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Hospital Acquired Infection PDF

301 Pages·2002·21.51 MB·English
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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

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Hospital acquired infections (HAI) are complications of health care that affect on average 10 percent of patients admitted to hospitals worldwide. They have serious public health implications by changing the quality of life of patients and sometimes causing disability of even death. The purpose of t
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