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Infection Prevention and Control in Healthcare, Part I: Facility Planning and Management, An Issue of Infectious Disease Clinics of North America, E-Book

Infection Prevention and Control in Healthcare, Part I: Facility Planning and Management, An Issue of Infectious Disease Clinics of North America, E-Book

Keith S. Kaye | Sorabh Dhar

(2016)

Additional Information

Abstract

Dr. Kaye and Dr. Dhor have assembled top experts to write about facility planning and management in Part I of their two issues devoted to Infection Prevention and Control in Healthcare. Articles in this issue are devoted to: Building a Successful Infection Control Program: Key Components, Processes and Economics; Hand Hygiene Sterilization; High Level Disinfection and Environmental Cleaning; Environement of Care; Infection Control in Alternative Healthcare Settings (Long Term Care and Ambulatory); Antibiotic Stewardship; Outbreak Investigations
Water Safety in Healthcare/Legionella in the Healthcare Setting; Construction and Renovation; Bloodborne and Body Fluid Exposures - prevention and management of Occupational Health Issues; and Informatics and Statistics in Infection Control. Part II is devoted to clinical management of infections.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Infection Prevention andControl in Healthcare,Part I: Facility Planningand Management i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents vii
Preface: Infection Prevention and Control in Healthcare, Part I: Facility Planning and Management\r vii
Building a Successful Infection Prevention Program: Key Components, Processes, and Economics\r vii
Hand Hygiene: An Update\r vii
Disinfection and Sterilization in Health Care Facilities: An Overview and Current Issues\r vii
Optimizing Health Care Environmental Hygiene\r viii
Outbreaks in Health Care Settings\r viii
Water Safety and Legionella in Health Care: Priorities, Policy, and Practice\r viii
Prevention by Design: Construction and Renovation of Health Care Facilities for Patient Safety and Infection Prevention\r viii
Occupational Health Update: Focus on Preventing the Acquisition of Infections with Pre-exposure Prophylaxis and Postexposur \r ix
Informatics in Infection Control\r ix
Antimicrobial Stewardship for the Infection Control Practitioner\r ix
Infection Control in Alternative Health Care Settings: An Update\r ix
Preventing Hospital-acquired Infections in Low-income and Middle-income Countries: Impact, Gaps, and Opportunities\r x
INFECTIOUS DISEASE CLINICS\rOF NORTH AMERICA\r xi
FORTHCOMING ISSUES xi
December 2016 xi
March 2017 xi
June 2017 xi
RECENT ISSUES xi
June 2016 xi
March 2016 xi
December 2015 xi
Preface:\rInfection Prevention and Control in Healthcare, Part I: Facility Planning and Management xiii
Building a Successful Infection Prevention Program 567
Key points 567
THE EMERGENCE AND DEVELOPMENT OF REGULATION AND REQUIREMENTS OF INFECTION PREVENTION AND CONTROL 567
INFECTION PREVENTION AND CONTROL PROGRAM 570
Mission, Vision, and Values 570
Infection Prevention and Control Committee 571
KEY MEMBERS OF THE INFECTION PREVENTION TEAM AND/OR PROGRAM 572
Hospital Physician Epidemiologist or Medical Director of Infection Prevention 572
Data Programmer and Analyst 572
Administrative Assistant 573
Infection Preventionist 573
Meeting Management 574
Infection Prevention Staffing 574
Budget 575
Surveillance 576
Outbreak Investigation 579
Quality Improvement: Role of the Infection Preventionist 581
ECONOMICS AND BUSINESS PLAN 581
SUMMARY 583
REFERENCES 583
Hand Hygiene 591
Key points 591
INTRODUCTION 591
HUMAN SKIN AND SKIN FLORA 592
EVOLUTION OF GUIDELINES 593
ALCOHOL-BASED HAND RUBS 594
HAND HYGIENE ADHERENCE 596
BARRIERS TO HAND HYGIENE 598
IMPROVING HAND HYGIENE ADHERENCE 600
HEALTH CARE–ASSOCIATED INFECTIONS 601
SUMMARY 602
REFERENCES 603
Disinfection and Sterilization in Health Care Facilities 609
Key points 609
INTRODUCTION 609
A RATIONAL APPROACH TO DISINFECTION AND STERILIZATION 610
Critical Items 613
Semicritical Items 613
Noncritical Items 617
CURRENT ISSUES IN DISINFECTION AND STERILIZATION 618
Reprocessing of Endoscopes 618
Outbreaks of carbapenem-resistant Enterobacteriaceae infection associated with duodenoscopes: what can we do to prevent inf ... 621
Role of the Environment in Disease Transmission 622
Improving room cleaning and disinfection and demonstrating the effectiveness of surface decontamination in reducing health ... 622
No-touch (or mechanical) methods for room decontamination 623
Ultraviolet light for room decontamination 623
Hydrogen peroxide systems for room decontamination 624
Comparison of ultraviolet irradiation versus hydrogen peroxide for room decontamination 624
Assessing Risk to Patients from Disinfection and Sterilization Failures 624
Human Papilloma Virus 624
Hydrogen Peroxide Mist System for Probes 628
Do Not Reuse Single-Use Devices 629
Storage of Semicritical Items 629
Immersion Versus Perfusion of Channel Scopes Such as Cystoscopes 629
Laryngoscopes 630
Emerging Pathogens, Antibiotic-Resistant Bacteria, and Bioterrorism Agents 631
SUMMARY 631
REFERENCES 631
Optimizing Health Care Environmental Hygiene 639
Key points 639
INTRODUCTION 639
EPIDEMIOLOGY OF CONTAMINATED SURFACES 641
CLEANING HEALTH CARE SURFACES 642
Methods for Evaluating Physical Cleaning 644
Covert direct practice observation 645
Basic culture methods 645
Agar slide cultures 645
Adenosine triphosphate assays 645
Fluorescent markers 646
Programmatic Benefits and Challenges of Environmental Cleaning Monitoring 646
DISINFECTING ENVIRONMENTAL SURFACES 648
Chemical Disinfectants 648
Technologies to Augment Disinfection Cleaning 649
No-touch technologies 649
Self-disinfecting surfaces 649
Challenges of Measuring Cleanliness Versus Cleaning 650
Cleanliness 650
Cleaning 651
ENVIRONMENTAL HYGIENE AND HAND HYGIENE—AN INTEGRATED APPROACH 651
RESEARCH OPPORTUNITIES AND CHALLENGES 653
Improving Study Design 653
A Proposed Hygienic Practice Research Agenda 654
Understanding transmission events related to patient room surfaces 654
Measuring cleanliness 654
Improving cleanliness by focusing on process 655
Improving cleanliness by evaluating emerging interventions 655
ACKNOWLEDGMENTS 655
REFERENCES 655
Outbreaks in Health Care Settings 661
Key points 661
OUTBREAKS 661
APPROACH TO AN OUTBREAK 662
PSEUDO-OUTBREAKS 670
LABORATORY AND TESTING 670
SOURCES 672
Health Care Personnel 672
Hospital Environment 672
Waterborne Sources 672
Legionella spp 673
ORGANISMS 674
Nontuberculous Mycobacteria 674
Acinetobacter spp 674
Pseudomonas spp 675
Carbapenem-Resistant Enterobacteriaceae 675
S aureus Including Methicillin-Resistant S aureus 676
Fungus and Mold, Including Aspergillus 676
Respiratory Infections 677
Gastrointestinal Infections 678
HIGH-RISK SETTINGS 678
Neonatal Intensive Care Unit 678
Endoscopes and Endoscopy Suites 679
Transplant Units 680
SUMMARY 680
REFERENCES 681
Water Safety and Legionella in Health Care 689
Key points 689
INTRODUCTION 690
WATER IN THE HEALTH CARE SETTING AND PATHOGENS 690
Water Management Priorities 692
Safety 692
Distribution and quality 692
Water stagnation in pipes 692
Disinfectant residual 692
Water temperature 694
The balance between scald prevention and microbial control 694
Thermostatic mixing valves/anti-scald devices 695
Construction activities 695
Leaking pipes/condensation 695
Decorative water features 695
Conservation 696
Emergency water supply (water security) 696
Water-based Health Care–associated Infections 696
Health care–associated infections and Legionella 697
Legionella in health care building water distribution systems 701
The unapparent or creeping outbreak 702
BUILDING WATER SAFETY PLANS 703
The Team Approach 703
Legionella Prevention Plans 704
SUMMARY: THE FUTURE OF WATER SAFETY IN HEALTH CARE IN THE UNITED STATES 706
REFERENCES 706
Prevention by Design 713
Key points 713
INTRODUCTION 714
CRITERIA FOR EVALUATING THE STRENGTH OF EVIDENCE FOR ENVIRONMENTAL SOURCES OF INFECTION 714
OVERVIEW OF DISEASE TRANSMISSION RISKS FROM THE BUILT ENVIRONMENT 715
Air as a Reservoir of Health Care–associated Infections 715
Water as a Reservoir of Health Care–associated Infections 716
HANDWASHING STATION DESIGN 716
WATER FEATURE: NOT ALLOWED 717
Inpatient Rooms, Surfaces, and Finishes 717
STRATEGIES AND DESIGN ELEMENTS TO SUPPORT INFECTION PREVENTION 718
Select Elements of Design 718
Heating, ventilation, and air conditioning 718
Universal or acuity-adaptable and single-occupancy patient-care rooms 719
Airborne-infection isolation room 719
Protective environment room 720
Handwashing stations and hand hygiene 720
Toilets and disposal of human waste 720
Surfaces, finishes, and furnishings 720
Floors, walls, and ceilings 721
FUTURE DIRECTIONS FOR HEALTH CARE IN THE UNITED STATES 721
Trends 721
Informing Future Guidelines Development 721
RESOURCES FOR DESIGNING IN INFECTION PREVENTION 722
SUMMARY/DISCUSSION 722
REFERENCES 722
Appendix A. APPENDIX A STEPWISE PROCESS FOR INFECTION CONTROL RISK MITIGATION RECOMMENDATIONS FOR CONSTRUCTION AND RENOVATION 725
Occupational Health Update 729
Key points 729
INTRODUCTION 729
DEFINITIONS 730
PRE-EXPOSURE SCREENING AND IMMUNIZATIONS 731
Pre-exposure Screening 731
Immunizations 731
POSTEXPOSURE PROPHYLAXIS 735
Sharp Injuries 737
Hepatitis B 739
Human Immunodeficiency Virus 739
Invasive Meningococcal Infections 741
Varicella 742
Pertussis 743
Postexposure Prophylaxis: Others 744
Tetanus 744
Diphtheria 745
Measles 745
Hepatitis A 745
Human bites 746
Rabies 746
Ectoparasites 747
Syphilis 747
Influenza 747
EVALUATION OF ILL HEALTH CARE PERSONNEL 750
REFERENCES 750
Informatics in Infection Control 759
Key points 759
BACKGROUND 759
INFECTION SURVEILLANCE 760
Fully Automated Versus Semiautomated Surveillance 761
Common Data Sources Needed for Surveillance Informatics 761
Examples of Surveillance Metrics Enhanced by Informatics 761
Central line–associated bloodstream infections 761
Surgical site infections 763
Ventilator-associated pneumonia/ventilator-associated events 763
Catheter-associated urinary tract infection 763
Multidrug-resistant organism module 764
Outbreak Detection 764
INFECTION PREVENTION 764
Increasing the Recognition of Multidrug-Resistant Organism Carriage on Admission 764
Identifying Inappropriate Infection Precautions 765
Reducing Device Use 765
Antibiotic Stewardship 765
INFORMATICS AND PUBLIC HEALTH 766
Electronic Communicable Disease Reporting 766
Syndromic Surveillance and Outbreak Detection 766
GENERAL CONSIDERATIONS FOR IMPLEMENTING INFORMATICS SOFTWARE 766
Challenges of Microbiology Data 767
Challenges of Device Data 767
Validation of Data 767
SUMMARY 768
REFERENCES 768
Antimicrobial Stewardship for the Infection Control Practitioner 771
Key points 771
CONSEQUENCES OF ANTIMICROBIAL RESISTANCE: IMPACT ON PUBLIC HEALTH AND SAFETY 771
THE IMPACT OF ANTIMICROBIAL USE, MISUSE, AND OVERUSE 772
NATIONAL INITIATIVES CALLING FOR IMPROVED ANTIMICROBIAL USAGE 773
WHAT IS ANTIMICROBIAL STEWARDSHIP AND WHAT ARE THE GOALS? 773
KEY MEMBERS AND DEPARTMENTS REPRESENTED ON THE ANTIMICROBIAL STEWARDSHIP TEAM 774
Infectious Diseases Physician 774
Clinical Pharmacist 775
Infection Preventionist and Health Care Epidemiologist 775
Microbiology Laboratory 775
Information Technology 775
Hospital Administration 776
Pharmacy and Therapeutics Committee 776
INFECTION CONTROL AND ANTIBIOTIC STEWARDSHIP 776
Drug-Based Antimicrobial Stewardship 776
Disease-Based Antimicrobial Stewardship and Multidisciplinary Bundles 777
Device-Associated Infection Prevention 778
Barriers to Implementation and Maintenance of Stewardship Programs 778
Making a Business Case for Antimicrobial Stewardship 779
Measuring the Impact of the Program 779
SUMMARY 780
ACKNOWLEDGMENTS 781
REFERENCES 781
Infection Control in Alternative Health Care Settings 785
Key points 785
BACKGROUND 785
INFECTION PREVENTION PROGRAMS IN NURSING HOMES 786
INFECTION PREVENTION PROGRAMS IN NURSING HOMES: FUNCTIONS, COMPONENTS, AND OVERSIGHT 787
Information Transfer During Care Transitions 788
Hand Hygiene 789
Multidrug-Resistant Organisms 790
Isolation Precautions 791
Surveillance for Infections and Antimicrobial Usage 792
Outbreak Management 793
Rehabilitation Services 793
Environmental Hygiene 794
Resident and Employee Health Program 794
Role of Infection Preventionist 794
Environmental Rounds 795
Staff Education 795
Oversight Committee 795
AMBULATORY CARE CENTERS 796
Communicable Disease and Isolation Management 796
Environmental Hygiene—Cleaning Disinfection and Sterilization 797
Ambulatory Surgical Centers 797
Safe Injection Practices 798
Bioterrorism and Disaster Planning 798
SUMMARY 799
REFERENCES 799
Preventing Hospital-acquired Infections in Low-income and Middle-income Countries 805
Key points 805
INTRODUCTION 805
HEALTH AND ECONOMIC IMPACT 806
GAPS AND OPPORTUNITIES 806
Surveillance and Rates of Health Care–associated Infections 807
Antimicrobial Resistance Surveillance 808
Health Care–associated Tuberculosis 809
Health Care–associated Infections After Natural Disasters and During Conflicts 810
SUCCESSFUL HEALTH CARE–ASSOCIATED INFECTION INTERVENTIONS IN LOW-INCOME AND MIDDLE-INCOME COUNTRIES 810
Examples of Successful Implementation of World Health Organization Hand Hygiene Guidelines 810
Example of Successful Infection Control Strategy in Resources-limited Settings 810
RECOMMENDATIONS 811
Building Infection Control Capacity Through Partnerships 811
Identify Health Care–associated Gaps 812
Designing and Sustaining Infection Control Programs and Interventions 813
Addressing Gaps While Prioritizing Resources 813
SUMMARY 814
REFERENCES 814
Index 819