Fundamentals of Infection Prevention and Control E-Book

Debbie Weston

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Fundamentals
• Sprache: Englisch

Seitenzahl: 720

Veröffentlichungsjahr: 2013

Beschreibung

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:

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Leseprobe

Table of Contents

Titles of related interest

Website ad

Title page

Copyright page

About the series

Preface

How to get the best out of your textbook

Features contained within your textbook

The anytime, anywhere textbook

How to use the companion website

Acknowledgements

Introduction

Part One: Introduction to infection prevention and control

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

Introduction

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

2: The Infection Prevention and Control Team

Introduction

The role of the Infection Prevention and Control Team

The role of Infection Control Link Practitioners

Responsibility, accountability and duty of care

Competency

Documentation

Avoidable versus unavoidable infections

The Health and Social Care Act 2008: Code of Practice on the Prevention and Control of Infections and Related Guidance

Root Cause Analysis (RCA)/Post Infection Review (PIR)

3: Audit and surveillance

Introduction

Audit

Surveillance

Surveillance of notifiable diseases

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

Introduction

Recognising a cluster, a period of increased incidence and an outbreak

Arranging a cluster, PII or outbreak control group meeting: who to invite and agenda planning

At the meeting and after: actions and closure of the incident

5: Microbial classification and structure

Introduction

Bacteria

Viruses

Prions

6: The collection and transportation of specimens

Introduction

General points

Commonly requested clinical specimens

Urine

Sputum

Wounds

Faeces

Rectal swabs

Throat swabs

Blood culture

Cerebral spinal fluid

7: The microbiology laboratory

Introduction

Bacterial growth

Cell division

Bacterial culture

Processing specimens

Other laboratory techniques

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

Introduction

The innate, or natural, immune response

The adaptive, or acquired, immune response

The immune response and allergy

Understanding the chain of infection

Colonisation, infection and the inflammatory response

9: Sepsis

Introduction

Sepsis and septicaemia

The pathogenesis of septic shock

The management of sepsis and septic shock

Neutropenic sepsis

Clinical considerations

Clinical practice points: infection control precautions

10: Antibiotics and the problem of resistance

Introduction

Part A

The discovery of penicillin

How antibiotics work

Antimicrobial resistance

Factors leading to the emergence of resistance and problems within the healthcare setting

Antimicrobial stewardship

Part B

Specific antibiotic-resistant organisms

Clinical practice points: the infection control management of patients colonised or infected with an ESBL or carbapenem-resistant organism

Part Two: The principles of infection prevention and control (standard precautions)

11: Isolation and cohort nursing

Introduction

Compliance with the Health and Social Care Act 2008

Standard precautions

EPIC and NICE guidelines

The purpose of isolating patients and different categories of isolation

Isolation and risk assessment

Infection control precautions within specialist areas

General points regarding the infection control management of infected and colonised patients

Negative-pressure isolation

The psychological effects of isolation

Care of deceased patients

12: Hand hygiene

Introduction

Ignaz Semmelweis

The microbial flora of the skin

How cross-infection via the hands occurs

Hand hygiene

Hand decontamination at the point of care – the 5 Moments for Hand Hygiene

Hand hygiene: patients and the public

Care of the hands

13: Personal protective equipment

Introduction

Personal protective equipment: risk assessment

PPE: common mistakes and important points

Aprons and gowns

Respiratory and facial protection: masks, goggles and visors (face shields)

Masks

Goggles and visors

The order of donning and removing PPE

14: The safe handling and disposal of sharps

Introduction

The incidence of sharps injuries

Safety devices

15: Cleaning

Introduction

Cleaning and the Health and Social Care Act 2008

Cleaning standards

Decontaminating beds and commodes

The cleaning of equipment

How clean is clean?

Cleaning isolation side rooms, and deep cleaning bays and wards

Part Three: Clinical practice

16: The management of vascular access devices and the prevention of bloodstream infections

Introduction

Vascular access devices

The pathogenesis of VAD-related BSIs (bacteraemia)

Best practice in the prevention of peripheral cannula infection

17: The prevention and management of catheter-associated urinary tract infections

Introduction

The economic burden of catheter-associated urinary tract infections, and the prevalence of urinary catheters in healthcare

The pathogenesis of CAUTIs

Clinical features of UTIs

Diagnosis

Clinical considerations: Best practice in the prevention of CAUTIs

18: The prevention and management of surgical site infections

Introduction

The prevalence of surgical site infections

The prevention of SSIs: Compliance with the Health and Social Care Act 2008

Defining SSIs

The process of wound healing

The pathogenesis of SSIs

Bacterial causes of SSIs

Risk factors for the development of SSIs

Best-practice recommendations for the prevention of SSIs

19: The prevention and management of hospital and community-acquired pneumonia

Introduction

Definition of pneumonia

Community-acquired pneumonia

Hospital-acquired or ventilator-associated pneumonia

The pathogenesis of infection

Diagnosis – Clinical Pulmonary Infection Score (CPIS)

Aspiration pneumonia

Prevention of HAP and VAP – best-practice recommendations

Part Four: Specific organisms

20: Stapylococcusaureus (including MRSA)

Introduction

Staphylococcus aureus

Meticillin-resistant Staphylococcusaureus

The clinical importance of MRSA infection, and risk factors associated with MRSA colonisation and infection

Community-acquired MRSA (CA-MRSA)

Control of MRSA

Treatment of MRSA colonisation and infection

Clinical practice points: the infection control management of MRSA-positive patients

Best-practice recommendations for the prevention of MRSA colonisation, infection and bacteraemia (Acute Trusts)

Best-practice recommendations for the prevention of MRSA colonisation, infection and bacteraemia (community and primary care)

21: Tuberculosis

Introduction

Background

Opportunistic mycobacteria

Non-respiratory tuberculosis

The pathogenesis of tuberculosis infection

The pathogenesis of respiratory tuberculosis infection

Diagnosing tuberculosis

Multidrug-resistant tuberculosis (MDR-TB)

TB and HIV

The treatment of tuberculosis

Contact tracing and screening

BCG vaccination

Clinical practice points: infection control precautions (drug-sensitive TB)

22: Clostridium difficile

Introduction

Background

The protective role of resident bowel flora

The pathogenesis of C. difficile infection

Clinical features of C. difficile infection

Diagnosis

The significance of community versus hospital-acquired C. difficile infection

Clinical considerations regarding the medical management of C. difficile infection

Treatment

Stool specimens for clearance

Treatment of recurrent C. difficile

Clinical practice points: the infection control management of patients with symptomatic C. difficile infection

23: Norovirus

Introduction

The virus

Incubation period, transmission and clinical features

Reporting patients with ‘diarrhoea and vomiting’

Laboratory diagnosis

The management of outbreaks in hospitals

24: Blood-borne viruses

Introduction

Exposure to blood-borne viruses

HIV and AIDS

The treatment of HIV

Hepatitis B

Hepatitis C

Clinical practice

Clinical practice points: the infection control management of patients

Resources

Glossary

Index

Titles of related interest

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Library of Congress Cataloging-in-Publication Data

Weston, Debbie.

Fundamentals of infection prevention and control : theory and practice / Debbie Weston. – 2nd ed.

p. ; cm.

Rev. ed. of: Infection prevention and control / Debbie Weston. c2008.

Includes bibliographical references and index.

ISBN 978-1-118-30665-9 (pbk. : alk. paper) – ISBN 978-1-118-30769-4 – ISBN 978-1-118-30770-0 (ePub) – ISBN 978-1-118-30771-7 – ISBN 978-1-118-67383-6 – ISBN 978-1-118-67388-1

I. Weston, Debbie. Infection prevention and control. II. Title.

[DNLM: 1. Cross Infection–prevention & control. 2. Hospitals. 3. Infection Control–methods. WX 167]

RA761

362.196'9–dc23

2013012753

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: iStockphoto File #22313218 © Mark Bowden

Cover design by Fortiori Design

About the series

Wiley's Fundamentals series are a wide-ranging selection of textbooks written to support pre-registration nursing and other healthcare students throughout their course. Packed full of useful features such as learning objectives, activities to test knowledge and understanding and clinical scenarios, the titles are also highly illustrated and fully supported by interactive MCQs, and each one includes access to a Wiley E-Text powered by VitalSource – an interactive digital version of the book including downloadable text and images and highlighting and note-taking facilities. Accessible on your laptop, mobile phone or tablet device, the Fundamentals series is the most flexible, supportive textbook series available for nursing and healthcare students today.

Preface

Since I wrote the first edition in 2007, which was published in February 2008, much has changed. The threat of an influenza pandemic became a reality in 2009 with the H1N1 ‘swine flu’ pandemic, antibiotic resistance remains an ever-increasing concern, particularly with the emergence of carbapenemase resistance and NDM-1, and although the overall prevalence of healthcare-associated infections (HCAIs) has decreased (and infections caused by meticillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile have decreased significantly), the prevalence of some specific HCAIs has increased. The NHS is experiencing a period of turmoil with the NHS reforms and there are huge concerns in the media not so much around HCAIs but around patient care.

Infection prevention and control are integral parts of patient care and they are everyone's responsibility. HCAIs are harm events, and the principles of infection prevention and control have to be embedded into everyday clinical practice and not be viewed as something separate. The focus now is very much on preventing avoidable HCAIs, with a culture of zero tolerance for avoidable infections and poor practice, and holding staff to account, and it is becoming even more essential that healthcare professionals have a firm grasp of both the principles of infection control that they can relate to clinical practice, and the current issues.

‘Infection control’ as a speciality is fascinating, complex (although the basic principles are simple), challenging, sometimes very frustrating and extremely diverse, and it is my passion. I hope that this revised and updated second edition will provide the reader with an insight into the work of the Infection Prevention and Control Team and that it will be a valuable resource, not only enhancing their knowledge and understanding of infection control but also encouraging them to look at their own clinical practice and that of others. I also hope that it fosters a real interest in, and enthusiasm for, the subject.

Debbie Weston

Deputy Lead Nurse / Operational Lead, Infection Prevention and Control

East Kent Hospitals University NHS Foundation Trust, Kent, UK

How to get the best out of your textbook

Welcome to the new edition of Fundamentals of Infection Prevention and Control. Over the next few pages you will be shown how to make the most of the learning features included in the textbook.

Features contained within your textbook

Every chapter begins with a contents list, an introduction to the topic, and the learning outcomes you should have achieved by the end of the chapter.

Fact boxes highlight need-to-know information.

Reflection boxes help you consider the wider implications of the topic or how it relates to your practice.

The glossary at the back of the book explains the meaning of the words in bold coloured text.

Every chapter ends with a summary listing the key points of the topic.

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How to use the companion website

Don't forget to visit the companion website for this book:

www.wiley.com/go/fundamentalsofinfectionprevention

There you will find valuable instructor and student material designed to enhance your learning, including:

interactive multiple choice questionsscenariosfact sheetswebsite content glossaryinstructions on how to access your free Wiley e-Text

The website contains a number of clinical practice scenarios to work through that are relevant to Chapters 2–5, 9–14 and 20–24.

They can be undertaken from any perspective (e.g. that of a nurse in training, infection control (IC) link practitioner, staff nurse or new-in-post infection prevention and control nurse) and they can be adapted to make them relevant to the reader's workplace.

The reader should apply his or her own local IC policies when responding to the questions where relevant. However, there aren't necessarily any right and wrong answers to some of the questions posed. This is because there are always slight differences in the application of the evidence base for infection prevention and control between different organisations, and therefore minor differences in local policy and practice.

Acknowledgements

I would like to thank:

My family and friends for their patience with me over the last 12 months or so.

The Infection Prevention and Control Specialist Nursing Team at East Kent Hospitals University NHS Foundation Trust for being so supportive – Sue Roberts, Alison Burgess, Zoe Nixon, Kathrin Penticost-Turnbull, Esther Taborn and Catherine Maskell.

I would particularly like to thank Zoe for her assistance with the Scenarios for Chapters 12 and 13 on the companion website.

Dr Angela Kearns at the Staphylococcus Reference Laboratory, HPA Colindale, London for the information regarding the evolution of MRSA and clones.

My very grateful thanks to those at Wiley in particular Magenta Styles, Executive Editor; Madeleine Hurd, Associate Commissioning Editor; Catriona Cooper, Project Editor; Angela Cohen, Production Manager; Cheryl Adam, Copy Editor and Kathy Syplywczak, Project Manager.

Introduction

This book is written with the intention of providing healthcare staff working within acute and primary care with a valuable and comprehensive text that will enable them to understand the theory behind the practice of infection prevention and control, and apply the principles in their day-to-day work. It is envisaged that this book will be a particularly useful resource for student nurses, nurses undertaking postgraduate education, staff nurses, ward or department managers, infection prevention and control link practitioners, and new-in-post infection prevention and control nurses. I hope that it will also be a resource for medical students and foundation year 1 junior doctors.

The book is in four parts. Part 1 consists of Chapters 1–10. Chapter1 introduces the reader to the problem of healthcare-associated infections (HCAIs), looking at the national and global burden of HCAIs, the risk factors for their development and the threat that infectious diseases pose to public health. It also briefly discusses the challenges of infection prevention and control in acute trust and primary care settings. Chapter2 describes the role of the infection prevention and control team and discusses the responsibility, accountability and duty of care that healthcare staff have regarding the prevention and control of infection. Chapter3 introduces audit and surveillance, and explains their value in HCAI prevention and reduction, and Chapter4 describes aspects of the investigation and management of clusters and outbreaks of infection. In Chapter5, the reader is introduced to the classification, structure and properties of bacteria and viruses, and is also introduced to some of the medically important viruses. Chapters6and7 aim to give the reader an insight into the importance of obtaining good-quality clinical specimens and the workings of the clinical microbiology laboratory, so that they will understand some of the processes that occur in order to identify the cause of the patient's infection, which in turn influences the patient's treatment. Chapter8 describes the basic components and functions of the immune system and how an immune response is generated in patients with an infection, giving rise to systemic signs and symptoms of illness. Chapter9 looks at sepsis and neutropenia. Part 1 concludes with Chapter10, which examines the problem of antimicrobial resistance and the implications for patient care and public health, and discusses specific antibiotic-resistant bacteria and associated infections.

In Part 2, Chapters11–15 focus on the basic principles of infection prevention and control and the underpinning evidence base for hand hygiene, the principles of isolation and cohort nursing, the use of personal protective equipment, the safe use and disposal of sharps, and cleaning.

In Part 3, Chapters16–19 focus on clinical practice in relation to the management of vascular devices and the prevention of bloodstream infections caused by them, the prevention and management of catheter-associated urinary tract infections, the prevention and management of surgical site infections, and the prevention and management of hospital and community-acquired pneumonia. In Part 4, Chapters20–24 are concerned with specific organisms and examine in detail Staphylococcus aureus (particularly meticillin-resistant S. aureus, or MRSA), tuberculosis, Clostridium difficile, norovirus and blood-borne viruses (HIV, hepatitis B and hepatitis C). Each organism is described along with the pathogenesis of infection, the clinical features of infection, laboratory testing and diagnosis, and the infection control management of infected or colonised patients, along with clinical practice points.

The book can be read as a whole from cover to cover, or dipped in and out of. All chapters are cross-referenced and contain learning outcomes, fact boxes, and reflection and clinical practice points. Throughout the book, reference is made to the evidence base arising from national and international guidance and Department of Health policies, drives and initiatives, and there is an emphasis on best practice.

The glossary at the back of the book explains words and terms used (in bold coloured print) in the text. It also directs the reader to the companion website at www.wiley.com/go/fundamentalsofinfectionprevention, where there are numerous fact sheets relating to specific organisms and infections (e.g. Neisseria meningitidis, the causative agent of meningococcal disease, and invasive group A streptococcal disease) and clinical practice points (such as aseptic non-touch technique), which are referred to within the chapters but not covered within the text in detail. The website also contains multiple choice questions (MCQs) and clinical practice scenarios for each chapter.

Note: Readers should always refer to the policies in the ‘Infection Prevention and Control Manual’ within their own place of work. There are often slightly different approaches and variations in local policies, although the basic principles are the same.

Part One

Introduction to infection prevention and control

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

1

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

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

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.

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.

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.

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.

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.