Table Of Content

K11161_cover 11/1/11 11:13 AM Page 1 C M Y CM MY CY CMY K ENVIRONMENTAL ENGINEERING K O W A HOSPITAL L S K I AIRBORNE INFECTION H O CONTROL S P I T Although nosocomial, or hospital-acquired, infections have been well cataloged and A are fairly well understood, traditional solutions have failed to completely eliminate the L problem. Even the most modern hospitals find themselves stymied by the persistence A of these pathogens in hospital wards and operating rooms. The degree to which most I of these infections are airborne is not known, but a growing body of evidence indicates R that airborne transmission plays a role in many hospital-acquired infections. B O Addressing one of the most important topics in health care, Hospital Airborne Infection R Control is the first book to deal with the control of airborne nosocomial infections in N detail. It identifies all pathogens known or suspected to be airborne, along with their E sources in hospital environments. It also summarizes all epidemiological evidence for I N airborne transmission. The text addresses respiratory, surgical site, burn wound, immunocompromised, pediatric, nursing home, and non-respiratory infections. In each F E category, an extensive number of examples show that inhalation is not the only airborne C route by which infections may be transmitted. T I Noting that airborne transmission and surface contamination are virtually inseparable, O the author emphasizes that both air and surface disinfection, including hand hygiene, N are important factors in controlling the transmission of airborne disease. He also proposes C a variety of new solutions and technologies, including ultraviolet, ionization, ozone, O plasma, and vegetative air cleaning systems. A compendium of scientific and medical information, this book helps hospitals control nosocomial infections and outbreaks N spread by the airborne route as well as by direct contact and contact with fomites or T contaminated equipment. R O L K11161 WLADYSLAW KOWALSKI 6000 Broken Sound Parkway, NW Suite 300, Boca Raton, FL 33487 711 Third Avenue an informa business New York, NY 10017 www.crcpress.com 2 Park Square, Milton Park www.crcpress.com Abingdon, Oxon OX14 4RN, UK Composite HOSPITAL AIRBORNE INFECTION CONTROL HOSPITAL AIRBORNE INFECTION CONTROL WLADYSLAW KOWALSKI Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2012 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20111020 International Standard Book Number-13: 978-1-4398-2200-5 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information stor- age or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copy- right.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that pro- vides licenses and registration for a variety of users. For organizations that have been granted a pho- tocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com I dedicate this book to all the doctors, nurses, health care workers, scientists, and engineers out there who are working in health care and who are seeking to save lives any way they can. I hope this book makes a small contribution to their understanding of this complex problem. Contents Preface......................................................................................................................xv Acknowledgments..............................................................................................xvii The.Author............................................................................................................xix 1. Airborne Nosocomial Infections..................................................................1 Introduction.......................................................................................................1 Nosocomial.Infection.Epidemiology.............................................................2 Airborne.Nosocomial.Pathogens...................................................................7 Airborne.Infection.Categories........................................................................8 Infection.Control.Precautions.......................................................................10 Infections.in.Health.Care.Workers...............................................................11 Multidrug.Resistance.....................................................................................12 Toward.Airborne.Infection.Control.............................................................13 References........................................................................................................14 2. Airborne Nosocomial Epidemiology.........................................................17 Introduction.....................................................................................................17 Airborne.Transmission.Routes.....................................................................18 Epidemiological.Principles............................................................................19 Dosimetry.of.Airborne.Disease....................................................................22 Survival.of.Microbes.Outside.the.Host.......................................................26 Settling.of.Microbes.in.Air............................................................................28 References........................................................................................................30 3. Hospital Aerobiology....................................................................................33 Introduction.....................................................................................................33 Airborne.Levels.of.Bacteria...........................................................................34 Airborne.Levels.of.Fungal.Spores................................................................36 Airborne.Virus.Levels....................................................................................37 References........................................................................................................38 4. Airborne Nosocomial Microorganisms....................................................41 Introduction.....................................................................................................41 Airborne.Nosocomial.Pathogens.................................................................41 Airborne.Nosocomial.Bacteria.....................................................................46 Airborne.Nosocomial.Viruses......................................................................47 Airborne.Nosocomial.Fungi.........................................................................48 Database.of.Airborne.Nosocomial.Pathogens............................................49 Acinetobacter:.Noncontagious.Bacteria—Airborne.Class.2...................49 Adenovirus:.Communicable.Virus—Airborne.Class.2........................49 vii viii Contents Alcaligenes:.Noncontagious.Bacteria—Airborne.Class.2......................50 Alternaria alternata:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................50 Aspergillus:.Noncontagious.Fungal.Spore—Airborne.Class.1.............51 Blastomyces dermatitidis:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................51 Bordetella pertussis:.Communicable.Bacteria—Airborne.Class.1.........51 Clostridium difficile:.Noncontagious.Bacterial.Spore— Airborne.Class.1.........................................................................................52 Clostridium perfringens:.Noncontagious.Bacterial.Spore— Airborne.Class.2.........................................................................................53 Coccidioides immitis:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................53 Coronavirus:.Communicable.Virus—Airborne.Class.1.......................53 Corynebacterium diphtheriae:.Contagious.Bacteria—. Airborne.Class.2.....................................................................................54 Coxsackievirus:.Communicable.Virus—Airborne.Class.2..................54 Cryptococcus neoformans:.Noncontagious.Fungal.Yeast— Airborne.Class.2.........................................................................................55 Enterobacter cloacae:.Noncontagious.Bacteria—Airborne.Class.2........55 Enterococcus.(VRE):.Communicable.Bacteria—Airborne.Class.2........55 Fugomyces cyanescens:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................56 Fusarium:.Noncontagious.Fungal.Spore—Airborne.Class.2................57 Haemophilus influenzae:.Communicable.Bacteria— Airborne.Class.2.....................................................................................57 Haemophilus parainfluenzae:.Communicable.Bacteria— Airborne.Class.2.........................................................................................57 Histoplasma capsulatum:.Noncontagious.Fungal.Spore— Airborne.Class.1.........................................................................................58 Influenza.A.Virus:.Contagious.Virus—Airborne.Class.1....................58 Klebsiella pneumoniae:.Communicable.Bacteria—..... Airborne.Class.2.........................................................................................59 Legionella pneumophila:.Noncontagious.Bacteria—... Airborne.Class.1.........................................................................................60 Measles.Virus:.Contagious.Virus—Airborne.Class.1...........................60 Mucor:.Noncontagious.Fungal.Spore—Airborne.Class.2....................61 Mumps.Virus:.Contagious.Virus—Airborne.Class.1...........................61 Mycobacterium avium:.Contagious.Bacteria—Airborne.Class.2...........62 Mycobacterium tuberculosis:.Contagious.Bacteria—... Airborne.Class.1.........................................................................................62 Mycoplasma pneumoniae:.Communicable.Bacteria— Airborne.Class.2.........................................................................................63 Neisseria meningitides:.Communicable.Bacteria—..... Airborne.Class.2.........................................................................................63 Contents ix Nocardia asteroides:.Noncontagious.Bacterial.Spore— Airborne.Class.2.........................................................................................64 Norwalk.Virus:.Contagious.Virus—Airborne.Class.1.........................64 Parainfluenza.Virus:.Contagious.Virus—Airborne.Class.2................64 Parvovirus.B19:.Contagious.Virus—Airborne.Class.2.........................65 Penicillium:.Noncontagious.Fungal.Spore—Airborne.Class.2.............65 Pneumocystis jirovecii:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................66 Proteus mirabilis:.Noncontagious.Bacteria—Airborne.Class.2.............66 Pseudallescheria boydii:.Noncontagious.Fungal.Yeast— Airborne.Class.2.........................................................................................67 Pseudomonas aeruginosa:.Noncontagious.Bacteria—. Airborne.Class.1.......................................................................................67 Reovirus:.Contagious.Virus—Airborne.Class.2....................................68 Respiratory.Syncytial.Virus.(RSV):.Contagious.Virus— Airborne.Class.1.........................................................................................68 Rhinovirus:.Contagious.Virus—Airborne.Class.2................................69 Rhizopus:.Noncontagious.Fungal.Spore—Airborne.Class.2................69 Rotavirus:.Contagious.Virus—Airborne.Class.2..................................70 Rubella.Virus:.Contagious.Virus—Airborne.Class.1...........................70 Scedosporium:.Noncontagious.Fungal.Spore—Airborne.Class.2.........71 Serratia marcescens:.Noncontagious.Bacteria—Airborne.Class.2.........71 Staphylococcus aureus.(MRSA):.Communicable.Bacteria— Airborne.Class.1.........................................................................................72 Staphylococcus epidermis:.Communicable.Bacteria— Airborne.Class.2.........................................................................................73 Streptococcus pneumoniae:.Communicable.Bacteria— Airborne.Class.2.........................................................................................74 Streptococcus pyogenes:.Communicable.Bacteria—.... Airborne.Class.1.........................................................................................74 Trichosporon:.Noncontagious.Fungal.Yeast—Airborne.Class.2...........75 Varicella-Zoster.Virus:.Contagious.Virus—Airborne.Class.1.............75 References........................................................................................................76 5. Airborne Nosocomial Etiology...................................................................83 Introduction.....................................................................................................83 Pathogen.Aerosolization................................................................................84 Aerobiological.Pathways................................................................................86 Airborne.Transmission.of.Respiratory.Infections.....................................87 Airborne.Transport.of.Fungal.Spores..........................................................88 Shedding.of.Bacteria.......................................................................................89 Shedding.of.Clostridium difficile.Spores........................................................90 References........................................................................................................90

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Although nosocomial, or hospital-acquired, infections have been well cataloged and are fairly well understood, traditional solutions have failed to completely eliminate the problem. Even the most modern hospitals find themselves stymied by the persistence of these pathogens in hospital wards and ope
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by  Wladyslaw Kowalski
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K11161_cover 11/1/11 11:13 AM Page 1 C M Y CM MY CY CMY K ENVIRONMENTAL ENGINEERING K O W A HOSPITAL L S K I AIRBORNE INFECTION H O CONTROL S P I T Although nosocomial, or hospital-acquired, infections have been well cataloged and A are fairly well understood, traditional solutions have failed to completely eliminate the L problem. Even the most modern hospitals find themselves stymied by the persistence A of these pathogens in hospital wards and operating rooms. The degree to which most I of these infections are airborne is not known, but a growing body of evidence indicates R that airborne transmission plays a role in many hospital-acquired infections. B O Addressing one of the most important topics in health care, Hospital Airborne Infection R Control is the first book to deal with the control of airborne nosocomial infections in N detail. It identifies all pathogens known or suspected to be airborne, along with their E sources in hospital environments. It also summarizes all epidemiological evidence for I N airborne transmission. The text addresses respiratory, surgical site, burn wound, immunocompromised, pediatric, nursing home, and non-respiratory infections. In each F E category, an extensive number of examples show that inhalation is not the only airborne C route by which infections may be transmitted. T I Noting that airborne transmission and surface contamination are virtually inseparable, O the author emphasizes that both air and surface disinfection, including hand hygiene, N are important factors in controlling the transmission of airborne disease. He also proposes C a variety of new solutions and technologies, including ultraviolet, ionization, ozone, O plasma, and vegetative air cleaning systems. A compendium of scientific and medical information, this book helps hospitals control nosocomial infections and outbreaks N spread by the airborne route as well as by direct contact and contact with fomites or T contaminated equipment. R O L K11161 WLADYSLAW KOWALSKI 6000 Broken Sound Parkway, NW Suite 300, Boca Raton, FL 33487 711 Third Avenue an informa business New York, NY 10017 www.crcpress.com 2 Park Square, Milton Park www.crcpress.com Abingdon, Oxon OX14 4RN, UK Composite HOSPITAL AIRBORNE INFECTION CONTROL HOSPITAL AIRBORNE INFECTION CONTROL WLADYSLAW KOWALSKI Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2012 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20111020 International Standard Book Number-13: 978-1-4398-2200-5 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information stor- age or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copy- right.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that pro- vides licenses and registration for a variety of users. For organizations that have been granted a pho- tocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com I dedicate this book to all the doctors, nurses, health care workers, scientists, and engineers out there who are working in health care and who are seeking to save lives any way they can. I hope this book makes a small contribution to their understanding of this complex problem. Contents Preface......................................................................................................................xv Acknowledgments..............................................................................................xvii The.Author............................................................................................................xix 1. Airborne Nosocomial Infections..................................................................1 Introduction.......................................................................................................1 Nosocomial.Infection.Epidemiology.............................................................2 Airborne.Nosocomial.Pathogens...................................................................7 Airborne.Infection.Categories........................................................................8 Infection.Control.Precautions.......................................................................10 Infections.in.Health.Care.Workers...............................................................11 Multidrug.Resistance.....................................................................................12 Toward.Airborne.Infection.Control.............................................................13 References........................................................................................................14 2. Airborne Nosocomial Epidemiology.........................................................17 Introduction.....................................................................................................17 Airborne.Transmission.Routes.....................................................................18 Epidemiological.Principles............................................................................19 Dosimetry.of.Airborne.Disease....................................................................22 Survival.of.Microbes.Outside.the.Host.......................................................26 Settling.of.Microbes.in.Air............................................................................28 References........................................................................................................30 3. Hospital Aerobiology....................................................................................33 Introduction.....................................................................................................33 Airborne.Levels.of.Bacteria...........................................................................34 Airborne.Levels.of.Fungal.Spores................................................................36 Airborne.Virus.Levels....................................................................................37 References........................................................................................................38 4. Airborne Nosocomial Microorganisms....................................................41 Introduction.....................................................................................................41 Airborne.Nosocomial.Pathogens.................................................................41 Airborne.Nosocomial.Bacteria.....................................................................46 Airborne.Nosocomial.Viruses......................................................................47 Airborne.Nosocomial.Fungi.........................................................................48 Database.of.Airborne.Nosocomial.Pathogens............................................49 Acinetobacter:.Noncontagious.Bacteria—Airborne.Class.2...................49 Adenovirus:.Communicable.Virus—Airborne.Class.2........................49 vii viii Contents Alcaligenes:.Noncontagious.Bacteria—Airborne.Class.2......................50 Alternaria alternata:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................50 Aspergillus:.Noncontagious.Fungal.Spore—Airborne.Class.1.............51 Blastomyces dermatitidis:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................51 Bordetella pertussis:.Communicable.Bacteria—Airborne.Class.1.........51 Clostridium difficile:.Noncontagious.Bacterial.Spore— Airborne.Class.1.........................................................................................52 Clostridium perfringens:.Noncontagious.Bacterial.Spore— Airborne.Class.2.........................................................................................53 Coccidioides immitis:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................53 Coronavirus:.Communicable.Virus—Airborne.Class.1.......................53 Corynebacterium diphtheriae:.Contagious.Bacteria—. Airborne.Class.2.....................................................................................54 Coxsackievirus:.Communicable.Virus—Airborne.Class.2..................54 Cryptococcus neoformans:.Noncontagious.Fungal.Yeast— Airborne.Class.2.........................................................................................55 Enterobacter cloacae:.Noncontagious.Bacteria—Airborne.Class.2........55 Enterococcus.(VRE):.Communicable.Bacteria—Airborne.Class.2........55 Fugomyces cyanescens:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................56 Fusarium:.Noncontagious.Fungal.Spore—Airborne.Class.2................57 Haemophilus influenzae:.Communicable.Bacteria— Airborne.Class.2.....................................................................................57 Haemophilus parainfluenzae:.Communicable.Bacteria— Airborne.Class.2.........................................................................................57 Histoplasma capsulatum:.Noncontagious.Fungal.Spore— Airborne.Class.1.........................................................................................58 Influenza.A.Virus:.Contagious.Virus—Airborne.Class.1....................58 Klebsiella pneumoniae:.Communicable.Bacteria—..... Airborne.Class.2.........................................................................................59 Legionella pneumophila:.Noncontagious.Bacteria—... Airborne.Class.1.........................................................................................60 Measles.Virus:.Contagious.Virus—Airborne.Class.1...........................60 Mucor:.Noncontagious.Fungal.Spore—Airborne.Class.2....................61 Mumps.Virus:.Contagious.Virus—Airborne.Class.1...........................61 Mycobacterium avium:.Contagious.Bacteria—Airborne.Class.2...........62 Mycobacterium tuberculosis:.Contagious.Bacteria—... Airborne.Class.1.........................................................................................62 Mycoplasma pneumoniae:.Communicable.Bacteria— Airborne.Class.2.........................................................................................63 Neisseria meningitides:.Communicable.Bacteria—..... Airborne.Class.2.........................................................................................63 Contents ix Nocardia asteroides:.Noncontagious.Bacterial.Spore— Airborne.Class.2.........................................................................................64 Norwalk.Virus:.Contagious.Virus—Airborne.Class.1.........................64 Parainfluenza.Virus:.Contagious.Virus—Airborne.Class.2................64 Parvovirus.B19:.Contagious.Virus—Airborne.Class.2.........................65 Penicillium:.Noncontagious.Fungal.Spore—Airborne.Class.2.............65 Pneumocystis jirovecii:.Noncontagious.Fungal.Spore— Airborne.Class.2.........................................................................................66 Proteus mirabilis:.Noncontagious.Bacteria—Airborne.Class.2.............66 Pseudallescheria boydii:.Noncontagious.Fungal.Yeast— Airborne.Class.2.........................................................................................67 Pseudomonas aeruginosa:.Noncontagious.Bacteria—. Airborne.Class.1.......................................................................................67 Reovirus:.Contagious.Virus—Airborne.Class.2....................................68 Respiratory.Syncytial.Virus.(RSV):.Contagious.Virus— Airborne.Class.1.........................................................................................68 Rhinovirus:.Contagious.Virus—Airborne.Class.2................................69 Rhizopus:.Noncontagious.Fungal.Spore—Airborne.Class.2................69 Rotavirus:.Contagious.Virus—Airborne.Class.2..................................70 Rubella.Virus:.Contagious.Virus—Airborne.Class.1...........................70 Scedosporium:.Noncontagious.Fungal.Spore—Airborne.Class.2.........71 Serratia marcescens:.Noncontagious.Bacteria—Airborne.Class.2.........71 Staphylococcus aureus.(MRSA):.Communicable.Bacteria— Airborne.Class.1.........................................................................................72 Staphylococcus epidermis:.Communicable.Bacteria— Airborne.Class.2.........................................................................................73 Streptococcus pneumoniae:.Communicable.Bacteria— Airborne.Class.2.........................................................................................74 Streptococcus pyogenes:.Communicable.Bacteria—.... Airborne.Class.1.........................................................................................74 Trichosporon:.Noncontagious.Fungal.Yeast—Airborne.Class.2...........75 Varicella-Zoster.Virus:.Contagious.Virus—Airborne.Class.1.............75 References........................................................................................................76 5. Airborne Nosocomial Etiology...................................................................83 Introduction.....................................................................................................83 Pathogen.Aerosolization................................................................................84 Aerobiological.Pathways................................................................................86 Airborne.Transmission.of.Respiratory.Infections.....................................87 Airborne.Transport.of.Fungal.Spores..........................................................88 Shedding.of.Bacteria.......................................................................................89 Shedding.of.Clostridium difficile.Spores........................................................90 References........................................................................................................90

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Although nosocomial, or hospital-acquired, infections have been well cataloged and are fairly well understood, traditional solutions have failed to completely eliminate the problem. Even the most modern hospitals find themselves stymied by the persistence of these pathogens in hospital wards and ope
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