Infection Control and Prevention

Infection control is a cornerstone of safe healthcare practice in the UAE and one of the most heavily examined topics in the DOH (UAE) licensure examination. The UAE healthcare system treats a diverse population from regions with varying endemic infectious diseases, making robust infection prevention and control (IPC) practices absolutely critical. Healthcare-associated infections (HAIs) affect 5–15% of hospitalised patients globally, and the UAE has made HAI surveillance and prevention a national health priority under the Ministry of Health and Prevention (MOHAP) and Dubai Health Authority (DHA) frameworks.

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🟢 Lite — Quick Review (1h–1d)

Rapid summary for last-minute revision before your exam.

The Chain of Infection — 6 Links (break any link to prevent infection):

1. Infectious agent (bacteria, virus, fungus, parasite)
2. Reservoir (person, animal, environment)
3. Portal of exit (respiratory, GI, blood, mucous membranes, broken skin)
4. Mode of transmission (contact, droplet, airborne, vector, common vehicle)
5. Portal of entry (same as portal of exit — respiratory, mucous membranes, etc.)
6. Susceptible host (age, immunosuppression, chronic disease, breaks in skin)

Standard Precautions — For ALL Patients:

• Hand hygiene (5 Moments — WHO)
• PPE based on risk assessment (gloves, gown, mask, eye protection)
• Safe injection practices (never reuse syringes, needle-free devices where possible)
• Respiratory hygiene/cough etiquette
• Proper sharps disposal
• Environmental cleaning

Droplet vs Airborne — Know the Difference:

	Droplet	Airborne
Particle size	>5 μm	<5 μm
Distance	Up to 1 metre	Indefinite (airborne nuclei)
Examples	Influenza, pertussis, meningococcus, COVID-19	TB, measles, varicella, chickenpox
Mask needed	Surgical mask sufficient	N95/FFP2 minimum

⚡ Exam Tip: MERS-CoV (Middle East Respiratory Syndrome Coronavirus) is droplet transmission in clinical settings. Standard + contact precautions are sufficient in most settings. N95 is used during aerosol-generating procedures (AGPs).

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🟡 Standard — Regular Study (2d–2mo)

Standard content for students with a few days to months.

1. Hand Hygiene — The Single Most Important Intervention

Hand hygiene prevents up to 50% of all HAIs. The WHO 5 Moments for Hand Hygiene in the UAE clinical setting:

Moment	When
1. Before patient contact	Clean hands before touching patient
2. Before aseptic task	Before any clean/aseptic procedure
3. After body fluid exposure risk	After exposure to blood, bodily fluids, mucous membranes
4. After patient contact	After touching patient
5. After contact with patient surroundings	After leaving patient’s immediate environment

Technique — Soap and Water vs Alcohol-Based Hand Rub (ABHR):

• ABHR (60–80% alcohol): Use when hands are NOT visibly soiled; rub all surfaces until dry (~20–30 seconds)
• Soap and water: Use when hands ARE visibly soiled, after caring for patients with C. difficile, norovirus, or Bacillus sp. (spore-formers not killed by alcohol); wash for 40–60 seconds

ABHR Technique (7 steps):

1. Palm to palm
2. Right palm over left dorsum with interlaced fingers, and vice versa
3. Palm to palm with interlaced fingers
4. Backs of fingers to opposing palms with fingers interlocked
5. Rotational rubbing of right thumb in left palm, and vice versa
6. Rotational rubbing of right fingertips in left palm, and vice versa
7. Each wrist

2. Personal Protective Equipment (PPE)

PPE Order — Donning (putting on):

1. Gown
2. Mask/respirator
3. Eye protection (goggles/face shield)
4. Gloves

PPE Order — Doffing (removing):

1. Gloves (most contaminated — remove first)
2. Hand hygiene
3. Gown (untie, roll away from body)
4. Hand hygiene
5. Eye protection
6. Mask (remove from behind; do not touch front)
7. Hand hygiene

Transmission-Based Precautions:

Contact precautions:

• Private room (or cohort with same pathogen)
• Gown and gloves for ALL patient contact
• Dedicated equipment
• Examples: MRSA, VRE, C. difficile, scabies, HSV, norovirus

Droplet precautions:

• Private room or cohort with same infection
• Surgical mask within 1 metre of patient
• Eye protection if splash risk
• Examples: Influenza, COVID-19, pertussis, meningococcal disease, mumps, rubella

Airborne precautions:

• Negative pressure isolation room (AGIIR)
• N95/FFP2 respirator (fit-tested — mandatory in UAE for TB)
• Eye protection; gown and gloves
• Patient should wear surgical mask when outside room
• Examples: Pulmonary TB, measles, varicella, disseminated zoster

3. Sharps Safety and Needlestick Prevention

The UAE has strict regulations regarding sharps injuries:

• Never recap needles (the leading cause of needlestick injury)
• Immediately dispose of sharps in approved sharps container (puncture-proof, labelled)
• Sharps containers must be at point of use, not moved once sealed
• Report all needlestick/sharps injuries immediately (within 2 hours per UAE MOHAP protocol)
• Post-exposure prophylaxis (PEP) for HIV, Hepatitis B, Hepatitis C must be initiated within 72 hours (ideally sooner)

Post-Exposure Protocol:

1. First-aid at bedside (wash wound, don’t scrub)
2. Report immediately to occupational health/exposed person service
3. Baseline blood tests (source patient and exposed HCW — with consent)
4. Risk assessment for HIV, HBV, HCV
5. Prophylaxis if indicated (HIV: 28-day course; HBV: vaccine ± HBIG)
6. Follow-up testing at 6 weeks, 3 months, 6 months

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🔴 Extended — Deep Study (3m+)

Comprehensive coverage for students on a longer study timeline.

4. Healthcare-Associated Infections (HAIs) — UAE Context

Most Common HAIs in UAE Hospitals:

• Catheter-associated urinary tract infection (CAUTI) — most common HAI overall
• Surgical site infection (SSI) — second most common; UAE surgical site infection rates are monitored by MOHAP
• Central line-associated bloodstream infection (CLABSI) — high mortality if not treated promptly
• Ventilator-associated pneumonia (VAP) — second most common in ICU
• Clostridioides difficile infection (CDI) — increasing in UAE due to broad-spectrum antibiotic use

MRSA (Methicillin-Resistant Staphylococcus aureus) in UAE:

• MRSA prevalence in UAE hospitals is moderate-to-high (10–30% in some settings)
• Risk factors: Prior antibiotic use, prolonged hospitalisation, ICU admission, surgical wounds
• Colonised patients: Decolonisation with mupirocin nasal ointment and chlorhexidine body washes
• Active surveillance cultures: Many UAE ICUs screen all patients on admission

Carbapenem-Resistant Enterobacteriaceae (CRE):

• Critical global health threat; particularly prevalent in Middle Eastern hospitals
• Associated with high mortality; very limited treatment options (last-resort antibiotics like colistin, tigecycline)
• Contact precautions mandatory; aggressive environmental cleaning; dedicated equipment

5. Environmental Cleaning and Disinfection

• Cleaning: Physical removal of dirt and organic material (soil, blood, secretions)
• Disinfection: Killing of microorganisms (not spores); use hospital-grade disinfectants
• Sterilisation: Killing of ALL microorganisms including spores; for critical items that enter tissue

UAE Hospital-Grade Disinfectants:

• 70% isopropyl alcohol (surfaces, equipment)
• Chlorhexidine 0.05% (skin, mucous membranes)
• Sodium hypochlorite (bleach) — diluted for surface disinfection; effective against C. difficile spores
• Hydrogen peroxide vapour (terminal cleaning of isolation rooms)
• UV-C light (supplementary for terminal room cleaning in some UAE facilities)

6. MERS-CoV and COVID-19 — What UAE Nurses Must Know

MERS-CoV (Middle East Respiratory Syndrome Coronavirus):

• First identified in Saudi Arabia in 2012; multiple UAE outbreaks
• Zoonotic origin: Dromedary camels are the major reservoir
• Transmission: Droplet and contact (not airborne under normal circumstances)
• Symptoms: Fever, cough, dyspnoea, pneumonia, ARDS
• Case fatality rate: ~35% (much higher than COVID-19)
• DOH protocol: Standard + contact precautions; N95 for AGPs

COVID-19:

• Spread via droplets, aerosols, and contact
• AGPs (aerosol-generating procedures) carry the highest transmission risk: intubation, suctioning, bronchoscopy, nebulisation
• PPE for AGPs: Fit-tested N95, gown, gloves, eye protection, face shield
• UAE’s vaccination programme and hospital protocols are among the most comprehensive in the region

Exam Watch: The DOH examiner frequently presents scenarios testing isolation category selection (contact, droplet, airborne), hand hygiene technique, and sharps injury management. A key concept: standard precautions apply to ALL patients regardless of diagnosis — assume every patient is potentially infectious.

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