Hospital Infection Control Guidelines: Principles and Practice Sanjeev Singh, Shakti Kumar Gupta, Sunil Kant
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1HOSPITAL INFECTION CONTROL GUIDELINES: Principles and Practice
Published under the aegis of
Department of Hospital Administration
All India Institute of Medical Sciences, New Delhi, India
and
The Research Foundation of Hospital and Healthcare Administration (RFHHA)
New Delhi, India2
“Nise Dominus Frustra”
“Without God We can do nothing”
3HOSPITAL INFECTION CONTROL GUIDELINES: Principles and Practice
Sanjeev SinghMBBS DCH MD MPhil Medical Superintendent and SHEA Ambassador Amrita Institute of Medical Sciences and Research Centre Kochi, Kerala, India Shakti Kumar GuptaMBBS MHA (AIIMS) FNAMS FIHE FAHA FIMSA Head Department of Hospital Administration Medical Superintendent All India Institute of Medical Sciences Dr RP Centre for Ophthalmic Sciences and Jai Prakash Narayan Apex Trauma Centre New Delhi, India Sunil KantMBBS DCE DCA MBA MHA Army Medical Corps
4
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© 2012, Editors
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
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This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Hospital Infection Control Guidelines: Principles and Practice
First Edition: 2012
9789350259061
Printed at
5Dedication
The book aims to facilitate the victory of humans over microbes and is dedicated to the patients and the practitioners of healthcare provisioning
6
7Contributors
8
9Experts
10
11Preface
Hospitals are intended to heal the sick, but they are also sources of infection. Despite the obvious benefits of modern medicine, there is a growing awareness that healthcare interventions may sometimes result in preventable harm to the patient. Infections acquired in healthcare institutions are a significant problem for patients and health services across the globe. These contribute to increased patient deaths, disability and promote resistance to antibiotics. The economic costs are considerable. The increased length of stay of patients, lost workdays, increased use of drugs for treatment, the need for isolation and the use of extra laboratory and other diagnostic studies contribute costs additional to the patient. As per the World Health Organization statistics, at any point of time, more than 1.4 million people worldwide suffer from infections in hospitals. The incidence of healthcare associated infections (HAIs) is anywhere between 10 and 30%. In intensive care, healthcare associated infection affects about 30% of patients and the attributability mortality may reach up to 44%.
Amongst the important variables which may guide healthcare professions to achieve reduction in healthcare associated infections is the availability and implementation of standard guidelines to control these infections. There have been significant initiatives at governmental and professional levels to formulate guidelines on Infection Control. The book Hospital Infection Control Guidelines: Principles and Practice aims to provide a comprehensive, acceptable, implementable and effective guidelines on Infection Control in various healthcare facilities. The book:
The book which is a multiauthor and multidisciplinary, will be a ready- reckoner for administrators, clinicians, academicians and practitioners in healthcare facilities for policy-making, formulation of standard operative procedures, implementing techniques and processes for infection control.
Editors
12
13Acknowledgments
The editors acknowledge all chapter authors and content experts for their valuable time and assistance.
Our special thanks to Dr Eileen Thatcher for reviewing and revising the document to bring it to perfection.
14
19Abbreviations AAMI
Association for the Advancement of Medical Instrumentation
ABS
Antimicrobial Stewardship
ACPH
Air Changes per Hour
AHU
Air Handling Units
AIMS
Amrita Institute of Medical Sciences
ALOS
Average Length of Stay
APIC
Association for Professionals in Infection Control
APLAC
Asia Pacific Laboratory Accreditation Corporation
ASB
Asymptomatic Bacteriuria
AVSC
Association for Voluntary Surgical Contraption
BAL
Bronchoalveolar Lavaqe
BBFE
Blood and Body Fluid Exposures
BI
Biological Indicators
BMW
Bio-Medical Waste
BOIM
Blood and Other Potentially Infection Material
BSI
Blood Stream Infection
CAUTI
Catheter Associated Urinary Tract Infection
CDC
Centre for Disease Control and Prevention
CEO
Chief Executive Officer
CFU
Colony Forming Units
CICPD
Central Infection Control and Prevention Department
CLSI
Clinical and Laboratory Standard Institutes
CLABSI
Central Line Associated Blood Stream Infection
CMS
Centre for Medicare and Medicaid Services
CME
Continuous Medical Education
COPD
Chronic Obstructive Pulmonary Disease
CPCB
Central Pollution Control Board
CSSD
Central Sterile Services Department
CSSU
Central Sterilization and Supply Unit
CSEP
Clinical Sepsis
CVC
Central Venous Catheter
DALYs
Disability Adjusted Life Years
DICC
District Infection Control Committee
DIP
Deep Incisional Primary
20DIS
Deep Incisional Secondary
EC
Exposure Code
EPA
Environmental Protection Agency
EQAS
External Quality Assurance Schemes
ERS
Elisa Rapid Simple
ESBL
Extended Spectrum Beta Lactamase
ETO
Ethylene Oxide
FDA
Food and Drug Administration
FICC
Facilities Infection Control Committee
GI
Gastrointestinal
HAI
Healthcare Associated Infection
HAP
Healthcare Associated Pneumonia
HBV
Hepatitis B Virus
HBIG
Hepatitis B Immune Globulin
HC
Health Care
HCF
Health Care Facilities
HCP
Health Care Professional
HCV
Hepatitis C Virus
HCW
Health Care Workers
HD
Hospital Director
HEPA
High Efficiency Particulate Air
HIV
Human Immunodeficiency Virus
HLD
High Level Disinfection
HOCT
Hospital Outbreak Control Team
HPRT
Hypoxanthine-Guanine Phospho-Ribosyl Transferase
HVAC
Heating Ventilation and Air Conditioning
IC
Infection Control
ICC
Infection Control Committee
ICD
Infection Control Doctor
ICN
Infection Control Nurse
ICRA
Infection Control Risk Assessment
ICT
Infection Control Team
ICU
Intensive Care Unit
IDSA
Infectious Disease Society of America
ILC
Inter Laboratory Comparisons
IMA
Indian Medical Association
IPA
Iso Propyl Alcohol
IPD
In Patient Department
ISO
International Standards Organization
IT
Information Technology
IV
Intravenous
KOH
Potassium Hydroxide
Lab
Laboratory
21LCBI
Laboratory Confirmed Bloodstream Infection
LLD
Low Level Disinfection
LVEF
Left Ventricular Ejection Fraction
MCI
Medical Council of India
MDR
Multi-drug Resistance
MOHP
Ministry of Health and Planning
MOHFW
Ministry of Health and Family Welfare
MRA
Mutual Recognition Arrangement
MRSA
Methicillin Resistant Staphylococcus aureus
MS
Medical Superintendent
MSD
Musculoskeletal Disorders
NIC
National Infection Control
NABH
National Accreditation Board for Hospitals and Healthcare Providers
NABL
National Accreditation Board of Testing and Calibration Laboratories
NACO
National AIDS Control Organisation
NICAC
National Infection Control Advisory Committee
NHSN
National Healthcare Safety Network
NICU
Neonatal Intensive Care Unit
NRHM
National Rural Health Mission
NSl
Needle Stick Injuries
OCT
Outbreak Control Team
OPA
Ortho-Phthalaldehyde
OPIM
Other Potentially Infectious Material
OSHA
Occupational Safety and Health Administration
OT
Operation Theater
OUTI
Other Urinary Tract Infection
PDCA
Plan Do Check Act
PEP
Post-exposure Prophylaxis
PICU
Pediatric Intensive Care Unit
PNEU
Pneumonia
PAA
Peracetic Acid
PPE
Personal Protective Equipment
QA
Quality Assurance
QC
Quality Control
RUP
Reuse Prevention Syringe
SAL
Sterlization Assurance Level
SED
Safety Engineered Device
SENIC
Study on Efficacy of Nosocomial Infection Control
SHEA
Society of Healthcare Epidemiology of America
Secy Gen
Secretary General
SICD
State Infection Control Department
22SIP
Superficial Incisional Primary
SIS
Superficial Incisional Secondary
SP
Standard Precautions
SSD
Sterile Services Department
SSI
Surgical Site Infection
SUTI
Symptomatic Urinary Tract Infection
SwF
Swiss Franks
TSSU
Theater Sterilization and Supply Unit
TWA
Time Weighted Average
URTI
Upper Respiratory Tract Infection
UTI
Urinary Track Infection
VAP
Ventilator Associated Pneumonia
VRE
Vancomycin-Resistant Enterococcus
VRSA
Vancomycin Resistant Staphylococcus aureus
WHO
World Health Organization