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E-raamat: Decontamination in Hospitals and Healthcare

Edited by (Former Scientific Leader in Water Microbiology and Decontamination, Public Health England (PHE), Porton, UK)
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Decontamination in Hospitals and Healthcare brings an understanding of decontamination practices and the development of technologies for cleaning and control of infection to a wide audience interested in public health, including healthcare specialists, scientists, students or patients.

Part one highlights the importance and history of decontamination in hospitals and healthcare before exploring the role of standards in decontamination, infection control in Europe, and future trends in the area. Part two focuses on decontamination practices in hospitals and healthcare. It considers the role of the nurse in decontamination, the issues of microbial biofilm in waterlines, control of waterborne microorganisms, and the use of gaseous decontamination technologies. Further chapters explore decontamination of prions, the use of protective clothing, no-touch automated room disinfection systems, and controlling the presence of microorganisms in hospitals. Part three discusses practices for decontamination and sterilization of surgical instruments and endoscopes. These chapters examine a range of guidance documents, including the choice framework for local policy and procedures for decontamination of surgical instruments, as well as novel technologies for cleaning and detection of contamination.

Decontamination in Hospitals and Healthcare provides a reference source on decontamination for public health professionals and students concerned with healthcare. It is particularly useful for scientists in microbiology and disinfection/decontamination laboratories, healthcare workers who use disinfectants, students in microbiology, clinicians, members of the Institute of Decontamination Sciences/Central Sterilising Club, and those employed in the Central Sterile Services departments of healthcare facilities.

Arvustused

"...a useful resource for all those actively involved and interested in the advances and innovations in decontamination technologiesI highly recommend this book in support of infection control and prevention for all operating theatres and sterile service departments."--Journal of Perioperative Practice

"While there are other books that do include this topic, it certainly deserves the special attention given here...I do think hospitals (and many libraries) should have a copy so that their relevant staff can access it." --Epidemiology & Infection, August 14 2014

Muu info

A look at the state of the art of decontamination and sterilization, and related technologies, in healthcare
Contributor contact details xv
Woodhead Publishing Series in Biomaterials xix
Acknowledgements and dedication xxv
Part I Fundamentals of decontamination in hospitals and healthcare
1(112)
1 The importance of decontamination in hospitals and healthcare
3(17)
J. T. Walker
1.1 Introduction
3(1)
1.2 Microbial resistance and infection control
4(3)
1.3 Current water system contamination issues
7(1)
1.4 The impact of prion discovery on sterilisation techniques
8(6)
1.5 Conclusion
14(1)
1.6 References
15(5)
2 The history of decontamination in hospitals
20(22)
S. W. B. Newsom
G. L. Ridgway
2.1 Introduction
20(2)
2.2 Healthcare-acquired infection (HAI)
22(1)
2.3 Key figures in decontamination control
23(3)
2.4 Heat for sterilisation and disinfection
26(8)
2.5 Chemical disinfectants
34(2)
2.6 Testing disinfectant activity
36(1)
2.7 European Medical Devices Directives
37(2)
2.8 Incidents of contamination as a result of human error
39(1)
2.9 Conclusion
40(1)
2.10 Acknowledgements
40(1)
2.11 References and further reading
41(1)
3 The role of standards in decontamination
42(18)
R. Bancroft
3.1 Introduction
42(1)
3.2 Relationship of standards to law and guidance
43(2)
3.3 Key aims and principles of standards
45(1)
3.4 Types of standard
46(1)
3.5 Vienna Agreement
46(1)
3.6 European standards
47(1)
3.7 International standards
48(1)
3.8 How standards are drafted
48(3)
3.9 How to read and understand a standard
51(1)
3.10 Accessing the most relevant standards and guidance documents
52(1)
3.11 Conclusion and future trends
53(1)
3.12 Sources of further information and advice
53(1)
3.13 References
54(1)
3.14 Appendix: standards in decontamination
54(6)
4 Infection control in Europe
60(32)
S. Brusaferro
4.1 Introduction
60(3)
4.2 Data available in Europe
63(5)
4.3 Standards for structures and organizations
68(1)
4.4 Training of personnel
69(16)
4.5 Conclusion and future trends
85(2)
4.6 Acknowledgements
87(1)
4.7 References
87(4)
4.8 Appendix: abbreviations
91(1)
5 Future trends in decontamination in hospitals and healthcare
92(21)
J. T. Walker
5.1 Introduction
92(2)
5.2 Decontamination in water systems
94(5)
5.3 Use of biocides
99(1)
5.4 Control of microorganisms in the built environment
100(1)
5.5 Hand hygiene
101(1)
5.6 Hand contact sites and environmental cleaning
101(1)
5.7 Manual cleaning
102(1)
5.8 Automated decontamination systems
102(1)
5.9 Decontamination of prions
103(3)
5.10 References
106(7)
Part II Decontamination practices in hospitals and healthcare
113(388)
6 Decontamination in primary care: dental and hospital perspectives
115(27)
A. Smith
6.1 Introduction
115(1)
6.2 Historic background of dental surgery
116(1)
6.3 Potential evidence of infections associated with dentistry
117(2)
6.4 The role of variant Creutzfeldt-Jakob disease (vCJD) in raising standards
119(2)
6.5 Challenges associated with dental instrument decontamination
121(3)
6.6 Instrument decontamination processes for dental surgery
124(3)
6.7 Centralization of dental instrument reprocessing
127(3)
6.8 Quality management systems (QMS)
130(4)
6.9 Future trends
134(1)
6.10 Conclusion
134(3)
6.11 Sources of further information and advice
137(1)
6.12 References
137(5)
7 The role of the nurse in decontamination
142(24)
R. Gallagher
7.1 Introduction
142(1)
7.2 Regulatory standards and decontamination
143(1)
7.3 Key principles
144(1)
7.4 Challenges associated with nursing and contamination
145(5)
7.5 Provision of cleaning services
150(1)
7.6 Management of cleaning services
151(6)
7.7 Decontamination of patient equipment
157(6)
7.8 Conclusion
163(1)
7.9 Sources of further information and advice
163(1)
7.10 References
164(2)
8 Minimising microbial contamination in dental unit water systems and microbial control in dental hospitals
166(42)
D. C. Coleman
M. J. O'Donnell
A. S. Miller
M. A. Boyle
8.1 Historical development of the dental chair unit
166(1)
8.2 Dental unit waterlines (DUWLs)
167(11)
8.3 Microorganisms identified in DUWL output water
178(1)
8.4 Evidence to date for infection or disease linked to DUWL biofilm
179(4)
8.5 A microbiological quality standard for DUWL output water
183(1)
8.6 Management of biofilm contamination of DUWLs
184(9)
8.7 Decontamination of DUWLs in dental hospitals
193(3)
8.8 Management of bacterial contamination of washbasin taps and output water in the dental hospital setting
196(2)
8.9 Outlook for the future
198(1)
8.10 References
199(9)
9 Control of waterborne microorganisms and reducing the threat from Legionella and Pseudomonas
208(24)
M. C. Kelsey
9.1 Introduction
208(1)
9.2 Legionnaires disease
208(5)
9.3 Pseudomonas aeruginosa
213(4)
9.4 The control of Legionella and Pseudomonas in water distribution systems
217(8)
9.5 Conclusion
225(1)
9.6 References
226(6)
10 The role of continuous microbial debulking in the hospital environment and its effect on reducing hospital-acquired infections (HAI)
232(22)
M. G. Schmidt
J. F. John
Ralph H. Johnson
10.1 Introduction
232(2)
10.2 Microbes: a clear and present danger common to the built hospital environment
234(2)
10.3 Alterations to the hospital environment and behavior mitigate risk
236(1)
10.4 Risk mitigation: impact of the application of continuously active no-touch solution
237(8)
10.5 Microbial debulking of the environment mitigates hospital-acquired infection (HAI) risk
245(1)
10.6 Conclusions
246(2)
10.7 References
248(6)
11 Provision and control of water for healthcare purposes
254(45)
R. Lacey
G. Walker
11.1 Introduction
254(4)
11.2 Water quality and water systems in the healthcare environment
258(3)
11.3 Water treatment and water purification technology
261(9)
11.4 Water quality monitoring
270(1)
11.5 Specialist departments and their unique requirements for water quality control
270(9)
11.6 Water Safety Group: an integrated or multi-modal approach
279(4)
11.7 Sustainability and conservation in healthcare water management
283(1)
11.8 Conclusion and future trends'
284(1)
11.9 References and further reading
285(14)
12 Use of gaseous decontamination technologies for wards and isolation rooms in hospitals and healthcare settings
299(26)
T. Pottage
J. T. Walker
12.1 Introduction
299(2)
12.2 Challenges and considerations for gaseous decontamination in a healthcare setting
301(8)
12.3 Validation methods to determine efficacy
309(4)
12.4 Practical use of gaseous decontamination in hospitals
313(6)
12.5 Conclusion and future trends
319(1)
12.6 Sources of further information and advice
320(1)
12.7 References
320(5)
13 Biocides and decontamination agents including sporicides for decontamination in hospitals
325(21)
E. S. Gilchrist
P. J. Collier
13.1 Introduction
325(4)
13.2 Currently available biocides and sporicides for use in healthcare and their limitations
329(5)
13.3 Testing standards for actives and sporicides
334(4)
13.4 Incidence of resistance and risk to the hospital patient
338(2)
13.5 Strengths/weaknesses of different disinfectants for a range of microorganisms
340(1)
13.6 Future trends
341(1)
13.7 Sources of further information and advice
342(1)
13.8 References
342(4)
14 Decontamination of prions
346(24)
G. McDonnell
14.1 Introduction
346(1)
14.2 Prion diseases: transmissible spongiform encephalopathies (TSEs)
347(1)
14.3 What are prions?
348(1)
14.4 Clinical transmission risks
349(2)
14.5 Decontamination investigations
351(13)
14.6 Future perspectives
364(1)
14.7 References
365(5)
15 Cleaning and decontamination of the healthcare environment
370(28)
S. J. Dancer
15.1 Introduction
370(1)
15.2 Pathogen survival time in the hospital environment
371(1)
15.3 Identifying the main reservoirs of microorganisms
372(2)
15.4 Transmission of contaminants by hands during healthcare
374(1)
15.5 The role of cleaning in reducing the infection risk for patients
375(6)
15.6 Contaminated cleaning equipment and fluids
381(1)
15.7 Assessment of environmental cleanliness
382(1)
15.8 Current and future trends
383(2)
15.9 Conclusion
385(1)
15.10 References
385(13)
16 The role of protective clothing in healthcare and its decontamination
398(15)
K. Laird
K. Riley
J. T. Williams
16.1 Introduction
398(2)
16.2 Disposable clothing
400(1)
16.3 Reusable clothing
401(2)
16.4 Microbiology
403(3)
16.5 Cleansing and disposal
406(4)
16.6 Conclusions and future trends
410(1)
16.7 References
410(3)
17 A guide to no-touch automated room disinfection (NTD) systems
413(48)
J. A. Otter
St Thomas' S. Yezli
Bioquell
T. M. Perl
17.1 Introduction
413(1)
17.2 Reasons to consider a no-touch automated room disinfection (NTD) system
414(1)
17.3 What level of surface contamination is a risk for transmission?
415(3)
17.4 Limitations of conventional cleaning and disinfection
418(2)
17.5 Overview of NTD systems
420(23)
17.6 When to consider an NTD system
443(2)
17.7 Using, validating and regulating NTD systems
445(3)
17.8 Sources of further information and advice
448(1)
17.9 Conclusion
449(1)
17.10 References
450(11)
18 New technologies to control the presence of microorganisms in hospitals
461(22)
A. P. R. Wilson
G. Moore
18.1 Introduction
461(2)
18.2 Designing out hospital infection
463(1)
18.3 Modifications to ward layout and design
464(3)
18.4 Modifications to the bed space
467(4)
18.5 Modifications to specific surfaces/patient care items
471(5)
18.6 Conclusion and future trends
476(1)
18.7 Sources of further information and advice
477(1)
18.8 References
477(6)
19 Testing strategies and international standards for disinfectants
483(18)
D. Ashworth
M. Greenhalgh
C. Woodall
19.1 Introduction
483(1)
19.2 How today's modern efficacy methods differ from those used historically
484(1)
19.3 The use of disinfectants and the role efficacy testing has to play in their selection
485(1)
19.4 The use of international standards in practice
486(11)
19.5 Conclusion
497(1)
19.6 References
498(3)
Part III Decontamination of surgical instruments and endoscopes
501(150)
20 An overview of current decontamination practices of surgical instruments and medical devices
503(45)
S. Holmes
20.1 Introduction
503(1)
20.2 Purpose of decontamination practice of surgical instruments in central decontamination units (CDUs)
504(3)
20.3 Current regulations, standards and guidance
507(12)
20.4 Risk minimization strategy
519(2)
20.5 Decontamination process
521(12)
20.6 Activities impacting on the decontamination process and the quality of sterile instruments
533(3)
20.7 Future trends
536(2)
20.8 Acknowledgement
538(1)
20.9 References
538(10)
21 An overview of the Choice Framework for local Policy and Procedures (CFPP) for decontamination of surgical instruments
548(39)
N. Tomlinson
H. Elliott
21.1 Introduction
548(9)
21.2 Essential quality requirements (EQR) and best practice (BP)
557(3)
21.3 Application of EQR in surgical instrument and endoscope decontamination
560(1)
21.4 Choice Framework for local Policy and Procedures (CFPP) access
561(3)
21.5 Comparing CFPP with the established Health Technical Memorandum (HTM) model
564(14)
21.6 Conclusions and future trends
578(3)
21.7 Sources of further information and advice
581(1)
21.8 Acknowledgements
582(1)
21.9 References and further reading
582(5)
22 An overview of new technologies for the decontamination of surgical instruments and the quantification of protein residues: low-pressure radiofrequency (RF) gas-plasma decontamination and epifluorescence scanning (EFSCAN) detection
587(11)
H. C. Baxter
A. C. Jones
R. L. Baxter
22.1 Introduction
587(2)
22.2 Radiofrequency (RF) gas-plasma removal of prion infectivity
589(1)
22.3 Potential future processes for prion removal
590(1)
22.4 RF gas-plasma inactivation of bacterial contamination
590(1)
22.5 An example of instrument decontamination using low-pressure gas-plasma
591(1)
22.6 Monitoring decontamination
591(1)
22.7 Epifluorescence scanning (EFSCAN)
592(2)
22.8 EFSCAN contamination monitoring for RF gas-plasma treated instruments
594(1)
22.9 Conclusion
594(1)
22.10 Acknowledgements
595(1)
22.11 References
595(3)
23 Efficacy of current and novel cleaning technologies (ProReveal) for assessing protein contamination on surgical instruments
598(22)
D. Perrett
N. K. Nayuni
23.1 Introduction
598(3)
23.2 General principles of protein detection
601(2)
23.3 Current general methods of protein detection (ninhydrin, Biuret, dyes): sensitivity, specificity and validation
603(4)
23.4 Methods of protein detection based on fluorescence
607(7)
23.5 Other possible technologies
614(1)
23.6 Strengths and weaknesses of new technologies
615(2)
23.7 Conclusion
617(1)
23.8 References
618(2)
24 Decontamination of flexible endoscopes
620(19)
P. N. Hoffman
C. R. Bradley
S. J. Line
24.1 Introduction
620(2)
24.2 Risk assessment
622(3)
24.3 Flexible endoscope decontamination
625(1)
24.4 Decontamination process
626(2)
24.5 Assessing and selecting endoscope washer-disinfector (EWD) systems
628(1)
24.6 Water treatment and potential machine contamination issues
629(1)
24.7 Endoscopy accessories
629(1)
24.8 Tracking and traceability
630(1)
24.9 Recontamination risks and preventative storage of endoscopes
631(2)
24.10 Testing for rinse water contamination
633(1)
24.11 Decontamination facilities
634(3)
24.12 Reasons for decontamination failure
637(1)
24.13 Conclusion
638(1)
24.14 References
638(1)
25 Sterilisation of flexible endoscopes
639(12)
M. Mikhail
T. Young
25.1 Introduction: key principles of sterilising flexible endoscopes
639(1)
25.2 Why sterilise flexible endoscopes?
640(2)
25.3 Problems associated with sterilisation of flexible endoscopes
642(1)
25.4 Methods used in the sterilisation of endoscopes
642(4)
25.5 Testing effectiveness and application of standards
646(1)
25.6 Example of an `in use' application
647(1)
25.7 Future trends
648(1)
25.8 Sources of further information and advice
648(1)
25.9 References
649(2)
Index 651
Dr Jimmy Walker worked as a Scientific Leader in water microbiology and decontamination at Public Health England (PHE), Porton UK. He has 30 years experience in public health microbiology with an extensive publication record, and regularly attended national and international scientific conferences. His particular interests were the presence of opportunistic pathogens in hospital water systems and advised hospitals on incidents and outbreaks associated with waterborne pathogens such as Legionella spp., Pseudomonas aeruginosa and Mycobacteria spp. He worked closely with the Department of Health (DH England) and Health and Safety Executive in writing and developing national and international guidance on the microbiology of water and decontamination in healthcare.
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