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Hospital infection control. Setting up a cost-effective programme
Journal
of Hospital
Infection
(1993) 24, 243-244
Book Review Hospital Oxford:
infection control. Setting up a cost-effective programme. S. Mehtar. Oxford University Press (1992), 190 pp. ISBN O-l 9-26203 339.
Hospital infection control is still a relatively new discipline. Because of this, many current practitioners have gradually assimilated the growth of knowledge as the field has developed. Such individuals may take for granted the underpinnings for a sound programme, and not make these clear to the beginner in the field. Dr Mehtar’s book assists these novices by reviewing principles behind current policies, and by offering suggestions about minimal requirements and standards to produce a good infection control practice. The book begins by providing a useful summary of nosocomial pathogens, sources of infection, routes of transmission and patient factors increasing infection risk. Features of the organization and management of an infection control programme are included, with useful details about the role and membership of the infection control committee, policy development, and training needs of staff. Specific examples of well presented key policies include disinfection and sterilization, waste management, handling and disposal of sharps, and antibiotic usage. Suggested procedures are also given for handwashing (distinguishing between ‘social’ and ‘aseptic’ methods), IV therapy administration, urinary Included in each are catheterization, wound care, and the like. recommendations, such as changing masks after each operation, that may be obvious to veterans in the field but quite helpful to the beginner. Especially clear is a concise summary of outbreak investigations, with a description of the steps to follow in a suggested priority order. The back cover, preface, and foreword by Professor G. A. J. Ayliffe all note a specific emphasis on good practice within the limits of small budgets, focusing on minimal requirements and standards that are ‘based on current practices in countries with well-developed programmes.’ To this end, alternative methods are often presented for use when resources to implement recommended strategies are unavailable. For example, methods are detailed for manual cleaning of surgical instruments where automated washers are impractical, and for use of pressure cookers to disinfect solid metal instruments where electricity or gas are unavailable. More controversial might be the suggestion for use of autoclaving or glutaraldehyde to recycle urinary catheters. Fortunately, along with these details are cautions about the disadvantages of recycling measures and 0195-6701,93:070243+02
$08 (IO,‘0
243
244
Book Review
listing of areas where recycling should be avoided if at all possible, such as the re-use of syringes and needles. Some recommendations might not be thought particularly cost-effective in the USA. For example, it is recommended that surgical patients be screened for hepatitis B and human immunodeficiency viruses. Special precautions then are to be taken for ‘infected patients,’ including special labelling of linen as ‘infected’ and of contaminated equipment as ‘high risk.’ These categories necessitate special handling and reprocessing. In the USA, current thinking suggests general infection control precautions for all patients. Likewise, in the book bedpans receive more attention than might be given in the USA, where priority for the use of scarce resources probably would not be given to bedpan sterilizers. The book would be of most benefit for new practitioners in the UK, although some aspects will assist the experienced worker as well. In developing countries, it will be useful primarily to those adopting UK regulations and using the same jargon. For example, the waste handling recommendations focus on placing clinical waste in colour coded bags, using a UK coding scheme. Likewise, explanations of ward design are specific to European layouts, such as ‘nightingale,’ ‘race track,’ or ‘bay’ wards. Regulations cited are UK or European, and often are not described or explained (e.g., sharps containers in the UK ‘must comply with BS 89/52770’). Most of the references presented at the end are from the British literature and The Journal of Hospital Infection is the only infection control journal listed (for this review, perhaps this should be applauded!). All in all, this book represents a laudable approach and (as Ayliffe suggests in the foreword) ‘fills an important gap.’
J. E. McGowan, G. Pugliese
Jr.
Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA American Hospital Association, Chicago, Illinois, USA
of Hospital
Infection
(1993) 24, 243-244
Book Review Hospital Oxford:
infection control. Setting up a cost-effective programme. S. Mehtar. Oxford University Press (1992), 190 pp. ISBN O-l 9-26203 339.
Hospital infection control is still a relatively new discipline. Because of this, many current practitioners have gradually assimilated the growth of knowledge as the field has developed. Such individuals may take for granted the underpinnings for a sound programme, and not make these clear to the beginner in the field. Dr Mehtar’s book assists these novices by reviewing principles behind current policies, and by offering suggestions about minimal requirements and standards to produce a good infection control practice. The book begins by providing a useful summary of nosocomial pathogens, sources of infection, routes of transmission and patient factors increasing infection risk. Features of the organization and management of an infection control programme are included, with useful details about the role and membership of the infection control committee, policy development, and training needs of staff. Specific examples of well presented key policies include disinfection and sterilization, waste management, handling and disposal of sharps, and antibiotic usage. Suggested procedures are also given for handwashing (distinguishing between ‘social’ and ‘aseptic’ methods), IV therapy administration, urinary Included in each are catheterization, wound care, and the like. recommendations, such as changing masks after each operation, that may be obvious to veterans in the field but quite helpful to the beginner. Especially clear is a concise summary of outbreak investigations, with a description of the steps to follow in a suggested priority order. The back cover, preface, and foreword by Professor G. A. J. Ayliffe all note a specific emphasis on good practice within the limits of small budgets, focusing on minimal requirements and standards that are ‘based on current practices in countries with well-developed programmes.’ To this end, alternative methods are often presented for use when resources to implement recommended strategies are unavailable. For example, methods are detailed for manual cleaning of surgical instruments where automated washers are impractical, and for use of pressure cookers to disinfect solid metal instruments where electricity or gas are unavailable. More controversial might be the suggestion for use of autoclaving or glutaraldehyde to recycle urinary catheters. Fortunately, along with these details are cautions about the disadvantages of recycling measures and 0195-6701,93:070243+02
$08 (IO,‘0
243
244
Book Review
listing of areas where recycling should be avoided if at all possible, such as the re-use of syringes and needles. Some recommendations might not be thought particularly cost-effective in the USA. For example, it is recommended that surgical patients be screened for hepatitis B and human immunodeficiency viruses. Special precautions then are to be taken for ‘infected patients,’ including special labelling of linen as ‘infected’ and of contaminated equipment as ‘high risk.’ These categories necessitate special handling and reprocessing. In the USA, current thinking suggests general infection control precautions for all patients. Likewise, in the book bedpans receive more attention than might be given in the USA, where priority for the use of scarce resources probably would not be given to bedpan sterilizers. The book would be of most benefit for new practitioners in the UK, although some aspects will assist the experienced worker as well. In developing countries, it will be useful primarily to those adopting UK regulations and using the same jargon. For example, the waste handling recommendations focus on placing clinical waste in colour coded bags, using a UK coding scheme. Likewise, explanations of ward design are specific to European layouts, such as ‘nightingale,’ ‘race track,’ or ‘bay’ wards. Regulations cited are UK or European, and often are not described or explained (e.g., sharps containers in the UK ‘must comply with BS 89/52770’). Most of the references presented at the end are from the British literature and The Journal of Hospital Infection is the only infection control journal listed (for this review, perhaps this should be applauded!). All in all, this book represents a laudable approach and (as Ayliffe suggests in the foreword) ‘fills an important gap.’
J. E. McGowan, G. Pugliese
Jr.
Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA American Hospital Association, Chicago, Illinois, USA