Fundamentals of Infection Prevention and Control

Theory and Practice

Debbie Weston

• Publisher: Wiley-Blackwell
• Year: 2013
• ISBN:
  9781118307700
• Edition: 2
• Topic: Médecine
• Subtopic: Soins infirmiers

Reviews of first edition:

"This book tells every healthcare professional all they need to know about infection control… A user-friendly, valuable source of knowledge on a subject that can be confusing and complicated." Nursing Standard

"A valuable contribution within any health or social environment." Journal of Community Nursing

Infection prevention and control is an essential component of nursing care, and a crucially important subject area for both nursing students and qualified nurses. Fundamentals of Infection Prevention and Control gives readers a firm grasp of the principles of infection control, how they relate to clinical practice and the key issues surrounding the subject. It provides a comprehensive guide to the prevention, management and control of healthcare associated infections, and the basic elements of microbiology, immunology and epidemiology that underpin them.

Thoroughly revised in line with current policy, this new edition contains brand-new chapters on a range of topics including the role of the Infection Prevention and Control Team, audit and surveillance, and the management of outbreaks. Also incorporating a range of case studies and examples as well as additional online content, it is essential reading for all nursing students as well as qualified nursing and healthcare professionals.

• Explores both principles and practice of a crucial subject area
• Accessible and user-friendly, with a range of features to help study including key definitions, links back to clinical practice, and chapter learning outcomes and summaries
• Accompanied by an online resource centre featuring MCQs, weblinks, case scenarios and downloadable fact sheets
• Features an increased clinical focus, with more application to practice

This title is also available:

• as a Wiley E-Text, powered by VitalSource: an interactive digital version of the book featuring downloadable text and images, highlighting and note-taking facilities, book-marking, cross-referencing, in-text searching, and linking to references and glossary terms
• instantly on CourseSmart at www.coursesmart.co.uk/9781118306659. CourseSmart offers extra
  functionality, as well as an immediate way to review the text. For more details, visit www.coursesmart.com/instructors or www.coursesmart.com/students

Part One

Introduction to infection prevention and control

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Chapter 1 The burden of healthcare-associated infections, and disease threats old and new

Chapter 2 The Infection Prevention and Control Team

Chapter 3 Audit and surveillance

Chapter 4 The investigation of clusters, periods of increased incidence and outbreaks of infection

Chapter 5 Microbial classification and structure

Chapter 6 The collection and transportation of specimens

Chapter 7 The microbiology laboratory

Chapter 8 Understanding the immune system and the nature and pathogenesis of infection

Chapter 9 Sepsis

Chapter 10 Antibiotics and the problem of resistance

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1

The burden of healthcare-associated infections, and disease threats old and new

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Contents

Background

The problem of HCAIs

HCAI point prevalence surveys

The challenge of disease threats old and new

Changes within the NHS and the provision of healthcare

Secondary versus primary care: infection control in acute trust and primary care settings

Chapter summary: key points

References

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Introduction

This introductory chapter is in two parts. The first part looks at the burden and impact of healthcare-associated infections on the NHS as an organisation and on patients, including risk factors for, and risk factors contributing to, the development of these infections, and the threats to public health posed by old and new infectious diseases. The second part briefly reflects on the changing face of healthcare and summarises some of the key differences and challenges regarding infection control in acute and community care settings.

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Learning outcomes

After reading this chapter, the reader will be able to:

• Define healthcare-associated infections (HCAIs).
• List six patient risk factors for the development of HCAIs.
• List 10 general factors that can increase the risk of HCAIs.
• List six ways in which HCAIs can affect patients and healthcare providers.
• Understand the continuing threat to public health from old and new diseases.

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Background

The problem of healthcare-associated infections (HCAIs) is not a new one. In 1941, seven years before the creation of the NHS, the British Medical Council recommended that ‘control of infection officers’ be appointed in hospitals to oversee the control of infection. This was followed in 1944 by the setting up of control of infection committees consisting of clinical and laboratory staff, nurses and administrators.

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Fact Box 1.1 The first Infection Control Nurse

The first Infection Control Nurse was appointed in the United Kingdom in 1959 (Gardner et al., 1962). The appointment of Miss E.M. Cottrell, formerly an Operating Theatre Superintendent, as Infection Control Sister at Torbay Hospital, Devon, was in response to a large outbreak of staphylococcal infections affecting both patients and staff. Staphylococci (see Chapters 5 and 20) had been causing problems in UK hospitals since 1955, and staphylococcal surveillance at Torbay Hospital revealed that the carriage rate amongst nursing staff on two of the major hospital wards was 100%, with high staff absentee levels due to staphylococcal skin sepsis, and evidence of post-operative wound infections and skin sepsis amongst the patients.

Miss Cottrell was appointed for an experimental period to assist in the collection of surveillance data and advise healthcare staff on the prevention of cross-infection through rigorous adherence to the principles of asepsis.

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In 1961, a report on the development of the post of Infection Control Sister was submitted by Dr Brendan Moore, Director of the Public Laboratory in Exeter, to the Joint Advisory Committee on Research of the South West Region Hospital Board. Although the appointment of a nurse as a full-time member of the Infection Control Team was nationally opposed by consultants, Infection Control Sisters were subsequently appointed in many other hospitals.

During the 1960s, an increase in infections caused by Gram-negative bacteria such as Escherichia, Klebsiella, Pseudomonas (see Chapter 10) and Proteus started to overtake Staphylococcus aureus as agents of cross-infection (Selwyn, 1991). (There are Fact Sheets on all these organisms on the companion website.) Pseudomonas in particular established itself as a major opportunistic hospital pathogen in those with underlying illness. During the 1960s and 1970s antibiotic resistance was recognised as an increasing problem, and lurking just around the corner were major resistance problems with staphylococci against methicillin (known as meticillin since 2005), which gave rise to meticillin-resistant S. aureus (MRSA). MRSA really started to become problematic in the 1970s, and it exploded during the 1980s (see Chapter 20). Since then, antibiotic resistance has become increasingly common with most strains of bacteria now resistant to one or more antibiotics, and as discussed in Chapter 10, the emergence of pan-resistant strains currently represents a major threat to public health.

The problem of HCAIs

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Fact Box 1.2 Definition of a healthcare-associated infection

A healthcare-associated infection can be defined as ‘an infection occurring in a patient during the process of care in a hospital or other healthcare facility, which was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge and also occupational infections amongst staff of the facility’ (World Health Organization [WHO], 2011). An infection occurring within 48–72 hours of admission is considered to be community acquired (unless there is a link with a previous hospital admission); an infection occurring more than 48–72 hours post admission is healthcare associated. HCAIs, especially those that are avoidable, are harm events.

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HCAIs are a global concern affecting hundreds of millions of patients per year, with the highest prevalence in developing or low-income countries (WHO, 2011), where resources are limited and reporting and surveillance strategies are weak. In 2011, the publication of the Report on the Burden of Endemic Healthcare Associated Infection Worldwide by WHO identified that:

• The prevalence of HCAIs in low and middle-income countries varies between 5.7% and 19.1%.
• Infection rates in newborn babies are 3–20 times higher in low and middle-income countries than in developed or high-income countries; in the former, HCAIs are responsible for 4–56% of deaths in the neonatal period (and 75% of neonatal deaths in Southeast Asia and Sub-Saharan Africa).
• The proportion of patients with infections acquired in intensive care units in low- and middle-income countries ranges from 4.4% to 88.9%.
• The incidence of surgical site infections is up to nine times higher than in developed countries.

As far back as 1995, the Department of Health (DH) (Department of Health and Public Health Laboratory Service, 1995) estimated that:

• Hospital-acquired infections (as they were referred to then) were responsible for the deaths of 5000 patients in the United Kingdom each year.
• HCAIs were probably a contributing factor, but not the primary cause, in at least 15 000 other deaths.
• At any one time, one in 10 patients receiving care in acute hospitals had a hospital-acquired infection, and a significant but undetermined number of patients discharged from hospital into the community also had, or developed, infections related to their hospital stay.
• While it was not possible to prevent all infections, there were several recognised risk factors which increased the risk to patients.
• Between 15 to 30% of infections could be prevented through good clinical or infection control practice.

In 1999, a report by Plowman et al. arising from a project funded by the DH had identified that:

• Of hospital in-patients, 7.8% had one or more hospital-acquired infections, and 19.1% of patients reported symptoms of infection post discharge.
• Costs associated with treati...

Table of contents

• Cover
• Titles of related interest
• Website ad
• Title page
• Copyright page
• About the series
• Preface
• How to get the best out of your textbook
• How to use the companion website
• Acknowledgements
• Introduction
• Part One: Introduction to infection prevention and control
• Part Two: The principles of infection prevention and control (standard precautions)
• Part Three: Clinical practice
• Part Four: Specific organisms
• Glossary
• Index