GUIDE TO INFECTION CONTROL IN THE HEALTHCARE SETTING
Written by international experts in the fields of infection control and hospital epidemiology, the ISID’s Guide to Infection Control in the Healthcare Setting brings together the most up-to-date principles and interventions that can reduce the rate of infection and the impact of associated consequences for patients, their families, and healthcare systems including: lengthier hospital stays; long-term disability; increased anti-microbial resistance; higher financial costs; and unnecessary deaths.
As the field of infection prevention grows in importance and the science supporting it continues to evolve, the Guide’s objectives are to facilitate the implementation of effective prevention and control measures across different resource levels to improve quality of care; minimize risk; save lives; reduce costs; and limit the use of antibiotics to fight these often preventable infections around the world.
To explore the Guide click on the chapter titles below:
Care bundles include a set of evidence-based measures that, when implemented together, have shown to improve patient care and have a greater impact than that of the isolated implementation of individual measures. Bundles help to create reliable and consistent care systems in hospital settings since they are simple, clear, and concise and contribute to infection prevention, reduce unnecessary antibiotic prescribing, and may limit the development of antibiotic resistance in healthcare facilities.
Disinfection of the inanimate environment decreases bioburden and limits cross transmission of pathogens in the hospital. This chapter summarizes recommended procedures for the disinfection of environmental surfaces and describes novel approaches such as self-cleaning surfaces and UV light emitting robots that may play a role in infection prevention.
Healthcare workers in the emergency department and receiving areas need to be aware of the risks posed by blood and air-borne infections, and take measures to limit exposure through early identification and isolation of high risk patients. This chapter summarizes how the adoption of reasonable healthcare safety precautions can minimize transmission of most contact-related infections in the emergency department.
Hospital acquired enteric outbreaks, although rare, have been reported. A growing number of hospitalized patients are susceptible to infectious diseases including the elderly and immunocompromised hosts. Coupled with mass production of food, the potential exists for large outbreaks of foodborne illnesses. This chapter summarizes the role of the Infection Control Team in incorporating principles of food safety management at every stage of food handling in the hospital.
Hand hygiene is the cornerstone of infection prevention and is associated with decreased disease transmission, reduced infection rates, and reduced antimicrobial resistance transfer. This chapter describes multimodal approaches that improve healthcare worker hand hygiene compliance.
Hand hygiene (HH) compliance by healthcare workers (HCWs) is an important quality measure in reducing healthcare associated infections. Monitoring compliance to provide feedback is critical to improving performance and has led to advances in direct and indirect measurement approaches. Though limitations apply to all of these methods, tools are available to aid implementation of HH measurement and feedback to support these efforts in a variety of settings.
Healthcare personnel (HCP) attire including scrubs, neckties, and white coats frequently become contaminated with bacteria during the course of clinical care. Although the choice of HCP attire may affect infection rates, the impact of apparel microbial burden on occurrence of hospital acquired infections is undefined and the role of HCP attire in cross-transmission of nosocomial pathogens has not been established.
Healthcare workers are not only at risk of acquiring infections in the hospital but can also be a source of infection to patients. This chapter provides a short overview of some of the most important infectious diseases that can be transmitted by healthcare workers and how to prevent transmission in the healthcare setting.
Strategies designed to prevent the spread of Healthcare Acquired Infections (HAI) can be grouped into two categories: vertical and horizontal. Vertical strategies focus on a single organism while horizontal strategies aim to control the spread of multiple organisms simultaneously.
Water supplies to healthcare facilities are frequently an overlooked yet essential element of safe patient care. Numerous healthcare-associated (HAI) outbreaks have been linked to contaminated water used for patient care. Good quality portable water is still an unmet need in many low- to middle-income countries.
In under-resourced countries, neonatal sepsis and post-partum endometritis continue to cause substantial morbidity and mortality, in both hospital and community settings. This chapter reviews the implementation of simple infection control measures that substantially reduce these infections.
Whether dealing with the recently dead or with old burials, and regardless of which infectious agents may be present, this chapter summarizes practices to greatly reduce the risk to individuals handling the dead of acquiring infection while not compromising the dignity of the deceased and, wherever possible, not interfering excessively with the grieving processes of their relatives.
Key factors in achieving effective containment of healthcare associated transmission in all hospitals are the availability of the necessary financial and logistic resources as well as the compliance of healthcare professionals (HCPs) with standard and isolation precautions. This chapter outlines the implementation of standard precautions and summarizes practices designed to contain airborne-, droplet-, and direct or indirect contact transmission.
Even with advances in laboratory safety, laboratory-acquired infections still occur. Infections can occur via inhalation, inoculation, ingestion, and contamination of skin and mucous membranes. To most effectively prevent laboratory-acquired infections, laboratories should follow the recommended guidelines, including primary and secondary barriers, for the specific risk group assigned.
New technologies to prevent cross-transmission of pathogens in healthcare centers are increasingly available to healthcare centers, though often at significant financial cost and with unique implementation considerations. This chapter summarizes the role for such technologies in existing infection prevention programs, as part of a multifaceted approach.
Surgical site infections cause significant patient morbidity and mortality and burden healthcare systems with immense costs. This chapter summarizes environmental, surgical and patient-related measures that effectively reduce the rate of surgical site infections across various resource settings and discusses the evidence gaps and controversies around other recommendations.
Organizing and recording infectious problems, including epidemics, are the foundation for infection control. By reducing infections associated with healthcare, surveillance is an integral part of the program for continuous quality improvement. Surveillance is the foundation for organizing and maintaining an infection control program; the program must include personnel with exclusive dedication.
Since the writings of Florence Nightingale in the 19th century, the need for a clean patient care environment has been unquestioned. The patient’s environment can serve as a major reservoir of microorganisms and has been linked to outbreaks of hospital acquired infections. This chapter outlines the implementation of various measures to reduce bacterial contaminationin the environment decreasing the riskfor acquiring hospital acquired infections.
The pharmacy plays a pivotal role in infection prevention and safety in the hospital. This chapter summarizes the role of the pharmacist in implementing and following procedures to prevent compounded sterile products from microbial contamination and exposure to excessive bacterial endotoxins; in promoting the rational use of antimicrobials in the hospital; and in establishing antimicrobial stewardship strategies for minimizing the development of resistant strains of microorganisms as well as for optimizing therapeutic outcomes in individual patients.
Positive Deviance (PD) is based on the observation that in every community there are certain individuals or groups whose uncommon practices enable them to find better solutions to problems than their colleagues despite having access to the same resources. These individuals are known as positive deviants. This chapter summarizes core principles of PD such as the belief that frontline healthcare workers are best positioned to identify challenges and to come up with innovative solutions.
Surgical site infections (SSIs) affect up to one third of patients who had surgery in low- and middle-income countries and are the second most common healthcare-associated infections in Europe and the USA. This chapter summarizes measures that can be taken before, during, and after surgery to reduce the rate of surgical site infections.
Reutilization of disposable devices is a common and growing practice but can be associated with infections and/or device malfunction. A facility committed to the reuse of single-use devices should have an institution-specific policy and work with clear guidelines to ensure the safety of patients taking into consideration ethical, regulatory and legal implications.
Infectious waste has the potential to transmit disease and should be collected, transferred, and disposed of in a manner that decreases the risk of injury to healthcare workers, waste management workers, patients, and the community. This chapter summarizes key steps in waste management in hospitals.
Blood transfusion can be a life-saving therapy for patients suffering with severe anemia. However, there are global problems associated with transfusion such as chronic shortages, risk of transfusion transmitted diseases and non-infectious transfusion related complications that can cause severe adverse events. This chapter discusses infectious disease agents associated with transfusion-associated infections and provides guidance on the protection of recipients of donor blood.
Over the last three decades, the role of medical imaging has extended from diagnosis to include more interventions. So, there is a need for standardized infection prevention and control (IPC) guidelines, particularly in interventional radiology (IR).
It is estimated that 700,000 people globally die from drug-resistant infections yearly. Unless major actions are taken this number is projected to rise to 10 million yearly by 2050 at an economic impact of 100 trillion dollars per year. This chapter summarizes facts, controversial issues and suggested practices to control the emergence of drug resistance in the healthcare setting.
The inappropriate use of antimicrobials in human medicine is widespread. This has a direct impact on antimicrobial resistance, one of the greatest threats to global health, food security, and development today. This chapter summarizes the principals of antimicrobial stewardship to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use, including toxicity, the selection of pathogenic organisms (such as Clostridioides difficile), and the emergence of resistance.
The microbiology laboratory plays an important role in the surveillance, treatment, control and prevention of nosocomial infections. This chapter summarizes the role of the microbiologist in the hospital infection control committee and antimicrobial stewardship group, the technical revolution taking place inside the hospital microbiology laboratory, and its importance in disease surveillance, notification and outbreak management.
The most common cause of healthcare-associated bacteremia is catheter-related bloodstream infection. These infections increase morbidity, mortality, length of stay, and hospital costs. Implementing the practices above has been shown to decrease these rates and improve quality of care for our patients.
A diarrheal disease outbreak in a healthcare facility may affect patients, healthcare workers, and visitors. Surveillance and initiation of prompt infection control management practices reduce morbidity and mortality.
“The decision to use urinary catheters should be made with the knowledge that it involves the risk of producing serious infections”. Even though this statement was formulated by Paul Beeson about sixty years ago, it remains relevant today. Urinary catheters represent the major risk factor related to the acquisition of hospital-acquired urinary tract infections. This chapter summarizes suggested practices to reduce the number of hospital-acquired urinary tract infections.
Tracheal intubation and mechanical ventilation are the most important risk factors for hospital-acquired pneumonia in critically ill patients. This chapter outlines multimodal strategies with different effective infection control measures to prevent ventilator acquired pneumonia.
Implementation of guidelines for preventing, diagnosing and treating pneumonia can reduce the associated mortality and morbidity. This chapter emphasizes the importance of implementing various measures at a time (prevention bundles) to reduce the risk of acquisition of nosocomial pneumonia. In clinical trials, this approach has proven to be more effective than isolated single measures.
Skin and soft tissue (SST) infections are common in the hospital setting. SST infections result from microbial invasion of the skin and its supporting structures.This chapter summarizes key issues and infection prevention and control measures around staphylococcal skin infections, staphylococcal scalded-skin syndrome (SSSS), severe skin and soft tissue infections, burn wound infections, and pressure sores (decubitus ulcers).
Prior to the emergence of SARS-CoV-2, the United States saw a significant decline in the prevalence of hospital acquired infections (HAIs). SARS-CoV-2 has rapidly spread worldwide since December 2019 and during this time, the prevalence of common HAIs began to increase. The purpose of this chapter is to reinforce best practices and update, clarify and emphasize the need to implement interventions to reduce HAI during this COVID-19 pandemic.
ISID's Guide to Infection Control has been immensely popular, with over 60,000 copies distributed around the world since it was first published in 1998. The ISID has freely given most of these copies to physicians, nurses, and other frontline healthcare workers in regions of the world that need it most. In 2015, the 5th edition of the Guide was made available as an open access PDF that has been downloaded by over 10,000 individuals from 160 countries. In 2019 the 6th Edition was made available on ISID's website.
Richard P. Wenzel is one of the leading infectious diseases epidemiologists in the world. Having established his reputation in the field of infection control in hospitals, he was the lead editor of the first edition of ISID's Guide to Infection Control published in 1998.
"When I was on sabbatical at the London School of Hygiene and Tropical Medicine (1985-86), I became a friend of Jean-Paul Butzler, a distinguished medical microbiologist in Brussels and recent President of ISID. He introduced me to several leading medical microbiologists throughout Europe, convinced me that a Guide to Infection Control in the Hospital would have global interest, and that I needed to edit such a document. I assembled a team of international authors who were enthusiastic supporters of the project, and my only condition was that no author or editor made money from the project and that it would be distributed free to all medical personnel in developing nations. Within a few years, we had increasing requests to translate the Guide into various languages, adding to its value. Our team at the Virginia Commonwealth University supported the Fifth Edition especially, and I am pleased to pass the baton to Dr. Gonzalo Bearman."
Richard P. Wenzel MD, MSc
18 December 2017
The Society’s ambition is to update and re-publish the Guide every two years. We welcome your ideas and suggestions for improving future editions.
Gonzalo Bearman MD, MPH, FACP, FSHEA, FIDSA
Gonzalo Bearman is the Chair of the Division of Infectious Diseases, Richard P. Wenzel Professor of Internal Medicine and Hospital Epidemiologist at the Virginia Commonwealth University Health System. He is a graduate of Colgate University (BA), SUNY at Buffalo School of Medicine and Biomedical Sciences (MD) and Columbia University (MPH). He completed a residency in Internal Medicine and was Chief Resident, both at SUNY at Buffalo. He then completed a fellowship in Infectious Diseases and a residency in Preventive Medicine/Public Health, both at Cornell University. Dr. Bearman is Board Certified in Internal Medicine, Infectious Diseases, and General Preventive Medicine and Public Health.
Since 2005, Dr. Bearman has worked on the VCU Global Health Program through the Honduras Medical Relief Brigade, a medical relief effort bringing medical and public health assistance to rural Honduran communities. In 2013, Dr. Bearman launched the Medical Literary Messenger, an online magazine for humanities and medicine, where he serves as the Editor in Chief. He serves as a section editor for Current Infectious Diseases Reports and as Editor in Chief of Current Treatment Options in Infectious Diseases. From 2013-2015, Dr. Bearman was the Chair of the Society for Healthcare Epidemiology of America’s (SHEA) Guidelines Committee.
His areas of research focus on the epidemiology of hospital-acquired infections. Dr. Bearman has multiple peer-reviewed publications in Annals of Internal Medicine, Archives of Internal Medicine, Archives of Medical Research, Clinical Infectious Diseases, Infection Control and Hospital Epidemiology, Journal of Clinical Microbiology, Current Infectious Diseases Reports, American Journal of Infection Control, BioMedCentral Infectious Diseases, Infections in Medicine, Journal of Rural and Remote Medicine, Journal of Hospital Infection, and Journal of Infection.
Michelle Doll, MD, MPH
Michelle Doll is an Assistant Professor of Internal Medicine at Virginia Commonwealth University (VCU) and an Associate Hospital Epidemiologist for the VCU Medical Center. She is a graduate of Jefferson Medical College and completed her medical residency and chief residency at Temple University Hospital. She went on to complete a clinical Infectious Disease Fellowship at the University of Maryland Medical Center, as well as a Hospital Epidemiology Fellowship and Masters of Public Health at VCU. She has worked as a volunteer faculty preceptor for medical students in Puentes de Salud Clinic in Philadelphia, Pennsylvania and currently at Crossover Clinic in Richmond, Virginia, both of which provide healthcare services to local under-served populations.
Dr. Lilani Karunanayake
Dr Lilani Karunanayake is a Consultant Clinical Microbiologist in the Medical Research Institute, which is Sri Lanka’s apex National Reference Laboratory complex. She is the Head of the Department of Bacteriology and leads the National Reference Laboratories in clinical microbiology & molecular biology, antimicrobial resistance surveillance, leptospirosis, and the quality control laboratory which is the Proficiency Testing Provider (PTP) for clinical microbiology laboratories islandwide. She is the proficiency testing coordinator and technical advisor for the National External Quality Assessment Scheme (NEQAS) in clinical microbiology. Her laboratory provides special and reference clinical microbiology tests for the country. Further, she also provides clinical services such as advice on infection prevention & control and investigation of hospital outbreaks.
She serves in several national advisory committees in the Ministry of Health, Sri Lanka, such as National Advisory committees on antimicrobial resistance, biosafety and biosecurity, infection prevention & control etc. She also engages as consortium partner to the Technical University of Denmark, and supports the strengthening of External Quality Assurance services in clinical microbiology to public health laboratories in Southeast Asia.
She obtained MBBS from the North Colombo Medical College, and MD (Medical Microbiology) from the Postgraduate Institute of Medicine of the University of Colombo, Sri Lanka. She also trained in medical microbiology at the Royal Liverpool University Hospital, UK. Her further training includes, antibiotic stewardship from National Centre for Infectious Diseases, Singapore; biosafety preparedness to handle infectious material from National Institute of Virology, Pune, India; antimicrobial consumption methodology from WHO, Geneva Switzerland; laboratory diagnosis for leptospirosis at WHO CC, Andaman Island, India; and laboratory training courses in ISO 15189 and 17043. She pioneered and obtained ISO 15189 and ISO 17043 for all microbiology and molecular biology investigations in her laboratory and the NEQAS program respectively.
She is also a postgraduate trainer, teacher and examiner for Diploma and MD programs, and thesis supervisor and examiner for MPhil and PhD programs both nationally and internationally. Her research interests are in antimicrobial resistance, leptospirosis, and vaccine preventable bacterial diseases. She has contributed to a significant number of peer-reviewed publications, including in journals Antimicrobial Resistance and Infection Control, PLOS Neglected Tropical Diseases, International Journal of Infectious Diseases, Antimicrobial Agents and Chemotherapy. She also has over 100 peer-reviewed conference presentations. On several occasions she has won ‘President’s award for Scientific Publications’, the highest for research in Sri Lanka. She has contributed to several books and delivered invited speeches both nationally and internationally.
Professor Ziad A. Memish
Prof. Ziad Memish is currently a senior consultant in infectious diseases and head of the Research Department at the Prince Mohamed Bin Abdulaziz Hospital in Riyadh, Saudi Arabia Ministry of Health; Professor at the College of Medicine in Alfaisal University, Riyadh Saudi Arabia; Adjunct Professor in the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Georgia, USA; and Adjunct Professor at the Liverpool School of Tropical Medicine, Liverpool, UK.
Prof. Memish obtained his MD from the University of Ottawa, Canada in 1987 and is Board certified by the American Board of Internal Medicine, the American Board of Infectious Diseases as well as a Fellow of the Royal College of Physicians (Canada, Edinburgh and London) and the American College of Physicians. He is widely recognized as a pioneer in Mass Gathering Medicine and Infection Control and established the WHO Collaborating Center for Mass Gathering Medicine in the Ministry of Health and the WHO Collaborating Center for Infection Control in Saudi National Guard Health Affairs. He was the first Deputy Minister of Health for Public Health, KSA (2009-2014).
He has presented many abstracts and plenary talks internationally and published more than 550 peer reviewed papers and book chapters. He is the editor-in-chief of two journals: Journal of Epidemiology & Global Health published by Elsevier and indexed in PubMed and the Journal of Health Science, a flagship journal of the Saudi Commission for Health Specialties published by Medknow. He is a recipient of the King Abdulaziz Medal from the First Degree, the highest national award in Saudi Arabia for achievements in the field of infectious diseases and infection control.
Dr. Samuel Ponce de León Rosales - Associate Editor of the Spanish Edition
Dr. Ponce ce León Rosales got his Medical Degree at the Universidad Nacional Autónoma de México (UNAM).He did his residency in Internal Medicine and Infectious Diseases at the Instituto Nacional de Ciencias Médicas y Nutrición. He also holds a Master of Science from the University of Virginia (USA).
He is a Medical Professor at the Universidad Nacional Autónoma de México (UNAM), as well as Head of the Microbiome laboratory, and Coordinator of the University Program for Health Research.
He began his work on nosocomial infections in Mexico and was the first coordinator of nosocomial infections at the National Institutes of Health. He has carried out clinical research in prevention and control of infections, quality of medical care, epidemic outbreaks and infectious and emerging diseases in general. Dr. Ponce de León has 189 scientific publications in addition to 264 more chapters, scientific dissemination and essays. He was part of the Influenza pandemic Response Group and the WHO Pandemic Emergency Council. He was General Director of CONASIDA and General Director of Birmex (Health Ministry). In 2000 he received the "Gerardo Varela" Merit Award for the General Health Council Health Ministry.
He is a member of the Editorial Board of Public Health of Mexico, the Archives of Medical Research, the Pediatric Infectious Diseases open Access, and the National Geographic in Spanish. Other memberships include the National Academy of Medicine, the Mexican Academy of Sciences, the American College of Physicians (ACP), and the International Society of Infectious Diseases (ISID) to name a few.
Dr. Victor Rosenthal, MD
Dr. Rosenthal is a specialist in Internal Medicine and Infectious Diseases in Buenos Aires. He completed an Infectious Diseases fellowship at the University of Wisconsin, USA. He is a graduate in Clinical Effectiveness from Harvard University. He is certified in Infection Control and Hospital Epidemiology.
Dr. Rosenthal is the founder and chairman of the International Nosocomial Infection Control Consortium (INICC), a nonprofit international research center which focuses on healthcare-associated infections. INICC brings together 3,000 researchers in 66 countries, spanning all six WHO regions. The consortium conducts multinational clinical studies with more than 300,000 patients.
Dr. Rosenthal has collaborated with the US Center for Diseases Control and Prevention (CDC) and currently collaborates with the Microbiology Lab of the US Navy (NAMRU) on international infection control programs. He is a co-author of the Joint Commission International Guidelines to prevent central line associated blood stream infections. He is a Task Force member and reviewer of the Infection Control Guidelines for the World Health Organization (WHO). He has collaborated to develop editions of the Infection Control Guidelines of Argentina, Brazil, Colombia, Peru, Hong Kong, Taiwan, China and several other countries.
He is an editorial board member and scientific reviewer of several international peer reviewed journals, such as the Lancet, the American Journal of Infection Control (AJIC); Infection Control and Hospital Epidemiology (ICHE); and several others. He is the author of more than 400 scientific publications and book chapters and has received several awards granted at different international scientific meetings, including SHEA, APIC, IFIC, Pan American Meetings, and others.
- World Health Organization (WHO) Infection prevention and control in health care for preparedness and response to outbreaks
- World Health Organization (WHO) Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level
- PAHO/WHO Infection Prevention and Control resources
- UNICEF Resources on Water, Sanitation and Hygiene (WASH)
- Infection Control Africa Network (ICAN) – Resources
- International Nosocomial Infection Control Consortium – INICC: Guidelines to prevent HAIs
- Public Health Agency of Canada: Disease Prevention and Control Guidelines
- US Centers for Disease Control and Prevention (CDC): Guidelines Library
- US Centers for Disease Control and Prevention (CDC): Tools for Healthcare Settings
- European Centre for Disease Prevention and Control: Directory of online resources for prevention and control of antimicrobial resistance (AMR) and healthcare-associated infections (HAI)
- Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010)
This chapter discusses the rapid development of multiple effective and safe COVID-19 vaccines based on rigorously executed and monitored clinical trials in multiple countries across the globe. In addition to discussing the usual concerns over vaccine safety and efficacy, other concerns are highlighted, including equitable access and how to allocate limited initial doses in the different countries. Substantial concerns are being raised about equity and justice because, historically, disadvantaged and minority groups have had lower vaccination rates and less access to healthcare (including newer vaccines).
Clostridioides difficile, Salmonella, Shigella, Escherichia coli, Campylobacter, Yersinia enterocolitica, Vibrio cholerae, and V. parahaemolyticus are among the various agents which may cause acute gastrointestinal infections in long-term care facility residents and health care workers. This chapter summarizes how to prevent and manage these infections.
Carbapenem resistance has increased in all regions of the world over the past decade. Colonization and infection rates are rising and have reached endemic levels in some regions. Although there is little specific evidence for many infection control measures, there is agreement on the general components of an adequate control programme. This chapter emphasizes organizational awareness of the problem of multidrug-resistant organisms and summarizes surveillance, rapid diagnosis, and the implementation of appropriate infection control and antimicrobial stewardship programmes to prevent and manage Carbapenem resistance.
The COVID-19 pandemic has not spared any nation or group, though has perhaps most severely affected patients with compromised immune systems, including people living with HIV, cancer patients, transplant recipients, or those taking immune suppressing medications for autoimmune conditions. These patients frequently have medical comorbidities which may be additionally immune suppressing, including diabetes or kidney disease, and may have more frequent or prolonged contact with healthcare facilities, warranting increased attention to the prevention of COVID-19 exposure and approach to the treatment of such in this vulnerable population.
Active immunization of the general population is effective to control the transmission of diphtheria, tetanus, and pertussis infections in the community, and the possible risk of infection in the healthcare setting. This chapter summarizes measures to prevent hospital transmission of diphtheria, tetanus, and pertussis interventions to reach high vaccine coverage against diphtheria, tetanus, and pertussis.
The cornerstone of infection prevention and control for Ebola is prompt recognition of the disease, deployment of well trained staff to manage patients, isolation of patients, and meticulous and correct use of personal protective equipment. This chapter summarizes key issues, known facts, and suggested practices for the management of Ebola Virus Disease (EBV) in healthcare settings including suggested practices in under-resourced settings.
Enterococci are ubiquitous Gram-positive cocci that are part of the normal flora of humans and animals. Enterococci are common hospital-acquired pathogens, accounting for 7.4% of all healthcare-associated infections. Infections caused by enterococci include urinary tract infections, abdominal-pelvic infections, wound (especially decubitus ulcers and diabetic foot) infections, and endocarditis. Resistance to nearly every known antibiotic has been described for various strains of enterococci and has been more problematic for E. faecium than E. faecalis. This chapter summarizes recommendations around the prevention and treatment of enterococcal infections.
Helicobacter pylori (H. pylori) is the most prevalent chronic bacterial infection in humans, colonizing the stomach of about half the world’s population. This chapter summarizes appropriate reprocessing procedures of endoscopes that are mandatory to avoid nosocomial transmission.
The incidence of healthcare associated fungal infections has increased in recent years, and the population of immunocompromised hosts at risk of these infections has also increased. This chapter summarizes measures to prevent nosocomial fungal infections, discusses environmental risk factors and outlines practices around air filtration during hospital construction and renovation.
More than thirty years after it was first recognized in Africa, HIV infection and its consequences are amongst the leading cause of adult deaths in many cities in low- and middle-income countries (LMICs), and have significantly increased childhood mortality. Despite considerable efforts to control the epidemic, HIV continues to spread in under-resourced countries. This chapter summarizes issues around ART access, adherence, monitoring, testing, pre-exposure prophylaxis, and management of co-infections.
COVID-19 has swept the globe since late 2019, with over 10.5 million cases and greater than 500,000 deaths on July 1, 2020. There are powerful non-pharmacologic interventions for interrupting the transmission of SARS-CoV-2. Social distancing and robust contact tracing with quarantine have been linked to control in several countries: the earlier the strict implementation, the lower the peak and the earlier the flattening of the epidemiologic curve of cumulative cases. Hand washing and isolation remain the pillars of infection prevention. Appropriate environmental cleaning and personal protective equipment also help prevent spread.
Despite progress in global immunization, measles remains a major infectious cause of mortality in under-resourced countries and is responsible for more than 100,000 deaths in children each year. The importance of nosocomial transmission of measles varies substantially from one region to another according to local measles epidemiology and to vaccine coverage. Whatever the local incidence of measles, the hospital represents a critical site for cross-infection.
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a new and formidable epidemic that is challenging infection control programs. Although close contact is necessary for transmission most of the time, the possibility exists for coincident transmission via airborne route and fomites. To contain this novel coronavirus, there is no room for error or relaxation of the highest standards of all features of infection control.
Nipah virus is an emerging zoonotic virus of public health importance in the South East Asia region, capable of infecting humans and a wide range of domesticated animals such as pigs, horses, goats, sheep, cats and dogs. Over the last 15 years, Nipah virus caused spill-over sporadic zoonotic outbreaks in Malaysia, Bangladish, Singapore and India killing more than 100 humans and leading to the culling of more than 1 million pigs. This chapter discusses known facts, modes of transmission and infection control practices.
Incidence of Carbapenemase-producing Enterobacteriaceae (CRE) is increasing worldwide. Screening of high risk patients to identify CRE carriers early and physical separation while in the hospital are important CRE control strategies. Modification and adaptation of international guidelines are necessary to control CREs in resource limited settings.
Nosocomial parasitic infections can be caused by enteric, blood, tissue and ectoparasites. Enteric protozoan parasites, malaria, American trypanosomiasis, toxoplasmosis, scabies (classic or crusted) and myasis are among the most frequent reported nosocomial infections. Patients with AIDS, children and transplant recipients are particularly at risk.
Streptococcus pneumoniae is increasingly reported as a pathogen causing infections in hospitals, healthcare settings, and nursing homes. These infections are often due to multiple antibiotic resistant pneumococcal serotypes and are likely to appear as small outbreaks. This chapter summarizes infection control measures to prevent endemic and epidemic nosocomial pneumococcal infections.
Pseudomonas aeruginosa is an important nosocomial pathogen that causes serious nosocomial infections and contributes significantly to morbidity and mortality. Antimicrobial resistance including carbapenem- and multidrug-resistance (MDR) also continues to increase, further limiting therapeutic options.
SARS is caused by a novel coronavirus phylogenetically distinct from all previously known human and animal coronaviruses. It emerged in Southern China in November 2002 and caused a large global outbreak. It spreads from person to person by droplets and contact direct or indirect. To contain this virus and other novel coronavirus, there is no room for error or relaxation of the highest standards of all features of infection control.
Whether dealing with the recently dead or with old burials, and regardless of which infectious agents may be present, this chapter summarizes practices to greatly reduce the risk to individuals handling the dead of acquiring infection while not compromising the dignity of the deceased and, wherever possible, not interfering excessively with the grieving processes of their relatives.
Streptococcus pyogenes (Group A beta-hemolytic streptococcus) clusters/outbreaks are uncommon, but have been described mainly in two healthcare settings, namely postpartum, and postsurgical populations. There has also been more recent interest in healthcare-associated clusters in the long-term care facility setting, where there have been growing cases identified. This chapter summarizes how to prevent and manage group A streptococcal infections in the healthcare setting.
Tuberculosis remains one of the leading causes of preventable death worldwide. Nosocomial transmission of tuberculosis to healthcare workers and patients occurs in high-, middle- and low-income countries. This chapter summarizes effective infection control practices that can reduce the risk of TB transmission in hospitals and clinics.
The COVID-19 disease is a newly emerging infectious disease caused by a novel coronavirus, SARS-CoV-2. This virus is phylogenetically distinct from previously known human and animal coronaviruses but is closer to the SARS virus. The SARS-CoV-2 virus was first identified in Wuhan city, Hubei, China in December 2019 and caused a large global outbreak. It spreads from person to person by droplets and contact, direct or indirect (although close contact was necessary for transmission most of the time), and fomites. To contain this virus and other novel coronaviruses, there is no room for error or relaxation of the highest standards of all features of infection control.