Introduction
Chapter I. Epidemiology of nosocomial infections
1.1 Definitions of nosocomial infections
1.2 Nosocomial infection sites
1.2.1 Urinary infections
1.2.2 Surgical site infections
1.2.3 Nosocomial pneumonia
1.2.4 Nosocomial bacteraemia
1.2.5 Other nosocomial infections
1.3 Microorganisms
1.3.1 Bacteria
1.3.2 Viruses
1.3.3 Parasites and fungi
1.4 Reservoirs and transmission
Chapter II. Infection control programmes
2.1 National or regional programmes
2.2 Hospital programmes
2.2.1 Infection Control Committee 9
2.2.2 Infection control professionals (infection control team)
2.2.3 Infection control manual
2.3 Infection control responsibility
2.3.1 Role of hospital management
2.3.2 Role of the physician
2.3.3 Role of the microbiologist
2.3.4 Role of the hospital pharmacist
2.3.5 Role of the nursing staff
2.3.6 Role of the central sterilization service
2.3.7 Role of the food service
2.3.8 Role of the laundry service
2.3.9 Role of the housekeeping service
2.3.10 Role of maintenance 14
2.3.11 Role of the infection control team (hospital hygiene service)
Chapter III. Nosocomial infection surveillance
3.1 Objectives
3.2 Strategy
3.2.1 Implementation at the hospital level
3.2.2 Implementation at the network (regional or national) level
3.3 Methods
3.3.1 Prevalence study
3.3.2 Incidence study
3.3.3 Calculating rates
3.4 Organization for efficient surveillance
3.4.1 Data collection and analysis
3.4.2 Feedback/dissemination
3.4.3 Prevention and evaluation
3.5 Evaluation of the surveillance system
3.5.1 Evaluation of the surveillance strategy
3.5.2 Feedback evaluation
3.5.3 Validity/data quality
Chapter IV. Dealing with outbreaks
4.1 Identifying an outbreak
4.2 Investigating an outbreak
4.2.1 Planning the investigation
4.2.2 Case definition
4.2.3 Describing the outbreak
4.2.4 Suggesting and testing a hypothesis
4.2.5 Control measures and follow-up
4.2.6 Communication
Chapter V. Prevention of nosocomial infection
5.1 Risk stratification
5.2 Reducing person-to-person transmission
5.2.1 Hand decontamination
5.2.2 Personal hygiene
5.2.3 Clothing
5.2.4 Masks
5.2.5 Gloves
5.2.6 Safe injection practices
5.3 Preventing transmission from the environment
5.3.1 Cleaning of the hospital environment
5.3.2 Use of hot/superheated water
5.3.3 Disinfection of patient equipment
5.3.4 Sterilization
Chapter VI. Prevention of common endemic nosocomial infections
6.1 Urinary tract infections (UTI)
6.2 Surgical wound infections (surgical site infections)
6.2.1 Operating room environment
6.2.2 Operating room staff
6.2.3 Pre-intervention preparation of the patient
6.2.4 Antimicrobial prophylaxis
6.2.5 Surgical wound surveillance
6.3 Nosocomial respiratory infections
6.3.1 Ventilator-associated pneumonia in the intensive care unit
6.3.2 Medical units
6.3.3 Surgical units
6.3.4 Neurological patients with tracheostomy
6.4 Infections associated with intravascular lines
6.4.1 Peripheral vascular catheters
6.4.2 Central vascular catheters
6.4.3 Central vascular totally implanted catheters
Chapter VII. Infection control precautions in patient care
7.1 Practical aspects
7.1.1 Standard (routine) precautions
7.1.2 Additional precautions for specific modes of transmission
7.2 Antimicrobial-resistant microorganisms
Chapter VIII. Environment
8.1 Buildings
8.1.1 Planning for construction or renovation
8.1.2 Architectural segregation
8.1.3 Traffic flow
8.1.4 Materials
8.2 Air
8.2.1 Airborne contamination and transmission
8.2.2 Ventilation
8.2.3 Operating theatres
8.2.4 Ultra-clean air
8.3 Water
8.3.1 Drinking-water
8.3.2 Baths
8.3.3 Pharmaceutical (medical) water
8.3.4 Microbiological monitoring
8.4 Food
8.4.1 Agents of food poisoning and foodborne infections
8.4.2 Factors contributing to food poisoning
8.4.3 Prevention of food poisoning
8.5 Waste
8.5.1 Definition and classification
8.5.2 Handling, storage and transportation of health care waste
Chapter lX. Antimicrobial use and antimicrobial resistance
9.1 Appropriate antimicrobial use
9.1.1 Therapy
9.1.2 Chemoprophylaxis
9.2 Antimicrobial resistance
9.2.1 MRSA (methicillin-resistant Staphylococcus aureus)
9.2.2 Enterococci
9.3 Antibiotic control policy
9.3.1 Antimicrobial Use Committee
9.3.2 Role of the microbiology laboratory
9.3.3 Monitoring antimicrobial use
Chapter X. Preventing infections of staff
10.1 Exposure to human immunodeficiency virus (HIV)
10.2 Exposure to hepatitis B virus
10.3 Exposure to hepatitis C virus
10.4 Neisseria meningitidis infection
10.5 Mycobacterium tuberculosis
10.6 Other infections
Annex 1. Suggested further reading
Annex 2. Internet resources
