CRC - Ayliffe's Control of Healthcare-Associated Infection A Practical Handbook

Organization: CRC
Publication Date: 29 May 2009
Page Count: 502


This handbook was first produced as infection control guidance for the West Midlands Region of the UK in the early 1970s. The first edition, published in 1975, was widely used throughout the UK and many other countries. The original contributors were mainly microbiologists, surgeons and physicians from the Midlands, and the original editors, Edward Lowbury, Graham Ayliffe, Alasdair Geddes and David Williams continued to edit and contribute to the recommendations in the second and third editions. For this, the fifth edition, the editors are Adam Fraise and Christina Bradley. It became clear to the current editors that tasks such as this can no longer be based on the opinion of a small group of experts. No matter how knowledgeable the group may be, there is now a requirement for recommendations to be based on sound published evidence or, at the least, the experience of an acknowledged expert in the field concerned. For this reason, a decision was taken to extend the authorship to bring in experts in particular areas of infection prevention and control. All chapters have been revised and some have been significantly overhauled. Others are completely new contributions.

In recent years the focus has changed from infection control to that of prevention. In the UK the introduction of the Code of Practice for the prevention and control of healthcare-associated infection has been paramount in bringing the importance of infection prevention and control to a higher level. In addition, guidelines and standards now identify the roles and responsibilities of individuals when it comes to the management of infection prevention.

The basic techniques and problems of prevention of infection are mainly similar to those described in previous editions, but clinical techniques have progressed and some 'new' and 'old' infections have emerged or re-emerged as major problems.

The increased use of heat-labile equipment, particularly flexible endoscopes, has highlighted the necessity for effective decontamination methods. The importance of cleaning medical and other equipment, particularly with respect to minimizing the risk of transmission of prion-related disease, continues to be stressed, and automated machines have provided improved standards of cleaning and patient and staff safety.

The problems of bloodborne viruses (hepatitis B and C, and HIV) continue to influence hospital practice, and guidance on preventing transmission to and from healthcare workers has been published by government agencies in most countries. One of the major problems world-wide is the increase in antibioticresistant strains of bacteria, mainly in hospitals, but also in the community and in animal husbandry. Epidemic strains of methicillin-resistant Staphylococcus aureus (MRSA) have spread in hospitals in most countries, and have proved difficult to control without considerable resources and expenditure. The reports of vancomycin-resistant strains are particularly worrying. Highly resistant strains of Gram-negative bacilli also continue to spread in hospitals, and outbreaks of Clostridium difficile and norovirus are an unfortunate, but frequent occurrence. Highly resistant strains of Mycobacterium tuberculosis are causing therapy problems in many parts of the world, particularly in developing countries, and isolation facilities for patients with resistant organisms are often inadequate.

The possibility of reducing resistance by controlling the use of antibiotics is a logical approach, but so far the implementation of effective policies has proved difficult in most situations. Clinicians are loath to restrict the use of any effective antibiotic in the treatment of individual patients. Infection control techniques can have a greater initial influence on the spread of resistant organisms in hospitals, and are easier to implement. However, a combined approach of antibiotic restriction, effective surveillance and good infection control practices is essential if antibiotic resistance is to be overcome.

The costs of hospital care have increased considerably, and the use of evidence- based guidelines and the elimination of rituals applies as much to infection prevention and control as to other aspects of care. Claims for negligence in many countries are now very high and they redirect urgently needed funds away from patient care. Improvements in quality control, the use of audits and risk assessment are therefore being encouraged by most governments. The effect of these methods on patient outcome (e.g. infection rates) is an obvious criterion for administrators wishing to demonstrate the quality of their services. Surveillance of infection alone can reduce infection but, depending on the method chosen, it can also provide useful information on infection rates. However, the use of rates to compare the incidence of infection in different hospitals is still rarely possible owing to the problem of correcting for risk factors and the early discharge of patients from hospital. Patient care in hospitals and the community is becoming more closely integrated, and the community section in this book has been expanded in order to address administrative structure, outbreaks of infection and the particular problems of infection control in the community.

In recent years, Directives and many international and European standards have been published, as well as guidelines from government agencies and professional organizations. European legislation and standards represent a consensus of opinion from many countries, often with different infection control philosophies, and they may not be appropriate throughout Europe or elsewhere. Many of these regulations and guidelines have been referenced in this book, but these recommendations are not necessarily endorsed where they are considered to be inappropriate.

It is hoped that the book will continue to be of interest and useful to infection control workers in all countries. Infection prevention and control staff should make their own assessments based, where possible, on scientific evidence or on knowledge of the behaviour of micro-organisms in the patient and in the environment. The safety of patients and staff is the main consideration, and all hospitals should have infection control procedures based (where relevant) on national guidelines.

Although this edition is more thoroughly referenced than previous editions, it is still intended as a practical guide. It has been prepared for use by all personnel involved, either directly or indirectly, with infection prevention and control. It is intended for infection control staff, other doctors and nurses, physiotherapists, radiographers and others involved in the treatment and care of patients. It will also be useful in part for administrators, architects, engineers, pharmacists, sterile services staff, domestic and catering managers and others whose work may influence the risk of infection among patients and staff.

Sadly, Professor Lowbury who was co-editor of the first three editions of this book died in 2007 and we would like to acknowledge the contribution that he played in the field of infection control and prevention.