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El. knyga: Decontamination in Hospitals and Healthcare

Edited by (Former Scientific Leader in Water Microbiology and Decontamination, Public Health England (PHE), Porton, UK)
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Decontamination in Hospitals and Healthcare, Second Edition, enables users to obtain detailed knowledge of decontamination practices in healthcare settings, including surfaces, devices, clothing and people, with a specific focus on hospitals and dental clinics.

  • Offers in-depth coverage of all aspects of decontamination in healthcare
  • Examines the decontamination of surgical equipment and endoscopes
  • Expanded to include new information on behavioral principles in decontamination, control of microbiological problems, waterborne microorganisms, pseudomonas and the decontamination of laundry
Contributors xiii
Acknowledgments and dedication xvii
Obituary xix
1 The importance of decontamination in hospitals and healthcare
1(24)
J.T. Walker
1.1 Introduction
1(1)
1.2 Microbial resistance and infection control
2(4)
1.3 Maintaining safe water provision
6(2)
1.4 Issues of prion transmissibility in healthcare
8(6)
1.5 Emerging infections
14(1)
1.6 Conclusion
15(1)
References
15(10)
2 The history of decontamination in hospitals
25(20)
S.W.B. Newsom
G.L. Ridgway
2.1 Introduction
25(1)
2.2 Healthcare-acquired infection
26(2)
2.3 Key figures in decontamination control
28(3)
2.4 Heat for sterilization and disinfection
31(7)
2.5 Chemical disinfectants
38(2)
2.6 Testing disinfectant activity
40(1)
2.7 European medical devices directives
41(1)
2.8 Incidents of contamination as a result of human error
42(1)
2.9 Conclusion
43(1)
Acknowledgments
43(1)
References
43(1)
Further reading
44(1)
3 Quality and supply of water used in hospitals
45(26)
E. Maynard
C. Whapham
3.1 Introduction
45(2)
3.2 Compliance in the healthcare environment
47(2)
3.3 Water treatment and water purification technology
49(9)
3.4 Water quality monitoring
58(1)
3.5 Specialist departments and their unique requirements for water quality control
59(1)
3.6 Sustainability and conservation in healthcare water management
59(1)
3.7 Conclusion and future trends
60(1)
References
61(8)
Further reading
69(2)
4 Control of Legionella in hospital potable water systems
71(30)
J.L. Baron
L. Morris
J.E. Stout
4.1 Introduction
71(2)
4.2 Systemic disinfection methods
73(11)
4.3 Emergency disinfection methods
84(1)
4.4 Selection and validation of disinfection method
84(4)
4.5 Regulatory requirements, standards, and guidelines
88(2)
4.6 Conclusion
90(1)
References
90(11)
5 Waterborne transmission of Pseudomonas aeruginosa
101(14)
M. Garvey
C. McMurray
E. Holden
J. T. Walker
5.1 Pseudomonas aeruginosa
101(1)
5.2 P. aeruginosa microbiology and pathogenicity
101(1)
5.3 Epidemiology and infections
102(1)
5.4 Environmental reservoir and nosocomial outbreaks
103(1)
5.5 What clinical settings and patient populations are affected by P. aeruginosa?
104(1)
5.6 What are the potential sources of P. aeruginosa within hospitals?
104(2)
5.7 What are the potential transmission routes for P. aeruginosa outbreaks?
106(1)
5.8 What control measures can be implemented to stop P. aeruginosa outbreaks?
107(1)
5.9 Infection prevention measures
107(3)
5.10 Conclusion
110(1)
References
110(5)
6 Mycobacteria chimaera infections and their transmission from heater-cooler units
115(20)
J.T. Walker
6.1 Introduction and background
115(1)
6.2 Waterborne nontuberculous mycobacteria (NTM)
115(2)
6.3 NTM transmission routes
117(1)
6.4 What is a heater cooler device?
118(1)
6.5 How are waterborne pathogens able to grow within HCUs?
118(3)
6.6 How was M. chimaera transmitted from the HCU to the patients?
121(1)
6.7 Clinical features and diagnosis
122(1)
6.8 Manufacturer's instructions for the decontamination of microorganisms in HCUs
123(1)
6.9 Compatibility of manufacturer's equipment
124(1)
6.10 Decontamination, containment, or relocation of HCUs
125(1)
6.11 Implications for ECMO equipment
126(1)
6.12 Summary
127(1)
References
127(8)
7 Decontamination of hand washbasins and traps in hospitals
135(28)
D.C. Coleman
E.C. Deasy
E.M. Moloney
J.S. Swan
M.J. O'Donnell
7.1 Water and wastewater networks in healthcare facilities
135(2)
7.2 Hand washbasins in the healthcare environment
137(4)
7.3 Nosocomial infection associated with washbasin traps
141(1)
7.4 Approaches used to minimize contamination of washbasin traps
142(11)
7.5 Cleaning of hand washbasins
153(1)
7.6 Outlook
154(1)
References
154(9)
8 Infection control in Europe
163(28)
S. Brusaferro
8.1 Introduction
163(2)
8.2 Data available in Europe
165(4)
8.3 Standards for structures and organizations
169(11)
8.4 Training of personnel
180(4)
8.5 Conclusion and future trends
184(1)
Acknowledgments
185(1)
Appendix: Abbreviations
186(1)
References
186(5)
9 The role of the nurse in decontamination
191(18)
R. Gallagher
9.1 Introduction
191(1)
9.2 Regulatory standards and decontamination
191(1)
9.3 Key principles
192(1)
9.4 Challenges associated with nursing and decontamination of the patient care environment
193(4)
9.5 Provision of cleaning services
197(1)
9.6 Management of cleaning services
198(5)
9.7 Decontamination of patient equipment
203(3)
9.8 Conclusion
206(1)
9.9 Sources of further information and advice
207(1)
References
207(1)
Further reading
208(1)
10 The role of protective clothing in healthcare and its decontamination
209(18)
K. Laird
L. Owen
10.1 Introduction
209(2)
10.2 Disposable clothing
211(2)
10.3 Reusable clothing
213(1)
10.4 Microbiology
214(4)
10.5 Cleansing and disposal
218(3)
10.6 Conclusions and future trends
221(1)
References
222(4)
Further reading
226(1)
11 Cleaning and decontamination of the healthcare environment
227(14)
L. Hall
B.G. Mitchell
11.1 Introduction
227(1)
11.2 Pathogens survive in the healthcare environment
227(1)
11.3 Evidence that contaminated surfaces contribute to transmission of hospital pathogens
228(1)
11.4 Key components of a successful environmental cleaning program
229(6)
11.5 Conclusion
235(1)
References
235(6)
12 Biocides and decontamination agents including sporicides for decontamination in hospitals
241(18)
E.S. Gilchrist
P.J. Collier
12.1 Introduction
241(3)
12.2 Currently available biocides and sporicides for use in healthcare and their limitations
244(4)
12.3 Testing standards for actives and sporicides
248(5)
12.4 Incidence of resistance and risk to the hospital patient
253(1)
12.5 Strengths/weaknesses of different disinfectants for a range of microorganisms
254(1)
12.6 Future trends
255(1)
12.7 Sources of further information and advice
256(1)
References
256(3)
13 The role of antimicrobial surfaces in hospitals to reduce healthcare-associated infections (HAIs)
259(42)
M.G. Schmidt
13.1 Introduction
259(1)
13.2 Relevance of the built environment to HAIs
260(2)
13.3 Antimicrobial surfaces
262(1)
13.4 Antiadhesive surfaces
262(3)
13.5 Nature inspired antifouling surfaces
265(3)
13.6 Nature inspired antibacterial surfaces
268(1)
13.7 Antimicrobial coatings
269(1)
13.8 Antimicrobial coatings---Triclosan
269(3)
13.9 Antimicrobial coatings---Utility of bacteriophages
272(2)
13.10 Antimicrobial coatings---Silver surfaces
274(5)
13.11 Light-activated antimicrobial surfaces
279(2)
13.12 Antimicrobial coatings---Copper surfaces
281(5)
13.13 Continuous microbial debulking of the environment mitigates HAI risk
286(1)
13.14 Perspectives---A role for antimicrobial surfaces in hospitals to reduce hospital-acquired infections
287(1)
References
288(11)
Further reading
299(2)
14 Use of gaseous decontamination technologies for wards and isolation rooms in hospitals and healthcare settings
301(22)
T. Pottage
J. T. Walker
14.1 Introduction
301(2)
14.2 Challenges and considerations for gaseous decontamination in a healthcare setting
303(6)
14.3 Validation methods to determine efficacy
309(3)
14.4 Practical use of gaseous decontamination in hospitals
312(5)
14.5 Conclusion and future trends
317(1)
14.6 Sources of further information and advice
318(1)
References
318(5)
15 An overview of automated room disinfection systems: When to use them and how to choose them
323(48)
J.A. Otter
S. Yezli
F. Barbut
T.M. Perl
15.1 Introduction
323(1)
15.2 Why consider an ARD system?
323(2)
15.3 What level of surface contamination is a risk for transmission?
325(1)
15.4 Limitations of conventional cleaning and disinfection
326(2)
15.5 Overview of ARD systems
328(25)
15.6 When to consider an ARD system
353(2)
15.7 Using, validating, and regulating ARD systems
355(2)
15.8 Sources of further information and advice
357(1)
15.9 Future trends
357(1)
15.10 Conclusions
358(1)
References
358(13)
16 Testing strategies and international standards for disinfectants
371(6)
C. Woodall
16.1 Introduction
371(1)
16.2 Selecting the standards to test against
372(1)
16.3 Design of test procedures
372(1)
16.4 Measuring different applications of disinfectants. Surface, hand, instrument, mechanical action, and zonal disinfection
373(1)
16.5 Europe, Middle East, Africa, and the rest of the world
373(1)
16.6 USA and the Americas
374(1)
16.7 OECD
374(1)
16.8 Canada
374(1)
16.9 Australia
375(1)
16.10 China and India
375(1)
References
375(2)
17 The role of standards in decontamination
377(18)
R. Bancroft
17.1 Introduction
377(1)
17.2 Relationship of standards to law and guidance
377(3)
17.3 Key aims and principles of standards
380(1)
17.4 Types of standards
380(1)
17.5 Vienna agreement
381(1)
17.6 European standards
381(1)
17.7 International standards
382(1)
17.8 How standards are drafted
383(2)
17.9 How to read and understand a standard
385(2)
17.10 Accessing the most relevant standards and guidance documents
387(1)
17.11 Conclusion and future trends
387(1)
Sources of further information and advice
388(1)
Appendix 1 Standards in decontamination
388(5)
References
393(2)
18 Decontamination of prions
395(24)
G. McDonnell
E. Comoy
18.1 Introduction
395(1)
18.2 Prion diseases: Transmissible spongiform encephalopathies (TSEs)
395(2)
18.3 What are prions?
397(1)
18.4 Clinical transmission risks
398(2)
18.5 Decontamination investigations
400(11)
18.6 Future perspectives
411(1)
References
412(6)
Further reading
418(1)
19 Decontamination of dental devices in the hospital and general dental practice setting
419(24)
A. Smith
19.1 Introduction
419(1)
19.2 Historic background of dental surgery
420(1)
19.3 Evidence of infections associated with dentistry
420(1)
19.4 The role of vCJD in raising standards
421(3)
19.5 Challenges associated with dental instrument decontamination
424(2)
19.6 Instrument decontamination processes for dental surgery
426(3)
19.7 Centralization of dental instrument reprocessing
429(3)
19.8 Quality management systems
432(4)
19.9 Future trends
436(1)
19.10 Conclusion
437(1)
19.11 Sources of further information and advice
437(1)
References
438(4)
Further reading
442(1)
20 An overview of current surgical instrument and other medical device decontamination practices
443(40)
S. Holmes
20.1 Introduction and background to central decontamination units (CDUs)
443(1)
20.2 Purpose of decontamination practice of surgical instruments in CDUs
444(2)
20.3 Current regulations, standards, and guidance
446(11)
20.4 Risk minimization strategy
457(2)
20.5 Decontamination process
459(10)
20.6 Activities impacting on the decontamination process and the quality of sterile instruments
469(3)
20.7 Future trends
472(2)
References
474(8)
Further reading
482(1)
21 Efficacy of current and novel cleaning technologies (ProReveal) for assessing protein contamination on surgical instruments
483(20)
D. Perrett
N.K. Nayuni
21.1 Introduction
483(3)
21.2 General principles of protein detection
486(1)
21.3 Current general methods of protein detection (ninhydrin, Biuret, dyes): Sensitivity, specificity, and validation
487(4)
21.4 Methods of protein detection based on fluorescence
491(7)
21.5 Other possible technologies
498(1)
21.6 Strengths and weaknesses of new technologies
498(2)
21.7 Conclusion
500(1)
References
500(3)
22 Decontamination of flexible endoscopes
503(16)
P. Hoffman
22.1 Types of endoscopes
503(1)
22.2 Structure of endoscopes
503(1)
22.3 Risk assessment
504(2)
22.4 Flexible endoscope decontamination
506(1)
22.5 Decontamination process
506(2)
22.6 Decontamination of duodenoscopes
508(1)
22.7 Rinse water
509(1)
22.8 EWD selection
510(1)
22.9 Testing
510(1)
22.10 Endoscopy accessories
511(1)
22.11 Tracking and traceability
511(1)
22.12 Documentation
512(1)
22.13 Staff training
512(1)
22.14 Extrinsic recontamination
512(1)
22.15 Intrinsic recontamination
513(1)
22.16 Storage of endoscopes
513(1)
22.17 Design of decontamination facilities
514(3)
22.18 Reasons for decontamination failure
517(1)
References
517(2)
23 Sterilization of flexible endoscopes
519(12)
M. Mikhail
T. Young
23.1 Introduction: Key principles of sterilizing flexible endoscopes
519(1)
23.2 Why sterilize flexible endoscopes?
520(1)
23.3 Problems associated with sterilization of flexible endoscopes
521(1)
23.4 Methods used in the sterilization of endoscopes
522(3)
23.5 Testing effectiveness and application of standards
525(1)
23.6 Chemical indicators
525(1)
23.7 Biological indicators (BI)
525(1)
23.8 Using indicators
526(1)
23.9 Example of an "in use" application
526(1)
23.10 Future trends
526(1)
Sources of further information
527(1)
References
527(2)
Further reading
529(2)
24 Future trends in decontamination in hospitals and healthcare
531(24)
J.T. Walker
24.1 Introduction
531(1)
24.2 The future of antibiotic resistance
531(1)
24.3 Decontamination in water systems
532(1)
24.4 Use of biocides in water systems
533(1)
24.5 Use of point of use filters
533(1)
24.6 Use of TMVs and design and use of outlets
534(1)
24.7 Exogenous contamination of water outlets
534(1)
24.8 Role of drains in the spread of infections
535(1)
24.9 Risks from medical equipment such as heater coolers
536(1)
24.10 Microorganisms in the built environment
536(1)
24.11 Control of microorganisms in the built environment
537(1)
24.12 Hand hygiene
538(1)
24.13 Hand contact sites and environmental cleaning
538(1)
24.14 Manual cleaning
539(1)
24.15 Automated decontamination systems in the built environment
540(1)
24.16 Decontamination of prions
541(2)
24.17 Guidance and the rapid detection of protein on surgical instruments
543(1)
References
544(11)
Index 555
Dr Jimmy Walker worked as a Scientific Leader in water microbiology and decontamination at Public Health England (PHE), Porton UK. He has 30 years experience in public health microbiology with an extensive publication record, and regularly attended national and international scientific conferences. His particular interests were the presence of opportunistic pathogens in hospital water systems and advised hospitals on incidents and outbreaks associated with waterborne pathogens such as Legionella spp., Pseudomonas aeruginosa and Mycobacteria spp. He worked closely with the Department of Health (DH England) and Health and Safety Executive in writing and developing national and international guidance on the microbiology of water and decontamination in healthcare.
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