Prevention and Control of Infections in Hospitals: Practice and Theory

1090 Pages·2019·15.76 MB·English

by  Bjørg Marit Andersen

Prevention and
Control of Infections

in Hospitals
Practice and Theory
Bjørg Marit Andersen
123
Prevention and Control of Infections
in Hospitals
Bjørg Marit Andersen
Prevention and Control
of Infections in Hospitals
Practice and Theory
Bjørg Marit Andersen
Department of Hospital Infections
Oslo University Hospital
Oslo
Norway
Faculty of Health and Social Science
University of South-Eastern Norway
Oslo
Norway
Original Norwegian edition published by Elefantus Forlag, Moss, 2016
ISBN 978-3-319-99920-3 ISBN 978-3-319-99921-0 (eBook)
https://doi.org/10.1007/978-3-319-99921-0
Library of Congress Control Number: 2018963171
© Springer Nature Switzerland AG 2016, 2019
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does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
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Preface
Prevention and Control of Infections in Hospitals: Practice and Theory deal with
infection control, surveillance and hygienic routines and key topics, both practical
and theoretical. The book is adapted to a necessary level of infection prevention to
cope with today’s emerging and resistant microbes, hygienic challenges and emer-
gency preparedness in practical work. It updates current knowledge about infection
protection as basic for selecting routines and guidelines to prevent hospital
infections.
Healthcare-associated infection (HAI) is primarily a patient safety issue, causing
more than 90% of patient injuries. Leaders at all levels in the healthcare system are
responsible for patient safety and infection control, from the director of the hospital
to the health minister and government, and this should be warranted by law. Lack of
management is associated with overcrowding, understaffing, corridor-beds, poor
maintenance of buildings and equipment, inadequate cleaning and basic hygienic
measures which often lead to HAIs. Hospital infections may occur in 5–20% or
more of hospitalized patients. In Europe, at least 7.5 million patients acquire HAI
each year, and more than 147,000 patients die directly or indirectly from HAIs each
year in European hospitals.
Hospital infections are detected more often after discharge, due to shorter and
shorter stay in hospitals. This may lead to spread of resistant bacteria between
healthcare levels and less favourable outcome for the patient with infection. Virus
like influenza and norovirus follow the patient and may spread like “fire in dry
grass”. Entire departments with patients and personnel will be “sick-reported” and
must shut down all activity for 2–3 weeks.
The spread of resistant and/or particularly pathogenic, contagious microbes
poses a risk to patients, employees, visitors and society as a whole. Dangerous
microbes often have a global spread pattern, which requires continuous readiness
with effective, limiting measures against epidemics or pandemics.
The book is focused on practical measures against severe hospital infections
such as postoperative wound infections; intravascular, blood-borne infections;
infections in lower respiratory tract, urinary tract, skin and gastrointestinal tract; and
infections in neonates and premature and in other patients with impaired infection
defence.
A good hygiene is important to protect patients, visitors and employees against
infections. Good hygiene routines, personal infection protection, cleanliness, textile
v
vi Preface
treatment, sterility, disinfection and high professional hygiene standards for patient
care increase patient safety and protect the working environment. Daily infection
surveillance, infection detection and adequate contraceptive measures and informa-
tion are required to stop the spread of infection.
The book is intended to be an aid and an optimal standard in practical work to
reduce the incidence of serious hospital infections and spread of infection. This
increases the quality of patient treatment; patient safety is better taken care of, and
infection control becomes a natural part of measures around hospital patients and
employees.
Prevention and Control of Infections in Hospitals: Practice and Theory is
updated from earlier (1996, 1999, 2003, 2008, 2016) Norwegian handbooks in
infection control, lastly published in 2016 (Elefantus forlag, Moss). Each chapter
has a practical part and a background information and documentation part.
Thanks to the following colleagues for professional advises and comments:
Infection control nurses, Mette Rasch and Kjersti Hochlin; chief physician, Kjell
Olafsen; and professor in medicine, PhD, Inggard Lereim.
In addition, I am grateful to my family, friends and colleagues for friendly assis-
tance and positive support during the writing period. However, my greatest and
most enthusiastic fan, my dog, Tito, left forever in May 2018.
Target groups: health professionals; doctors, nurses and other health profession-
als; students in health-related subjects, hospital leaders and health agencies; and
patients and their relatives.
Oslo, Norway Bjørg Marit Andersen
June 2018
Contents
Part I I ntroduction (Surveillance, Microbes and Pathways,
Tracing and Preventing)
1 Patient Protection Is Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Lack of Leader Competence and Responsibility . . . . . . . . . . . . . . . 4
1.2 Hospital Organization Is Important for Hospital
Infections and Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3 A Future for Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2 Hospital Infections: Surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.1 Prevalence and Incidence Surveillance of HAI . . . . . . . . . . . . . . . . 13
2.2 Effect of Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.3 The Burden of Healthcare-Associated Infections . . . . . . . . . . . . . . 18
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3 Microbes, Transmission Routes and Survival Outside the Body . . . . 23
3.1 Microbes are Mostly Normal, Nonpathogenic Flora . . . . . . . . . . . . 23
3.2 Pathogenic Microbes: New and Old . . . . . . . . . . . . . . . . . . . . . . . . 24
3.3 Transmission Routes: Spread of Infection . . . . . . . . . . . . . . . . . . . . 24
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
4 Antibacterial Agents and Drug Resistance . . . . . . . . . . . . . . . . . . . . . . 29
4.1 Antimicrobials: Sensitivity and Resistance . . . . . . . . . . . . . . . . . . . 30
4.2 Reasons for Resistance Development . . . . . . . . . . . . . . . . . . . . . . . 31
4.3 Multidrug-Resistant Organisms (MDRO)
Are Worldwide Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
4.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
5 Tracing and Preventing Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
5.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
vii
viii Contents
5.6 Notification and Warning on Suspected Infection
and Dissemination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Part II I nfection Control for Health Care Workers
6 Staff Uniforms and Uniform Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
6.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
6.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
6.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
6.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
6.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7 Vaccination and Control of Employees . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
7.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
7.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
7.5 Hepatitis A/B vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
7.6 Polio Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
7.7 Influenza Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
7.8 Rubella Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
7.9 Varicella Zoster Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
7.10 Mumps Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
7.11 Measles Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
7.12 Other Viral Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
7.13 Diphtheria and Tetanus Vaccines: Duo-Vaccines—Optionally
Including Pertussis (Tdap) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
7.14 Pertussis Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
7.15 Pneumococcal Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
7.16 Haemophilus Influenzae Type B Vaccine . . . . . . . . . . . . . . . . . . . . . 77
7.17 Meningococcal Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
7.18 BCG Vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
7.19 Other Bacterial Vaccines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
7.20 Vaccine Combinations to Children . . . . . . . . . . . . . . . . . . . . . . . . . 78
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
8 Employees with Infections or Carrier Status . . . . . . . . . . . . . . . . . . . . 79
8.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
8.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
8.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
8.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
8.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
8.6 Actual Infections or Carrier State . . . . . . . . . . . . . . . . . . . . . . . . . . 81
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Contents ix
9 Pregnant Employee Exposed to Infection . . . . . . . . . . . . . . . . . . . . . . . 87
9.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
9.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
9.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
9.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
9.5 Basic Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
10 Tuberculosis: Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
10.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
10.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
10.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
10.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
10.5 Basic Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
11 Accidents with Blood or Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
11.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
11.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
11.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
11.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
11.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
11.6 Occupation-Associated Blood-Borne Infection and Disease . . . . . 106
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
12 Hand Hygiene and Glove Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
12.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
12.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
12.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
12.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
12.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
13 Protection of Upper Respiratory Tract, Mouth and Eyes . . . . . . . . . . 129
13.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
13.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
13.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
13.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
13.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
13.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Part III Isolation
14 Microbes, Transmission and Protection . . . . . . . . . . . . . . . . . . . . . . . . 149
14.1 Isolation at Risk of Spread of Infection . . . . . . . . . . . . . . . . . . . . . 149
x Contents
15 General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
15.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
15.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
15.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
15.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
15.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
16 Contact Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
16.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
16.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
16.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
16.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
16.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
17 Blood-Borne Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
17.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
17.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
17.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
17.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
17.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
18 Airborne/Droplet Infection Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . 187
18.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
18.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
18.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
18.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
18.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
19 Strict Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
19.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
19.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
19.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
19.4 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
19.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
19.6 Strict Isolation Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
20 Protective Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
20.1 Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
20.2 Comprise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
20.3 Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
20.4 Protective Isolation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
20.5 Background Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
20.6 Practical Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221