Table Of ContentAyliffe’s
Control of
Healthcare-Associated
Infection
Fifth edition
This page intentionally left blank
Fifth edition
Ayliffe’s
Control of
Healthcare-Associated
Infection
A practical handbook
Edited by:
Adam P Fraise MB BS FRCPath
Consultant Medical Microbiologist and Director,
Hospital Infection Research Laboratory,
University Hospital Birmingham, Birmingham, UK
Christina Bradley MIBMS
Manager, Hospital Infection Research Laboratory,
University Hospital Birmingham, Birmingham, UK
First published in Great Britain in 1975 by Chapman & Hall
This fifth edition published in 2009 by
Hodder Arnold, an imprint of Hodder Education,
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CONTENTS
List of contributors vii
Foreword by Graham AJ Ayliffe ix
Preface to the fifth edition xi
Part One: Basic principles
1 Introduction Adam Fraise 3
2 Administration and responsibility Adam Fraise 13
3 Surveillance, audit, records and reports Peter Wilson 41
4 Sterilization Peter Hooper 67
5 Physical and chemical disinfection Christina Bradley 88
6 Decontamination of equipment, the environment and the skin
Adam Fraise and Christina Bradley 107
7 Laundry, kitchens and healthcare waste Peter Hoffman 150
Part Two: Prophylaxis and treatment of infections
8 Use of antimicrobial agents Elizabeth SR Darley and Alasdair P MacGowan 171
9 Control of bloodborne viral infections Samir Dervisevic and Deenan Pillay 187
10 Immunization and specific prophylaxis Jonathan North 209
11 The role of occupational health services in the control of infection
Tar-Ching Aw 226
12 Special problems of infections
MRSA Georgia Duckworth 237
Glycopeptide-resistant enterococci Gary L French 245
Clostridium difficile Mark H Wilcox 253
Resistant Gram-negative rods Peter M Hawkey and Savita Gossain 259
CJD Donald J Jeffries 270
Tuberculosis Adam Fraise and E Grace Smith 279
Legionnaire’s disease (Legionellapneumonia)
Christina Bradley and Adam Fraise 285
Part Three: Prevention
13 Prevention of infection in wards and outpatient departments
Dawn Hill and Susan Millward 305
14 Prevention of infection in special wards and departments
Paediatrics Adam Fraise 330
Burns Michael J Weinbren 336
vi Contents
Renal Muhammad Raza and Alison Hames 343
Critical care units Michael A Cooper 351
Obstetrics and gynaecology Richard PD Cooke and Julie Hughes 359
Transplants Manjusha Narayanan and Kate Gould 367
Operating theatres Eric Taylor and Peter Hoffman 375
15 Prevention of infection in allied health areas and service departments
Radiology Rebecca Evans 396
Physiotherapy and occupational therapy Christine Perry 405
Pharmacy Conor Jamieson and Said Noorazar 410
Sterile services department Adam Fraise and Christina Bradley 416
Ambulance service Avril Weaver 421
Pathology laboratories Adam Fraise and Christina Bradley 428
Dental practice Andrew J Smith 436
Chiropody Rebecca Evans 447
16 Infection prevention and control in the community Iain Blair 458
Index 487
LIST OF CONTRIBUTORS
Tar-Ching Aw Professor and Head, Department of Community Medicine, Faculty of
Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab
Emirates, and Visiting Professor, Canterbury Christ Church University, Canterbury, UK
Iain Blair Associate Professor, Department of Community Medicine, Faculty of Medicine
and Health Sciences, UAE University, Al Ain, United Arab Emirates
Christina Bradley Manager, Hospital Infection Research Laboratory, University Hospital
Birmingham, Birmingham, UK
Richard PD Cooke Consultant Microbiologist, Honorary Senior Lecturer, University Hospital
Aintree, Liverpool, UK
Mike Cooper Consultant Microbiologist, New Cross Hospital, Wolverhampton, UK
Elizabeth SR Darley Director of Infection Prevention and Control, North Bristol NHS Trust,
Bristol, UK
Samir Dervisevic Consultant Virologist and Clinical Lead in Virology, Norfolk and Norwich
University Hospitals NHS FoundationTrust, Norwich, UK
Georgia J Duckworth National HCAI and AMR Surveillance Lead and Director, Department
of Healthcare Associated Infection and Antimicrobial Resistance, Centre for Infections,
Health Protection Agency, London, UK
Rebecca Evans Head of Infection Control Nursing Services, Sandwell and West
Birmingham Hospital NHS Trust, Birmingham, UK
Adam P Fraise Consultant Medical Microbiologist and Director, Hospital Infection Research
Laboratory, University Hospital Birmingham, Birmingham, UK
Gary L French Professor of Microbiology and Consultant Microbiologist, King’s College
London and Department of Infection, Guy’s and St Thomas’ Hospital, London, UK
Savita Gossain Consultant Medical Microbiologist, Health Protection Agency West
MidlandsPublicHealthLaboratory,HeartofEnglandNHSFoundationTrust,Birmingham,UK
Kate Gould Consultant Microbiologist, Freeman Hospital, Newcastle upon Tyne, UK
Alison Hames Specialist Registrar Microbiology, Microbiology Department, Freeman
Hospital, Newcastle, UK
Peter M Hawkey School of Immunity and Infection, University of Birmingham, and Health
Protection Agency West Midlands Public Health Laboratory, Heart of England NHS
Foundation Trust, Birmingham, UK
Dawn Hill Nurse Consultant, Welsh Healthcare Associated Infection Programme, National
Public Health Service for Wales, UK
Peter Hoffman Consultant Clinical Scientist, Laboratory of Healthcare-associated Infection,
Health Protection Agency, London, UK
viii List of contributors
Peter Hooper Authorizing Engineer (Decontamination), Banbury, Oxfordshire, UK
Julie Hughes Nurse Consultant in Infection Control, University Hospital Aintree, Liverpool, UK
Conor Jamieson Pharmacy Team Leader –Antimicrobial Therapy, Department of
Microbiology, City Hospital, Birmingham, UK
Donald J Jeffries Emiritus Professor of Virology, University of London; Chair ACDP TSE
Working Group
Alasdair P MacGowan Professor of Clinical Microbiology and Antimicrobial Therapeutics,
University of Bristol and Department of Medical Microbiology, North Bristol NHS Trust,
Bristol, UK
Susan Millward Infection Prevention Nurse Consultant (working with Nuffield Health
Group, UK), and Director, Infection Prevention Ltd, UK
Manjusha Narayanan Consultant Microbiologist, Freeman Hospital, Newcastle upon Tyne, UK
Said Noorazar Quality Control Pharmacist, Pharmacy Department, City Hospital,
Birmingham, UK
Jonathan North Consultant Immunologist, Immunology Department, City Hospital,
Birmingham, UK
Christine Perry Director, Infection Prevention and Control, University Hospitals Bristol NHS
Foundation Trust, Bristol, UK
Deenan Pillay Professor of Virology, University College London Hospitals NHS Foundation
Trust and University College London, London, UK
Muhammad Waqar Raza Consultant Microbiologist, Microbiology Department, Freeman
Hospital, Hon Sen Lecturer, University of Newcastle, Newcastle, UK
Andrew J Smith Senior Lecturer/Honorary Consultant in Microbiology, Infection Research
Group, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK
E Grace Smith Consultant Microbiologist and Clinical Service Director, Regional Centre for
Mycobacteriology, Heartlands Hospital, Birmingham, UK
Eric W Taylor Consultant Surgeon, Greater Glasgow and Clyde Acute Hospitals NHS Trust,
Inverclyde Royal Hospital, Greenock, UK
Avril WeaverHealth Protection Nurse, West Midlands West Health Protection Unit,
Kidderminster, UK
Michael J Weinbren Consultant Microbiologist, University Hospital of Coventry and
Warwickshire NHS Trust, Coventry, UK
Mark H Wilcox Professor of Medical Microbiology, Head of Microbiology, and Clinical
Director of Pathology, Leeds Teaching Hospitals and University of Leeds; Lead on
Clostridium difficilefor the Health Protection Agency Regional Microbiology Network, UK
Peter Wilson Consultant Microbiologist, Royal London Hospital, London, UK
FOREWORD
It is a great honour for me to be associated with the fifth edition and to be
asked to write the foreword. The book has been in existence for over 30 years
and the advice it has provided has always been useful and reliable, not only in
the UK but around the world.
Hospital infection, particularly when associated with multiple antibiotic
resistance, still remains a major problem. In the early 1960s some Staphylococ-
cus aureus strains, resistant to most of the available antibiotics, including
methicillin, were spreading in hospitals. Gram-negative bacilli, particularly
Pseudomonas aeruginosa, were often responsible for severe outbreaks. Aseptic
methods were often poor, the use of disinfectants was excessive and inade-
quately controlled, and defects in sterilization were common. A West Midlands
Regional Working Party was set up at this time, chaired by Professor Edward
Lowbury, consisting of microbiologists, infection control nurses, clinicians,
engineers, administrators and others as necessary to tackle these problems.
Meanwhile, the Hospital Infection Research Laboratory was carrying out
prevalence surveys of infection and practices in West Midlands hospitals, pro-
viding useful data for the Working Party. It was then decided to produce a
Regional Code of Practice which was so successful that a hardback book, Con-
trol of Hospital Infection: a practical handbook, was published and the first edi-
tors were EJL Lowbury, GAJ Ayliffe, AM Geddes and JD Williams. Since
then, three more editions have been published.
This new edition has been expanded and updated and has a distinguished
team of authors. The title has been altered to Control of Healthcare-Associated
Infection since the increase in day surgery, minor surgery in general practice,
and shorter hospital stay has meant that many more infections become mani-
fest in the community.
Most of the recommendations in this book are, as previously, found to be
effective in practice. Although methods based on good controlled clinical stud-
ies are desirable, these are rarely practical for hospital infection owing to the
multiplicity of routes of spread of organisms and the varying number of factors
influencing the emergence of infection. As an example, handwashing or disin-
fection is widely accepted as the most important technique in preventing the
spread of infection but it is still uncertain whether an alcohol rub is more effec-
tive clinically than washing with soap and water, despite the laboratory evi-
dence in favour of alcohol. The importance of cleaning the environment to
control infection is often stressed by patients and politicians, although a risk
assessment shows floors to be a minimal risk for transferring infection.
The principles of infection control have changed little over the years, but
new problems have continued to emerge, such as multi-resistant tuberculosis
and Clostridium difficile, which is now one of the major hospital infections in
