat water supplies and sewage. It is also frequently used as a bleaching agent and sanitizer in industrial applications. Calcium hypochlorite disinfectant usually contains 65% available chlorine. As calcium hypochlorite is a strong oxidant, there are fire and explosion risks on contact with acids, combustible substances and reducing agents. It reacts violently with many other substances including ammonia, amines, nitrogen compounds, etc. causing explosion hazard.

4. Calcium oxide (CaO), commonly known as lime or quicklime, is a white caustic solid. It is soluble in water, forming calcium hydroxide and generating heat. Contact with water or moisture may generate enough heat to ignite nearby combustible materials. Calcium oxide reacts violently with acids and halogens. Dissolved in water, calcium oxide forms a medium strong alkali that has biocidal effect on some bacteria and viruses. The chemical is often used to disinfect animal carcasses. Solutions of slaked lime (i.e. calcuim hydroxide) are used to disinfect premises. Calcium oxide is corrosive and can severely irritate and burn the skin and eyes on contact. Inhalation of calcium oxide dust will cause respiratory discomfort.

5. Chlorhexidine is one of the biguanide disinfectants that destroy microorganisms by damaging the cell membrane permeability. It is reported non-irritating and, while considered a bactericidal, virucidal and fungicidal, is less effective against these agents than many other disinfectants. Chlorhexidine could maintain effectiveness in the presence of organic matters.

6. Cresol and hexachlorophene are phenol disinfectants. The phenols are broad-spectrum disinfectants. They are ideal for destroying many bacteria but less effective against viruses. They are not active against bacterial spores. The disinfectants are applicable in situations where a heavy load of organic materials is present. Phenol compounds are the active ingredients in most bottles of "household disinfectant". The compounds are commonly found in scrub soaps and surface disinfectants. Phenol compounds can be irritating to the skin and eyes and have a distinct odour. When phenol compounds are breathed, ingested, or applied to the skin at high concentrations, they can be very harmful. Ingestion of phenol compounds may cause vomiting, circulatory collapse, paralysis, convulsions, and coma.

7. Ethyl alcohol, also known as ethanol, a colourless, volatile, highly flammable liquid with characteristic odour. Ethanol is an effective disinfectant that is commonly available. Its rapid killing action and lack of chemical residue make chemical ideal for disinfection for many medical items. The activity of ethanol drops sharply when diluted to below 50% in concentration, with the optimal concentration range being 60-90% solutions with water (volume/volume). Ethanol and solutions containing more than 50% ethanol are flammable and easily ignited. Excessive exposure to ethanol could pose health hazards.

8. Ethylene oxide is used primarily as a means of sterilizing heat-sensitive materials such as medical preparations and instruments. It is active against a wide variety of bacteria, fungi, and viruses. Ethylene oxide is a colourless and odourless gas. It is highly toxic, flammable and explosive. Ethylene oxide has an explosion concentration range of 3-100% in air by volume. It is an irritant to the skin, eyes and respiratory system. Ethylene oxide may damage the nervous system. It is a carcinogen.

9. Formaldehyde is a toxic and colourless gas with pungent and suffocating odour at room temperature. Formaldehyde is a carcinogen. The chemical is readily soluble in water. Commercial formaldehyde chemical is produced and sold as an aqueous solution (formalin) containing 37-50% formaldehyde by weight. Aqueous formaldehyde could be used as a disinfectant or preservative. Besides being a liquid disinfectant, formaldehyde may be used as a fumigant to disinfect objects surface and air.

10. Glutaraldehyde (1,5-pentanedial) is an effective disinfectant against bacteria, fungi and viruses. Glutaraldehyde is widely used as an antimicrobial agent in a variety of applications such as in cooling water systems, paper-pulp industry, poultry industry, cosmetic field, microbiological field, food industry and medical area. The extensive use of this biocide is due to being non-corrosive to metals, stainless steel, rubber, etc. Glutaraldehyde is soluble in water and organic solvents and the solutions are stable for long periods of time. Its efficacy is highly dependant on pH and temperature. Glutaraldehyde works best at a pH greater that 7 and high temperatures. It is considered more efficacious than formaldehyde in the presence of organic matters, soap and hard water. Exposure to glutaraldehyde liquid or vapour may cause health problems including skin sensitisation, exacerbation of asthma and leading to allergic contact dermatitis, etc.

11. Hydrogen peroxide is a colourless liquid at ambient conditions. It is a common oxidizing and bleaching agent. The chemical is widely used in deodorants, water and sewage treatment or as rocket fuels and disinfectants. A preparation containing hydrogen peroxide at 15- 20% concentration is considered bactericidal, virucidal and fungicidal. At high concentrations, it is a sporicidal. Diluted forms of hydrogen peroxide are often used as cleansers for human cuts and scrapes. Concentrated hydrogen peroxide solution is reactive and explosive. It is also corrosive and on contact, the concentrated hydrogen peroxide solutions may cause chemical burn of the skin and eyes.

12. Iodine compounds are broad spectrum and considered effective for a variety of bacteria, fungi and viruses. Iodines are often formulated with soaps and considered to be relatively safe. Concentrated iodine compounds can be irritating to the skin, stain clothes or damage rubber and metals. Tincture of iodine has been used as an antiseptic for skin cuts and scrapes. Iodine agents are inactivated by quaternary ammonium compounds and organic debris.

13. Iodophors are preparations containing elemental iodine complex with a polymer carrier (i.e. the complexing agent) of high molecular weight. The resulting complex provides a sustained-release of iodine in aqueous solution. Iodophors' bactericidal activity is relatively slow. Iodophors are general use disinfectants, which are less readily inactivated by organic matter than elemental iodine. Povidone-iodine (PVI) is a commonly available iodophor, usually prepared as a 7.5-10% solution. Formulations with lower concentrations have good antimicrobial activity because dilution can increase iodine concentrations. As the amount of free iodine increases, the degree of skin irritation also may increase.

14. Isopropyl alcohol, also known as isopropanol, is a highly flammable colourless liquid with an odour reminiscent of ethanol or acetone. Isopropyl alcohol is found in alcohol sponges, cleaning agents, and rubbing alcohol. The rubbing alcohol generally contains 70% isopropyl alcohol. Isopropyl alcohol is an irritant of the eyes and mucous membranes. Prolonged skin contact with isopropyl alcohol may cause eczema.

15. Ortho-phthalaldehyde (OPA) is a light yellow solid and is chemically related to glutaraldehyde. Like glutaraldehyde, high pH may make the chemical more active against microorganisms. OPA is widely used as glutaraldehyde alternative. It is a potential skin and respiratory sensitiser and thus can aggravate pre-existing asthma or dermatitis. OPA is non-flammable and is stable at a wide pH range.

16. Paraformaldehyde is a white powder with the odour of formaldehyde. Paraformaldehyde has been used as a fumigant for over 30 years to decontaminate laboratory facilities and to disinfect sick rooms, clothing, linen, and sickroom utensils. When heated, paraformaldehyde releases formaldehyde gas, an effective disinfectant. Paraformaldehyde is an irritant to the skin, eyes and the respiratory system. High concentrations exposures to paraformaldehyde could lead to pulmonary edema.

17. Peracetic acid (or peroxyacetic acid) is a colourless liquid with a strong vinegary odour. Peracetic acid is an irritant and it decomposes to acetic acid, oxygen and water and therefore does not pose an environmental hazard. Peracetic acid is a strong oxidizing agent that rapidly kills a wide range of microorganisms. A concentration of 0.2% peracetic acid is active against all microorganisms including bacterial spores, and is effective in the presence of organic matter at low temperature. It is usually applied as a spray, or as a mop-on solution. Peracetic acid can corrode metals and it can also cause materials discolouration.

18. Sodium hypochlorite is the active ingredient in common bleach and is effective against bacteria, viruses and fungi. It is one of the most widely used of the chlorine containing disinfectants used. Sodium hypochlorite solution is used on a large scale for surface purification, bleaching, odour removal and water disinfection. Liquid chlorine bleach usually contains 5.25% solution of sodium hypochlorite as disinfectant. Diluted hypochlorite solutions lose potency quickly and therefore it should be made freshly prepared before use. Sodium hypochlorite is corrosive to metal surfaces at high concentrations. When the hypochlorite solution come in contact with formaldehyde, bis-chloromethyl ether, a known carcinogen, is produced. Mixing hypochlorite solution with an acid would rapidly release chlorine, a toxic gas. Bleached articles should not be autoclaved without removing the hypochlorite residue by reduction with sodium thiosulphate or sodium bisulphate.

Infection control in any hospital or health care setting / facility is a very  vital and important discipline concerned with preventing / controlling nosocomial and other healthcare associated infections / cross contaminations, to the patients, attendants, visitors, doctors, nurses and all other technical and non-technical support staff who practically come in contact with any or all such risks.

Infection prevention & control is an essential part of treatment, though it is often under-recognized and under-supported, and not considered as an integral part of the care providing infrastructure in health care.

The overall aim of this document is to provide evidence based information to help or assist in the prevention and control of all types of infections inside or outside of the hospital.

It is relevant to all the stake holders including doctors, nurses, other clinical, non clinical professionals and   support staff working in any hospital or other types and kinds of settings / facilities that provide healthcare, or treat infections.

Our products have been developed to help and assist in several applications, in the every day protocol in any Hospital or Health care facility to manage / control / prevent & treat infections.