Guide to Infection Control cover

The latest edition of A Guide to Infection Control in the Hospital is now available. This handy pocket-sized manual contains 51 chapters that explain key principles and guidelines for reducing the rate of nosocomial infections and practical measures intended to improve quality of care, minimize risk, save lives, and reduce costs.

In developed countries, anywhere from 5 to 10% of patients admitted to acute care hospitals acquire an infection which was not present or incubating on admission. The attack rate for developing countries can exceed 25%.

Because the illnesses, deaths, and added costs related to nosocomial infections, the field of infection control has grown in importance over the last 30 years. Although estimates vary regarding the proportion of nosocomial infections which are preventable, it may be as high as 20% in developed countries and as high as 40% or more in developing countries. Furthermore, in developed countries 5 to 10% of infections acquired in the hospital occur as part of an epidemic or cluster. The figure is larger for developing countries.

The emphasis, however, is that all nosocomial infections, clusters and outbreaks are potentially preventable, and that now, more than ever, opportunities are excellent for risk reduction interventions. At the center of this are the basic principles of good infection control.

Although our discipline, like others, is in constant evolution, this booklet contains the most up to date principles and interventions designed to reduce the rate of nosicomial infections. The chapters herein have been written by international authorities in infection control and hospital epidemiology. They are intended to improve quality of care, minimize risk, save lives, and reduce costs. As out intention is to publish and up to date guide every two years, we welcome your comments and thoughts as we proceed with future editions.

The English print version of the Guide may be purchased directly through the Society. The 4th edition of the Guide is available in Chinese. Individuals from developing countries may receive the Guide free of charge upon request by contacting ISID directly.

To contact ISID about the Guide, please send an email to

How to order the current English version or Chinese(4th Ed.) of the Guide:

Purchase the Guide by mail by sending payment and correspondence to the address at the bottom of the webpage.

The Infection Control Working Group intends to revise and update the Guide every two years. Feedback and comments from users of the Guide are welcome and encouraged.
Richard P. Wenzel, MD, MSc, Professor and Chairman, Department of Internal Medicine, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia, USA

Gonzalo M.L. Bearman, MD, MPH, Department of Internal Medicine, Associate Hospital Epidemiologist, Medical College of Virginia Campus, Virginia Commonwealth University, Richmond, Virginia, USA

Timothy F. Brewer, MD, MPH, FACP Director, Global Health Programs, McGill University Medical School, Montreal, Quebec, Canada

Jean-Paul Butzler, MD, PhD, Department of Human Ecology, Faculty of Medicine, Vrije Universiteit Brussel, Brussels, Belgium

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Chapter 1: Importance of Infection Control
Richard P. Wenzel, MD, MSc
Health is a high priority for any society, and infections remain a leading cause of disease globally. Those infections which occur among patients in hospitals and become manifest only after 48 hours of stay are called "nosocomial."

Chapter 2: Organization
Richard P. Wenzel, MD, MSc
A necessary feature for a successful program in infection control is dedicated leadership that creates a culture for excellence.

Chapter 3: Role of the Microbiology Laboratory in Infection Control
Mohamed Benbachir, PhD
The microbiology laboratory plays an important role in the surveillance, treatment options, control, and prevention of nosocomial infections.

Chapter 4: The Hospital Environment
William A. Rutala, PhD, MPH and David J. Weber, MD, MPH
In the last twenty-five years, evidence has accumulated that the hospital environment represents an important source of nosocomial pathogens for hospitalized patients.

Chapter 5: Waste Management
Mussaret Zaidi, MD
Infectious waste requires special procedures for handling, transport, and storage in order to prevent disease transmission to health care workers, waste management workers and the community.

Chapter 6: Reuse of Disposable Devices
Samuel Ponce de Leon R. MD, MSc
Reutilization of disposable devices is a common practice in most hospitals but there are no well-founded standard guidelines to assure the quality and the safety of this practice.

Chapter 7: Hand Hygiene
Professor Didier Pittet, MD, MS
Hand hygiene is the cornerstone of infection prevention. Health-care workers' compliance with hand hygiene practices remains low. Enhanced compliance is associated with decreased transmission.

Chapter 8: Isolation of Communicable Diseases
Bart Gordts, MD, MBA
The combination of standard precautions and isolation procedures represents an effective strategy in the fight against nosocomial transmission of infectious agents.

Chapter 9: Sterilization
Constanze Wendt, MD, MS
Critical medical devices must be sterilized and kept from being contaminated before use to avoid infections in patients exposed to them.

Chapter 10: Disinfection
Mussaret Zaidi, MD
Improperly disinfected medical equipment and devices can harbor microorganisms that cause infection. Environmental surfaces may also play an important role in the transmission of nosocomial pathogens.

Chapter 11: The Health Care Worker as a Source of Transmission
Margreet C. Vos, MD, Phd
Within the hospital, health care workers (HCWs) are often exposed to infections. Any transmissible disease can occur in the hospital setting and may affect HCWs. HCWs are not only at risk of acquiring infections but also of being a source of infection to patients. Therefore, both the patient and the HCW need to be protected from contracting or transmitting nosocomial infections by using recommended infection control measures.

Chapter 12: Antibiotic Resistance
Richard P. Wenzel, MD, MSc
Begun in the 1940's, the antibiotic era is under 70 years' duration, yet now is challenged by the worldwide increase in the incidence of resistance by microorganisms.

Chapter 13: Managing Antibiotic Resistance: What Works in the Hospital
Amy L. Pakyz, PharD, MS and Denise R. Kockler, PharmD, BCPS
Antibiotic resistence in the healthcare setting has emerged as a key factor for impacting patient outcomes and healthcare-related costs.

Chapter 14: Organizing and Recording Problems Including Epidemics
R. Samuel Ponce de Leon, MD, MSc, Alejandro Macias MD, MSc
Surveillance is the foundation for organizing and maintaining an infection control program.

Chapter 15: Keeping the Environment Safe with Limited Resources
Adriano G. Duse, MT, MBBCh, DTM&H, MMed (Microbiology), FCPath (SA)
Ever-increasing budgetary constraints and contracting out cleaning services have resulted in an overall deterioration in hospital hygiene practices in healthcare facilities of many developing countries.

Chapter 16: Patient Areas
Constanze Wendt, MD, MS
The patient environment harbors a number of potential reservoirs for pathogens.

Chapter 17: Food: Considerations for Hospital Infection Control
Susan Assanasen, MD and Gonzalo M.L. Bearman, MD, MPH
The responsibility of a hospital food service is to provide nutritious and safe food to patients and employees. Although food safety has dramatically improved in the lasgt decades, outbreaks of nosocomial gastroenteritis continue to occur worldwide.

Chapter 18: Hospital Water
M. Sigfrido Rangel-Frausto, MD, MSc
Hospital water is frequently an overlooked, important and controllable source of nosocomial infections.

Chapter 19: Laboratory Areas
Betty A. Forbes, PhD
Laboratory workers are exposed to a variety of potential occupational health risks that include infectious materials and cultures.

Chapter 20: The Pharmacy
Mary D. Nettleman, MD, MS and Elizabeth Nettleman, PharmD
A pharmacist can play a pivotal role in reducing infection throughout the hospital. The dissemination of infection from and to the pharmacy can be prevented.

Chapter 21: The Operating Room
Marie-Claude Roy, MD, MSc
Two to five percent of patients undergoing surgical procedures suffer from surgical site infections. These infections continue to burden surgical patients with important morbidity, mortality and immense cost.

Chapter 22: Emergency Room and Receiving Areas
Heike von Baum, MD and Richard P. Wenzel, MD, MSc
Healthcare workers in emergency rooms and receiving areas need to protect themselves from blood and air-borne infections and also recognize and attempt to isolate quickly all patients with infections posing a risk to nearby personnel, patients, and visitors.

Chapter 23: HIV Infection and AIDS in Developing Countries
Philippe Van de Perre, MD, PhD
Less than 20 years after it was first recognized in Africa, HIV infection is already the leading cause of adult deaths in many cities in developing countries, and it has significantly increased childhood mortality. Despite considerable efforts to control the epidemic, HIV continues to spread at a rapid pace in developing countries. Out of an estimated 42 million people infected with HIV worldwide as of December 2002, 70% of the adults and 90% of the children are living in developing countries.

Chapter 24: Tuberculosis
Timothy Brewer, MD, MPH
Tuberculosis (TB) remains one of the leading causes of preventable deaths in adults worldwide. The vast majority of TB cases and deaths occur in low-resource areas.

Chapter 25: Diarrhea
Made Sutjita, MD and Herbert L. DuPont, MD
A diarrheal disease outbreak in health care facilities may affect patients, healthcare workers, and visitors. Recognizing the risk factors, surveillance, and initiation of prompt infection control management practices will reduce the morbidity and mortality rate.

Chapter 26: Skin and Soft Tissue Infections
Antoni Trilla, MD, MSc
Skin and soft tissue (SST) infections are not uncommon in the hospital setting. In addition to localized complications, skin and soft tissue infections may cause life-threatening bacteremia or a sepsis syndrome.

Chapter 27: Bloodstream Infections
K Marhoum El Filali, and Hakima Himmich
Hospital acquired bloodstream infections (BSIs) are related to diagnostic and therapeutic invasive procedures. BSIs have been divided into two groups: primary BSIs, which occur without any other infectious site with the same organism at the time of BSI diagnosis (positive blood culture), and the secondary BSIs, which are subsequent to bacteraemia from another infectious site.

Chapter 28: Managing Vascular Catheters
Andreas Widmer, MD, MS
Intravascular catheters are frequent sources of bloodstream infections. Their prevention should be part of any infection control program. Surveillance for catheter-related bloodstream infections requires few resources compared to other nosomial infections, but has an important impact on the prevention of the most serious type of nosocomial infections: bloodstream infections.

Chapter 29: Hospital-Acquired Urinary Tract Infection
Emanuele Nicastri MD, PhD
"The decision to use the urinary catheter should be made with the knowledge that it involves risk of producing a serious disease." Even though this statement was made by Paul Beeson about fifty years ago, it is still relevant for both patients and health care workers.

Chapter 30: Pneumonia
Javier Ena, MD
Nosocomial pneumonia occures in 0.4 to 1.1% of hospitalized patients. It is the most common infection in intensive care units and the second most common cause of nosocomial infection overall.

Chapter 31: Diphtheria, Tetanus, Pertussis
Jack Levy, MD
Active immunization of the general population is effective to control the transmission of these infections in the community as well as an eventual risk in the hospital setting.

Chapter 32: Measles
Patrick De Mol, MD, PhD, and Phillippe Lepage, MD, PhD
Measles is caused by rubeola virus, one of the most contagious pathogenic agents known. Despite progress in global immunization, measles remains one of the major infectious causes of mortality in developing countries and is responsible for about 1 million deaths in children each year.

Chapter 33: Transfusions
Sigfrido Rangel Frausto MD, MSc, and Samuel Ponce de León R. MD, MSc
Although life-saving, transfusions are not infrequently associated with life-threatening complications. In the USA alone, between 10 and 12 million units are transfused every year. There is at least a 1% risk of complications but this risk is higher in other regions.

Chapter 34: Mechanical Ventilation
Stephan Harbarth, MD, MS and Didier Pittet, MD, MS
Mechanical ventilation is the main risk factor for hospital-acquired pneumonia in critically ill patients.

Chapter 35: Preparing the Patient for Surgery
Helen Giamarellou, MD
Appropriate skin preparation plus antimicrobial prophylaxis can decrease the incidence of both superficial and deep wound infections (surgical site infection) after certain operations.

Chapter 36: Infection Control in Obstetrics
J.A.J.W. Kluytmans, MD, PhD
Neonatal sepsis and postpartum endometritis can be largely prevented by simple infection control measuress. However, in developing countries they still cause substantial morbidity and mortality. Most infections are caused by microorganisms in the mothers' vaginal flora.

Chapter 37: The Infection Hazards of Human Cadavers
P.N. Hoffman , BSc HonDipHIC, T.D. Healing, MCs, PhD, and S.E. J. Young, FRCP
Cadavers may pose hazards to those handling them. ... None of the organisms that caused mass death in the past (e.g., plague, cholera, typhoid, tuberculosis, smallpox) is likely to survive long in burials.

Chapter 38: Streptococcus Pyogenes (Group A Streptococcus Infections)
Belinda Ostrowsky, MD, MPH
Handwashing is one of the most important infection control practices for the prevention of the spread of infection with Streptococcus pyogenes (Group A Streptococcus).

Chapter 39: Staphylococcus Aureus
Michael P. Stevens, MD, and Michael B. Edmond, MD, MPH, MPA
Staphylococcus aureus is a major human pathogen that commonly causes nosocomial and community-acquired infections. It is a highly virulent organism that is exhibiting increasing antibiotic resistance.

Chapter 40: Enterococcal Species
Michael P. Stevens, MD, and Michael B. Edmond, MD, MPH, MPA
Enterococci are important nosocomial pathogens because 1) they are the normal flora in the human gastrointestinal tract, 2) antimicrobial resistance allows for their survival in an environment with heavy antimicrobial usage, 3) they contaminate the hospital environment and survive for prolonged periods of time, and 4) contamination of the hands of healthcare workers coupled with poor hand washing compliance provides the potential for spread in the hospital.

Chapter 41: Pneumococcus
Roman Pallares, MD
Streptococcus pneumoniae (pneumococcus) remains a magor pathogen for human beings. In recent years, important changes in the epidemiology of pneumococcal infections have been observed....

Chapter 42: Legionella
Marc Struelens, MD, PhD
Nosocomial legionellosis (also called Legionnaires' disease) is a serious pneumonia caused by inhalation of Legionella in aerosols from a contaminated hospital water system. Prevention should be based on a risk management plan including targeted surveillance for cases, adequate design and manintenance of water distribution system and adherence to appropriate respiratory care practices.

Chapter 43: Bacterial Enteric Pathogens: Clostridium Difficile, Salmonella, Campylobacter, Shigella, Escherichia Coli, and Others
Awa Aidara Kane, PhD, Oliver Vandenberg, MD, Mahbubur Rahman, MD, PhD and Jean-Paul Butzler, MD, PhD
Clstridium difficile, Salmonella, Campylobacter, Shigella, Escherichia coli, Yersinia enterocolitica, Vibrio cholerae, and Vibrio parahaemolyticus are among the various agents which may cause acute gastrointestinal infections in long-term care facility residents and healthcare workers.

Chapter 44: Pertussis
Susan Assanasen, MD, and Gonzalo M.L. Bearman, MD, MPH
...Pertussis remains an important cause of infant death worldwide and continues to be a public health concern even in developed countries.

Chapter 45: Other Enterobacteriaceae
Heike von Baum, MD, Diane Franchi, MD, and Michael T. Wong, NM, MD
Enterobacteriaceae (other than enteropathogenic Salmonella, Shigella, and E. coli) are important nosocomial pathogens. More than 340 different types of beta-lactamases including extended spectrum beta-lactamases (ESBL) have been characterized in multidurg-resistant Enterobacteriaceae.

Chapter 46: Pseudomonas Aeruginosa
H. Wisplinghoff, MD, and Harald Seifert, MD
Pseudomonas aeruginosa is an important nosocomial pathogen that causes serious nosocomial infections and contributes significantly to morbidity and mortality.

Chapter 47: Helicobacter Pylori
Anne Dediste, MD, Jeanne-Marie Devaster, MD
Helicobacter pylori is the most prevalent chronic bacterial infection in humans, colonizing approximately 60% of the world's population.

Chapter 48: Fungi
Sergio B. Wey, MD
The incidence of nosocomial fungal infections has increased in recent years, and antibiotic resistence is an issue in some hospitals.

Chapter 49: Viruses
M.W.H. Wulf, MD, C.M.A. Swanink, MD, PhD, and Andreas Voss, MD, PhD
Viral infections are common in the community and can cause a variety of symptoms.

Chapter 50: Lessons from SARS
Richard P. Wenzel, MD, MSc
Severe acute respiratory syndrome (SARS) was one of the latest epidemics to challenge infection control experts in the early years of the 21st century. The etiology is a novel coronavirus execially capable of being transmitted in hospitals.

Chapter 51: Parasites
Tom van Gool, MD, PhD
Nosocomial parasitic infections are infrequently reported in developed countries. As a result, little attention is paid to these infections, which can resul tin under diagnosis and unwanted delay of installment of proper preventative measures. In developing countries, nosocomial outbreaks with parasitic infection probably are more common, but detection is hampered due to the high prevalence of parasitic infections in the population and the liimited financial resources.

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