| List of abbreviations |
|
xxiii | |
| Glossary of infection control terms |
|
xxvii | |
| 1 Basic concepts and prevention strategies |
|
1 | (25) |
|
|
|
1 | (4) |
|
|
|
1 | (4) |
|
1.2 Transmission of infections |
|
|
5 | (8) |
|
1.2.1 Factors necessary for transmission |
|
|
7 | (6) |
|
1.3 Prevention and control strategies |
|
|
13 | (6) |
|
1.3.1 Multimodal prevention strategies |
|
|
14 | (5) |
|
1.4 Implementation and sustainability |
|
|
19 | (2) |
|
|
|
21 | (3) |
|
|
|
23 | (1) |
|
|
|
23 | (1) |
|
Key references and further reading |
|
|
24 | (2) |
| 2 Building infection prevention programmes |
|
26 | (26) |
|
2.1 Burden of healthcare-associated infections |
|
|
26 | (1) |
|
2.2 Impact of healthcare-associated infections |
|
|
27 | (12) |
|
2.3 Responsibility of the healthcare facility |
|
|
39 | (3) |
|
2.4 Organization of IPC programmes |
|
|
42 | (7) |
|
2.4.1 Infection prevention and control doctor |
|
|
42 | (2) |
|
2.4.2 Infection prevention and control nurse |
|
|
44 | (1) |
|
2.4.3 Infection prevention and control team |
|
|
44 | (2) |
|
2.4.4 Infection prevention and control committee |
|
|
46 | (1) |
|
2.4.5 Infection prevention and control link nurse |
|
|
46 | (1) |
|
2.4.6 Policies and procedures manual |
|
|
47 | (2) |
|
Key references and further reading |
|
|
49 | (3) |
| 3 Epidemiology and biostatistics |
|
52 | (16) |
|
|
|
52 | (10) |
|
|
|
53 | (3) |
|
3.1.2 Measures of disease frequency |
|
|
56 | (2) |
|
3.1.3 Measures of association |
|
|
58 | (1) |
|
3.1.4 Bias and confounders |
|
|
59 | (3) |
|
|
|
62 | (5) |
|
3.2.1 Measures of central tendency |
|
|
62 | (1) |
|
3.2.2 Measures of dispersion |
|
|
63 | (1) |
|
|
|
63 | (1) |
|
3.2.4 Tests of statistical significance |
|
|
64 | (1) |
|
3.2.5 Confidence intervals |
|
|
64 | (1) |
|
3.2.6 Sensitivity and specificity |
|
|
65 | (1) |
|
3.2.7 Statistical process control |
|
|
66 | (1) |
|
Key references and further reading |
|
|
67 | (1) |
| 4 Surveillance and outbreak management |
|
68 | (27) |
|
|
|
68 | (12) |
|
4.1.1 Objectives of surveillance |
|
|
68 | (1) |
|
|
|
69 | (1) |
|
4.1.3 Methods of surveillance |
|
|
70 | (5) |
|
|
|
75 | (1) |
|
4.1.5 Calculating HAI rates |
|
|
75 | (1) |
|
4.1.6 Types of surveillance |
|
|
76 | (3) |
|
4.1.7 Public reporting of HAIs |
|
|
79 | (1) |
|
|
|
80 | (12) |
|
4.2.1 Is it really an outbreak? |
|
|
81 | (1) |
|
4.2.2 Recognition of outbreaks |
|
|
82 | (5) |
|
4.2.3 Outbreak control measures |
|
|
87 | (4) |
|
4.2.4 Look-back investigations |
|
|
91 | (1) |
|
Key references and further reading |
|
|
92 | (3) |
| 5 Disinfection and sterilization |
|
95 | (48) |
|
|
|
95 | (3) |
|
5.1.1 Decontamination policy |
|
|
96 | (1) |
|
5.1.2 Education and training |
|
|
97 | (1) |
|
5.1.3 Installation and maintenance |
|
|
97 | (1) |
|
|
|
98 | (1) |
|
5.2 Risk assessment of contaminated items |
|
|
98 | (1) |
|
|
|
98 | (2) |
|
5.4 Transport of sterile instruments |
|
|
100 | (1) |
|
5.5 Decontamination methods |
|
|
100 | (6) |
|
|
|
100 | (2) |
|
|
|
102 | (1) |
|
|
|
103 | (2) |
|
5.5.4 Sterilization by chemical gas |
|
|
105 | (1) |
|
|
|
105 | (1) |
|
5.5.6 Hydrogen peroxide gas plasma |
|
|
105 | (1) |
|
|
|
106 | (1) |
|
5.6 Sterilizer and decontamination of items and equipment |
|
|
106 | (4) |
|
5.6.1 Types of steam autoclaves |
|
|
107 | (3) |
|
5.7 Storage of sterile items |
|
|
110 | (9) |
|
5.8 Chemical disinfectants and antiseptics |
|
|
119 | (14) |
|
5.8.1 Characteristics of an ideal disinfectant |
|
|
120 | (1) |
|
5.8.2 Antimicrobial activity disinfectants and antiseptics |
|
|
120 | (3) |
|
5.8.3 Types of various antiseptic and disinfectants |
|
|
123 | (10) |
|
5.9 Decontamination of endoscopes |
|
|
133 | (7) |
|
5.9.1 Types of endoscopes |
|
|
134 | (1) |
|
5.9.2 General considerations |
|
|
135 | (1) |
|
5.9.3 Decontamination process |
|
|
136 | (4) |
|
5.10 Investigation after a failure of decontamination |
|
|
140 | (1) |
|
Key references and further reading |
|
|
140 | (3) |
| 6 Practical aspects of prevention and control |
|
143 | (90) |
|
6.1 Isolation precautions |
|
|
143 | (36) |
|
6.1.1 Types of isolation precautions |
|
|
144 | (3) |
|
6.1.2 General consideration |
|
|
147 | (32) |
|
|
|
179 | (14) |
|
6.2.1 Understanding microorganisms on the hands |
|
|
179 | (1) |
|
6.2.2 Hand hygiene using alcohol-based hand rub |
|
|
180 | (3) |
|
6.2.3 Hand washing using soap and water |
|
|
183 | (1) |
|
6.2.4 Indications and effectiveness |
|
|
184 | (4) |
|
6.2.5 Hand hygiene compliance |
|
|
188 | (2) |
|
6.2.6 Observations of compliance |
|
|
190 | (1) |
|
6.2.7 Skin reactions and hand care |
|
|
191 | (2) |
|
6.3 Personal protective equipment |
|
|
193 | (15) |
|
|
|
193 | (5) |
|
|
|
198 | (4) |
|
6.3.3 Protective eye and facewear |
|
|
202 | (6) |
|
|
|
208 | (4) |
|
6.4.1 Needle and syringes |
|
|
209 | (1) |
|
6.4.2 Single-and multi-dose vials and IV solutions |
|
|
209 | (1) |
|
6.4.3 Injection equipment and area for preparation of injections |
|
|
210 | (2) |
|
6.5 Prevention by building design |
|
|
212 | (11) |
|
6.5.1 Demolition, construction, and renovation |
|
|
212 | (1) |
|
6.5.2 The general hospital environment |
|
|
213 | (1) |
|
6.5.3 Patient accommodation |
|
|
214 | (1) |
|
6.5.4 Hand washing facilities |
|
|
215 | (1) |
|
6.5.5 Design of isolation rooms |
|
|
216 | (2) |
|
6.5.6 Ventilation and air-conditioning |
|
|
218 | (1) |
|
|
|
218 | (5) |
|
6.6 Prevention of infection transmission after death |
|
|
223 | (5) |
|
Key references and further reading |
|
|
228 | (5) |
| 7 Prevention of healthcare associated infections |
|
233 | (72) |
|
7.1 Surgical site infections |
|
|
233 | (29) |
|
7.1.1 Source of microbial contamination |
|
|
233 | (1) |
|
|
|
234 | (1) |
|
7.1.3 Surveillance of surgical site infections |
|
|
235 | (2) |
|
7.1.4 Types of surgical site infections |
|
|
237 | (1) |
|
|
|
238 | (1) |
|
7.1.6 General preventative measures |
|
|
238 | (8) |
|
7.1.7 Strategies to prevent surgical site infections |
|
|
246 | (16) |
|
7.2 Intravascular catheter-related infections |
|
|
262 | (12) |
|
|
|
262 | (1) |
|
7.2.2 Sources of infections |
|
|
262 | (1) |
|
|
|
263 | (1) |
|
7.2.4 Definitions and surveillance |
|
|
264 | (1) |
|
7.2.5 Diagnosis of catheter-associated bloodstream infections |
|
|
264 | (1) |
|
|
|
265 | (1) |
|
7.2.7 General prevention strategies |
|
|
265 | (9) |
|
7.3 Catheter-associated urinary tract infections |
|
|
274 | (14) |
|
|
|
277 | (1) |
|
|
|
277 | (1) |
|
7.3.3 Diagnosis and surveillance of CAUTI |
|
|
277 | (2) |
|
7.3.4 Prevention strategies |
|
|
279 | (8) |
|
7.3.5 Management of patients with bacteriuria and infections |
|
|
287 | (1) |
|
7.4 Hospital-acquired pneumonias |
|
|
288 | (10) |
|
7.4.1 Definition and microbiology |
|
|
288 | (2) |
|
7.4.2 General preventative measures |
|
|
290 | (2) |
|
7.4.3 Ventilator-associated pneumonia |
|
|
292 | (6) |
|
Key references and further reading |
|
|
298 | (7) |
| 8 Control of multidrug-resistant microorganisms |
|
305 | (33) |
|
8.1 Burden of multidrug-resistant organisms |
|
|
305 | (4) |
|
8.1.1 Burden and impact of antibiotic resistant bacteria |
|
|
305 | (1) |
|
8.1.2 Factors promoting emergence and spread of multidrug-resistant organisms |
|
|
306 | (1) |
|
8.1.3 Types of antibiotic resistance |
|
|
306 | (3) |
|
8.2 Antibiotic stewardship |
|
|
309 | (4) |
|
8.2.1 Strategies to promote appropriate use |
|
|
309 | (4) |
|
8.3 Measures to prevent and control multidrug-resistant organisms |
|
|
313 | (6) |
|
8.3.1 Infection prevention and control measures |
|
|
313 | (6) |
|
8.4 Methicillin-resistant Staph. aureus organisms |
|
|
319 | (8) |
|
8.4.1 Community-associated MRSA |
|
|
321 | (1) |
|
8.4.2 Laboratory investigations |
|
|
321 | (1) |
|
|
|
322 | (1) |
|
|
|
322 | (1) |
|
|
|
323 | (1) |
|
|
|
323 | (2) |
|
8.4.7 Ambulance transportation |
|
|
325 | (1) |
|
8.4.8 Decolonization therapy for MRSA |
|
|
326 | (1) |
|
8.5 Vancomycin-resistant Enterococci |
|
|
327 | (2) |
|
8.6 Multidrug-resistant Gram-negative bacteria |
|
|
329 | (4) |
|
8.6.1 Extended-spectrum beta-lactamases (ESBL) |
|
|
329 | (1) |
|
8.6.2 Carbapenem-resistant Enterobacteriaceae (CRE) |
|
|
329 | (1) |
|
8.6.3 Non-fermentative Gram-negative bacteria |
|
|
330 | (3) |
|
Key references and further reading |
|
|
333 | (5) |
| 9 Special pathogens |
|
338 | (90) |
|
9.1 Bloodborne viral infections |
|
|
338 | (13) |
|
9.1.1 IPC measures to protect against bloodborne viruses |
|
|
338 | (2) |
|
9.1.2 Precautions during surgical procedures |
|
|
340 | (3) |
|
|
|
343 | (3) |
|
|
|
346 | (2) |
|
|
|
348 | (1) |
|
|
|
348 | (3) |
|
|
|
351 | (11) |
|
|
|
354 | (3) |
|
9.2.2 Risk of acquisition |
|
|
357 | (3) |
|
|
|
360 | (1) |
|
|
|
360 | (2) |
|
9.3 Clostridium difficile-associated infection |
|
|
362 | (8) |
|
9.3.1 Laboratory diagnosis |
|
|
364 | (2) |
|
9.3.2 Infection prevention and control measures |
|
|
366 | (2) |
|
9.3.3 Clinical management of patients |
|
|
368 | (2) |
|
9.4 Gastrointestinal infections |
|
|
370 | (15) |
|
9.4.1 Viral gastroenteritis |
|
|
371 | (9) |
|
|
|
380 | (2) |
|
|
|
382 | (1) |
|
9.4.4 Infection control measure for viral gasteroentritis |
|
|
383 | (2) |
|
9.5 Respiratory viral infections |
|
|
385 | (7) |
|
|
|
386 | (2) |
|
9.5.2 Respiratory syncytial virus |
|
|
388 | (2) |
|
|
|
390 | (2) |
|
9.6 Legionnaires' disease |
|
|
392 | (4) |
|
9.6.1 Infection prevention and control measures |
|
|
393 | (3) |
|
9.6.2 Surveillance and notification |
|
|
396 | (1) |
|
9.7 Meningococcal infections |
|
|
396 | (4) |
|
9.8 Varicella zoster virus |
|
|
400 | (6) |
|
9.8.1 Management of contacts |
|
|
402 | (3) |
|
|
|
405 | (1) |
|
9.9 Viral haemorrhagic fevers |
|
|
406 | (7) |
|
|
|
406 | (1) |
|
|
|
407 | (1) |
|
|
|
408 | (1) |
|
9.9.4 Crimean-Congo haemorrhagic fever |
|
|
408 | (1) |
|
|
|
409 | (1) |
|
9.9.6 Infection prevention and control precautions |
|
|
410 | (3) |
|
|
|
413 | (5) |
|
9.10.1 Surgical procedure |
|
|
415 | (1) |
|
9.10.2 Infection control precautions |
|
|
415 | (3) |
|
9.11 Scabies and pediculosis |
|
|
418 | (4) |
|
|
|
418 | (2) |
|
|
|
420 | (2) |
|
|
|
422 | (1) |
|
Key references and further reading |
|
|
422 | (6) |
| 10 Support services |
|
428 | (57) |
|
10.1 Occupational health services |
|
|
428 | (20) |
|
10.1.1 Role of the occupational health department |
|
|
428 | (1) |
|
10.1.2 Pre-employment assessment |
|
|
429 | (1) |
|
10.1.3 Responsibility of healthcare workers |
|
|
429 | (1) |
|
10.1.4 Education and training |
|
|
430 | (1) |
|
|
|
430 | (8) |
|
10.1.6 Management of sharps injuries and blood and body fluid exposure |
|
|
438 | (3) |
|
10.1.7 Post-exposure prophylaxis |
|
|
441 | (1) |
|
10.1.8 Infected healthcare workers with bloodborne viral infection |
|
|
442 | (1) |
|
10.1.9 Protection against tuberculosis |
|
|
443 | (1) |
|
10.1.10 Pregnant healthcare workers |
|
|
444 | (4) |
|
10.2 Environmental cleaning |
|
|
448 | (13) |
|
10.2.1 Self-disinfecting surfaces |
|
|
458 | (1) |
|
10.2.2 No-touch room decontamination methods |
|
|
458 | (2) |
|
10.2.3 Measurements of cleanliness |
|
|
460 | (1) |
|
10.2.4 Management of potentially infectious spills |
|
|
461 | (1) |
|
10.3 Management of clinical waste |
|
|
461 | (10) |
|
10.3.1 Categories of healthcare waste |
|
|
463 | (1) |
|
|
|
463 | (1) |
|
10.3.3 Safe handling of clinical waste |
|
|
464 | (2) |
|
10.3.4 Disposal of clinical waste |
|
|
466 | (1) |
|
10.3.5 Safe use, handling, and disposal of sharps |
|
|
467 | (4) |
|
10.4 Kitchen and catering services |
|
|
471 | (6) |
|
|
|
472 | (5) |
|
10.5 Linen and laundry services |
|
|
477 | (3) |
|
10.5.1 General considerations |
|
|
477 | (2) |
|
|
|
479 | (1) |
|
|
|
480 | (1) |
|
Key references and further reading |
|
|
481 | (4) |
| Index |
|
485 | |