Hospital-Acquired Infection: Causes and Control

300 Pages·2009·9.14 MB·English

by  Zsolt Filetoth(auth.)

Hospital-acquiredI nfection
Control
Causes and
In consequence of my conviction I must affirm that only God knows the
number of patients who went prematurely to their graves because of me. I have
examined corpses to an extent equalled by few other obstetricians. If I say this
also of another physician, my intention is only to bring to consciousness a truth
that, to humanity’s great misfortune, has remained unknown through so many
centuries. No matter how painful and oppressive such a recognition may be,
the remedy does not lie in suppression. If the misfortune is not to persist
forever, then this truth must be made known to everyone concerned.
Ip.nacz Semmelweis, ?he Etiologv, Concept, and Prophylaxis of Childbed Fever
Hospital-
uired
P
ac
In
ection
and Control
Causes
ZSOLTF ILETOTHM, D, MSC
Head of Clinical Epidemiology Unit of the
National Institute of Traumatology, Budapest, Hungary
and
Consultant in Infectious Disease and Epidemiology,
National Institute of Neurosurgery, Budapest, Hungary
W
W H U R R PUBLISHERS
L O N D O N A N D P H I L A D E L P H I A
02 003 Whurr Publishers Ltd
First published 2003
by Whurr Publishers Ltd
19b Compton Terrace, London N 1 2UN England and
325 Chestnut Street, Philadelphia PA 19106 USA
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording
or otherwise, without the prior permission of
Whurr Publishers Limited.
This publication is sold subject to the conditions that it shall not, by
way of trade or otherwise, be lent, resold, hired out, or otherwise
circulated without the publisher’s prior consent in any form of
binding or cover other than that in which it is published and
without a similar condition including this condition being imposed
upon any subsequent purchaser.
Library Cataloguing in Publication Data
British
A catalogue record for this book is available from the British Library.
ISBN: 1 86156 344 2
Printed and bound in the UK by Athenaeum Press Ltd,
Gateshead, Tyne & Wear.
Contents
The author vii
Acknowledgements
ix
Preface ...
xi
Introduction
Xlll
Chapter 1 1
Causes and determinants of hospital-acquired infection
Chapter 2 53
Infection and its characteristics
Chanter 3 74
The chain of infection and the transmission of an infective agent
Chapter 4 97
Definitions and general characteristics of infections in hospitals
Chapter 5 116
Preventive strategies for hospital-acquired infection
Chapter 6 180
Common hospital-acquired infections in developed countries
Chapter 7 220
Infection control and surveillance
References 252
V
vi Hospital Acquired Infection
Bibliography
262
Annexe 1: American National Standards in United States
263
regulating sterilization in hospitals and in industry
Annexe 2: Standards of the European Union regulating
266
sterilization in hospitals
Annexe 3: Required amount of disinfectant for an appropriate
268
concentration of total solution in the SI system
Index
269
The author
Zsolt Filetoth was born in 1961 and grew up in Hungary. In 1979, after
finishing high school in Budapest, he entered medical school in St Peters-
burg, Russia, where he graduated as an MD in 1985.
In 1985 he became a resident and clinical fellow in infectious disease
and received training in hospital hygiene in Hungary. He organized the
first course in Hungary in hospital-acquired infection for senior nurses and
operating room nurses, which was recognized by the Postgraduate School
for Nurses of Hungary. In 1992 and 1993 he studied basic epidemiology in
the USA at the Centers for Disease Control and Prevention, Atlanta, Geor-
gia, completing courses in Hospital Epidemiology and International
Epidemic Intelligence Services.
In 1995 he studied at the Public Health Laboratory Service, London,
and received individual training in hospital infection control at the Middle-
sex Hospital. In 1998 he was awarded an MSc degree by the University of
London and the Diploma in Communicable Disease Epidemiology by the
London School of Hygiene and Tropical Medicine.
Since 1994 he has been head of the Clinical Epidemiology Department
of the National Institute of Traumatology, Budapest, Hungary. In 1999 he
was appointed as a consultant in infectious disease and epidemiology at the
National Institute of Neurosurgery, Budapest, Hungary.
Professionally, he is interested in the epidemiology of infectious diseases,
especially in the surveillance of nosocomial infections, and in antibiotic
policy. He is practice oriented, collaborating in molecular epidemiology at
the Institute of Medical Microbiology of the Semmelweis University of
Budapest, Hungary. He is an invited lecturer in communicable disease
epidemiology at medical schools throughout Hungary, and has presented
more than 40 lectures in hospital infection control.
vii
Acknowledgements
I should like to express my thanks to people who contributed to my profes-
s.
sional development, to Professor Philip Brachmann at Emory University,
Atlanta, to Barry Cookson at the Public Health Laboratory Service,
London, to Donna Dryer at Parkland Memorial Hospital, Dallas, to all my
teachers at the Centers for Disease Control and Prevention, Atlanta, and
the London School of Hygiene and Tropical Medicine.
Some chapters of this book contain data collected by clinical epidemio-
logical assistants: Fugedi Albert, Ringbauer Zsuzsanna, Ruszin Aniko,
Jakab Zsuzsanna and Zsupos Edit. Many thanks for their contributions.
I really appreciate the help of David Stevens, Michael Howell, Simon
Andrea, KleernC Klement Zsuzsanna, and librarians Almasynt Kovacs
Eva and Maderspack KarolynC in the technical preparation of the manu-
script.
Finally I should like to express my gratitude to Tamasnt Nagy Edit dr,
who was my English language teacher.
Zsolt Filetoth
ix
Preface
Hospital-acquired infection (HAI) is a complication of health care which
affects on average 10% of patients admitted to hospitals worldwide. Such
infections have serious public health implications by changing the quality of
life of patients, and sometimes causing disability or even death. Moreover,
the economic impact of HAI includes not only the cost of the extra time
spent in hospital but also the increased cost to society due to lost working
time, which also has financial implications for the patient and hidher
family. It has been estimated that in the UK alone the annual cost of HAI is
about &2 billion.
Infection control in hospital is an essential component of quality
control in countries with high-quality healthcare. It began in the nine-
teenth century with the work of Florence Nightingale and Ignacz
Semmelweis, who first recognized the importance of HAI. Today, the
sickest patients admitted to hospital are the most susceptible to acquiring
HAI, and the more invasive diagnostic and therapeutic procedures that
they have to undergo increase the risk of opening the gates to further
invasion of germs.
Medical staff must play a key role in the control of HA1 because many
of the procedures they undertake can lead to the development of HA1
and to the transmission of nosocomial germs among patients. Their
active participation is also important for self-defence, as they themselves
can become infected during the care of infected patients.
The purpose of this book is to provide nurses and junior doctors with an
understanding of the basics of infection control by explaining the methods
employed and their purpose. It is based on lectures presented by the author
at training courses for nurses and doctors, and gives simple, understandable
and essential information that is vital knowledge for medical staff in hospitals.
It is intended for both graduate and postgraduate levels.
Xi
Introduction
Hospital acquired infection (HAI) was first described in the nineteenth
century. The antibiotic era, which began in 1929 with the discovery of
penicillin by Fleming, has contributed much to the successful therapy of
many infections. Antibiotics are used for both prophylactic and therapeutic
purposes but they alone are not able to control HAI. Eradication of HAI is
still beyond the scope of medicine, despite its rapid development. Today’s
medicine is more invasive, which increases the risk of the development of
HAI by providing more opportunities for the invasion of germs. Addition-
ally, the proportion of the sickest, immuno-compromised patients has been
increasing in hospitals, and these are at greater risk of acquiring infections.
Many HAIs have been described, and their distribution varies widely.
However, the most ubiquitous are: surgical wound infection, pneumonia,
urinary tract infection, bloodstream infection, device-associated infections
and decubitus, which are explained by the universal occurrence of those
risk factors influencing these most common types of HAI.
Infections in hospitals are dynamic: patients, staff and visitors can
import any kind of infection into hospital, and they can also acquire infec-
tions within hospital and carry infectious agents to other hospitals or into
the community. The term ‘nosocomial infection’ is usually restricted to the
infections that patients acquire in hospital, but has importance in occupa-
tional medicine as well. The development of infections follows certain well-
defined rules, the understanding of which is important for prevention. The
same rules apply to both HAI and infections acquired in the community. In
addition, HA1 have some specificities as they are mainly associated with
invasive medical procedures.
This book is intended to provide a basic introduction to the subject. It
summarizes the main topics that are important to understanding the
xiii