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)
“Nise Dominus Frustra”
“Without God We can do nothing”
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
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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
- Sanjeev Singh
- Medical Superintendent
- Amrita Institute of Medical Sciences and Research Centre
- Kochi, Kerala, India
- Murali R Chakravarthy
- Chief
- Cardiac Intensive Care and Anesthesia Fortis Wockhardt Hospital
- Bengaluru, Karnataka, India
- Purnima Parthasarthy
- Chief
- Infectious Diseases, Apollo Hospital
- Bengaluru, Karnataka, India
- Sharmila Sengupta
- Senior Consultant and head, Department of Microbiology
- BLK Superspecialty Hospital
- New Delhi, India
- Anita Arora
- Chief
- Labs and Quality
- Fortis Escorts Hospital, New Delhi, India
- Arti Kapil
- Professor of Microbiology
- All India Institute of Medical Sciences, New Delhi, India
- Bhaskar Jyoti Sonowal
- Technical Advisor
- Infection Control and Patient Safety
- Becton Dickinson (BD)
- NJ, USA
- Shalini Bhalla
- Senior Resident Administrator
- All India Institute of Medical Sciences, New Delhi, India
- Pankaj Arora
- Senior Resident Administrator
- All India Institute of Medical Sciences, New Delhi, India
- Parmeshwar Kumar
- Senior Resident Administrator
- All India Institute of Medical Sciences, New Delhi, India
- Anjana Chaudhary
- Resident Administrator
- All India Institute of Medical Sciences, New Delhi, India
- Shakti Kumar Gupta
- 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
- Eileen Thatcher
- Professor of Microbiology and Immunology
- Sonoma, State University, Rohnert Park
- CA, USA
- Barbara Bor
- Nurse Educator
- Gillette Children's Hospital
- Minnesota, USA
- Linus Ndwega
- Infection Control Officer
- CDC, Kenya
- Ling Moi Lin
- Director
- Infection Control
- Singapore General Hospital, Singapore
- Janine Jagger
- Head International Centre for Health Care Worker Safety University of Virginia, USA
- Dilip Mathai
- Head
- Internal Medicine and Infectious Diseases
- Christian Medical College
- Vellore, Tamil Nadu, India
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:
- Deliberates on all aspects of infection control in healthcare facilities including prevention, processes, infrastructure and training.
- Analyses the existing guidelines on infection control and recommends micro- and macroguidelines appropriate to healthcare facilities at various levels, i.e. primary, secondary and tertiary.
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
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.
19Abbreviations
AAMIAssociation for the Advancement of Medical Instrumentation
ABSAntimicrobial Stewardship
ACPHAir Changes per Hour
AHUAir Handling Units
AIMSAmrita Institute of Medical Sciences
ALOSAverage Length of Stay
APICAssociation for Professionals in Infection Control
APLACAsia Pacific Laboratory Accreditation Corporation
ASBAsymptomatic Bacteriuria
AVSCAssociation for Voluntary Surgical Contraption
BALBronchoalveolar Lavaqe
BBFEBlood and Body Fluid Exposures
BIBiological Indicators
BMWBio-Medical Waste
BOIMBlood and Other Potentially Infection Material
BSIBlood Stream Infection
CAUTICatheter Associated Urinary Tract Infection
CDCCentre for Disease Control and Prevention
CEOChief Executive Officer
CFUColony Forming Units
CICPDCentral Infection Control and Prevention Department
CLSIClinical and Laboratory Standard Institutes
CLABSICentral Line Associated Blood Stream Infection
CMSCentre for Medicare and Medicaid Services
CMEContinuous Medical Education
COPDChronic Obstructive Pulmonary Disease
CPCBCentral Pollution Control Board
CSSDCentral Sterile Services Department
CSSUCentral Sterilization and Supply Unit
CSEPClinical Sepsis
CVCCentral Venous Catheter
DALYsDisability Adjusted Life Years
DICCDistrict Infection Control Committee
DIPDeep Incisional Primary
20DISDeep Incisional Secondary
ECExposure Code
EPAEnvironmental Protection Agency
EQASExternal Quality Assurance Schemes
ERSElisa Rapid Simple
ESBLExtended Spectrum Beta Lactamase
ETOEthylene Oxide
FDAFood and Drug Administration
FICCFacilities Infection Control Committee
GIGastrointestinal
HAIHealthcare Associated Infection
HAPHealthcare Associated Pneumonia
HBVHepatitis B Virus
HBIGHepatitis B Immune Globulin
HCHealth Care
HCFHealth Care Facilities
HCPHealth Care Professional
HCVHepatitis C Virus
HCWHealth Care Workers
HDHospital Director
HEPAHigh Efficiency Particulate Air
HIVHuman Immunodeficiency Virus
HLDHigh Level Disinfection
HOCTHospital Outbreak Control Team
HPRTHypoxanthine-Guanine Phospho-Ribosyl Transferase
HVACHeating Ventilation and Air Conditioning
ICInfection Control
ICCInfection Control Committee
ICDInfection Control Doctor
ICNInfection Control Nurse
ICRAInfection Control Risk Assessment
ICTInfection Control Team
ICUIntensive Care Unit
IDSAInfectious Disease Society of America
ILCInter Laboratory Comparisons
IMAIndian Medical Association
IPAIso Propyl Alcohol
IPDIn Patient Department
ISOInternational Standards Organization
ITInformation Technology
IVIntravenous
KOHPotassium Hydroxide
LabLaboratory
21LCBILaboratory Confirmed Bloodstream Infection
LLDLow Level Disinfection
LVEFLeft Ventricular Ejection Fraction
MCIMedical Council of India
MDRMulti-drug Resistance
MOHPMinistry of Health and Planning
MOHFWMinistry of Health and Family Welfare
MRAMutual Recognition Arrangement
MRSAMethicillin Resistant Staphylococcus aureus
MSMedical Superintendent
MSDMusculoskeletal Disorders
NICNational Infection Control
NABHNational Accreditation Board for Hospitals and Healthcare Providers
NABLNational Accreditation Board of Testing and Calibration Laboratories
NACONational AIDS Control Organisation
NICACNational Infection Control Advisory Committee
NHSNNational Healthcare Safety Network
NICUNeonatal Intensive Care Unit
NRHMNational Rural Health Mission
NSlNeedle Stick Injuries
OCTOutbreak Control Team
OPAOrtho-Phthalaldehyde
OPIMOther Potentially Infectious Material
OSHAOccupational Safety and Health Administration
OTOperation Theater
OUTIOther Urinary Tract Infection
PDCAPlan Do Check Act
PEPPost-exposure Prophylaxis
PICUPediatric Intensive Care Unit
PNEUPneumonia
PAAPeracetic Acid
PPEPersonal Protective Equipment
QAQuality Assurance
QCQuality Control
RUPReuse Prevention Syringe
SALSterlization Assurance Level
SEDSafety Engineered Device
SENICStudy on Efficacy of Nosocomial Infection Control
SHEASociety of Healthcare Epidemiology of America
Secy GenSecretary General
SICDState Infection Control Department
22SIPSuperficial Incisional Primary
SISSuperficial Incisional Secondary
SPStandard Precautions
SSDSterile Services Department
SSISurgical Site Infection
SUTISymptomatic Urinary Tract Infection
SwFSwiss Franks
TSSUTheater Sterilization and Supply Unit
TWATime Weighted Average
URTIUpper Respiratory Tract Infection
UTIUrinary Track Infection
VAPVentilator Associated Pneumonia
VREVancomycin-Resistant Enterococcus
VRSAVancomycin Resistant Staphylococcus aureus
WHOWorld Health Organization