Patients:

• Wash and/or disinfect hands frequently.

• Wash hands after using the toilet and before meals.

• Ask staff (all professions) to ensure they have clean hands before caring for you.

If you have catheters or lines, such as nasal oxygen, a urinary catheter, or intravenous lines, it is important to ask staff for guidance on how to manage them properly.

Visitors:

• Wash and/or disinfect hands upon arrival to the ward.

• Do not visit if you have a cold, cough, diarrhoea, or vomiting.

Posters on the use of gloves:

• Do you need to wear gloves?

Videos about how to clean your hands:

Washing your hands in 60 seconds:

Hand sanitizing:

Patients

Patients staying at Landspítali are encouraged to do their part in preventing infections, and simple actions such as hand hygiene are important. Patients should clean their hands frequently (handwashing or hand sanitizing), especially in the following situations:

• After using the toilet, by washing hands

• Before meals, by washing hands or using hand sanitizer

• Before and after touching wounds or devices such as catheters or lines (if present); it is also important to receive guidance from staff on how to handle these devices properly

Patients are welcome to remind staff to perform hand hygiene if it is forgotten.

Relatives and visitors

Relatives and visitors coming to Landspítali can carry microorganisms onto the ward and infect patients. Following the guidelines below can significantly reduce this risk.

Important for relatives and other visitors:

• Wash or sanitize hands upon arrival to the ward

• Postpone visits if you have had fever, a cold, cough, diarrhea, or vomiting within the past two days

Staff

Standard precautions

Staff at Landspítali use specific work practices to interrupt contact transmission, both direct and indirect. These practices are known as standard precautions and include rules on hand hygiene, not wearing jewelry on the hands, correct use of personal protective equipment, proper practices when caring for patients, cleaning of equipment and devices, and more.

Isolation

In some cases, isolation is necessary to prevent the spread of certain microorganisms. Patients in isolation stay in single rooms with a private bathroom. Anyone entering the room of a patient in isolation must wear personal protective equipment according to specific guidelines and ensure proper hand hygiene when leaving the room. All items leaving the room must also be handled correctly to prevent the spread of microorganisms. While isolation is in place, it is advisable to limit visits, and visitors use the same protective equipment as staff.

A healthcare-associated infection is an infection that a patient acquires in hospital or after receiving hospital care.

According to infection prevention guidelines from the World Health Organization, about 7% of patients in developed countries acquire healthcare-associated infections. Landspítali’s operational plan aims to reduce the rate of such infections so that it remains below this level.

Healthcare-associated infections are recorded four times a year at Landspítali and are overseen by the Quality and Infection Prevention Department. These infections cause discomfort and increased illness for patients. They also lead to higher healthcare costs due to longer hospital stays, increased medication use, and sometimes additional procedures. Preventing healthcare-associated infections is therefore highly important.

Common healthcare-associated infections:

• Urinary tract infections, the most common HAIs, often associated with the use of urinary catheters.

• Lower respiratory tract infections or pneumonia, often linked to the use of ventilators.

• Surgical site infections, which may be superficial or deep. Signs include redness and swelling at or around the surgical wound, increased pain, and pus.

• Bloodstream infections, often associated with invasive devices such as central venous catheters, certain treatments such as immunosuppressive therapy, or occurring as complications of other infections, for example urinary tract infections.

• Other healthcare-associated infections may be caused by infectious microorganisms (bacteria or viruses) present in the hospital, such as:

  • Influenza

  • Diarrhoea caused by Clostridium difficile

  • Diarrhoea caused by norovirus

Routes of transmission

Contact transmission
Contact transmission is the most common route of transmission both inside and outside hospitals. It is divided into direct and indirect contact transmission. Direct contact transmission occurs, for example, when contaminated hands transfer microorganisms between individuals. Indirect contact transmission occurs when microorganisms are transferred to individuals from the environment. Microorganisms may establish temporary or permanent colonisation on or in the body.

(A video showing how microorganisms can spread through contact transmission when hands are not cleaned.)

Airborne transmission
Airborne transmission includes droplet transmission and aerosol transmission. It occurs when droplets or aerosols spread between people, for example through coughing, sneezing, or talking. Microorganisms can survive for varying lengths of time outside the body and may contaminate objects in the environment.

Antibiotic-resistant bacteria are common worldwide. They may be resistant to varying numbers of antibiotics, and some can even be resistant to all available antibiotics.

Antibiotic-resistant bacteria are also found in Iceland, though much less frequently than abroad. In recent years, antibiotic resistance among bacteria has increased internationally, and the same trend is being observed in Iceland.

Infections caused by antibiotic-resistant bacteria can lead to delays in receiving appropriate antibiotic treatment, longer hospital stays, increased costs, and other complications.

In line with guidance from the Chief Epidemiologist, all patients who seek care at Landspítali are asked specific questions to assess whether samples need to be taken to screen for antibiotic-resistant bacteria.

Sampling is painless and usually involves taking swabs from specific areas of the body. Results may be available within a few hours or up to three days.

Patients are required to remain in isolation while awaiting test results. If antibiotic-resistant bacteria are detected, isolation must continue.

Infectious diseases A–Ö on the website of the Directorate of Health.

The Quality and Infection Control Department at Landspítali is part of the Office of the Executive Director of Nursing and Medical Services.

The department has a broad scope of work, with a primary focus on infection prevention within the hospital, as well as surveillance and registration of infections and specific microorganisms. Education of students and staff is a major part of the work, along with collaboration with the Chief Epidemiologist.

The Infection Prevention team at Landspítali provides education for staff and works to reduce the risk of healthcare-associated infections.

All staff practices within the hospital are aimed at preventing the spread of pathogens in the environment and between patients.

According to Regulation No. 817/2012 on infection control measures, Landspítali is required to operate an infection control department.

The regulation specifies that the Quality and Infection Control Department is responsible for registering healthcare-associated infections and promoting infection prevention within Landspítali.