Although nosocomial, or hospital-acquired, infections have been well cataloged and are fairly well understood, traditional solutions have failed to completely eliminate the problem. Even the most modern hospitals find themselves stymied by the persistence of these pathogens in hospital wards and operating rooms. The degree to which most of these infections are airborne is not known, but a growing body of evidence indicates that airborne transmission plays a role in many hospital-acquired infections.
Addressing one of the most important topics in health care, Hospital Airborne Infection Control is the first book to deal with the control of airborne nosocomial infections in detail. It identifies all pathogens known or suspected to be airborne, along with their sources in hospital environments. It also summarizes all epidemiological evidence for airborne transmission. The text addresses respiratory, surgical site, burn wound, immunocompromised, pediatric, nursing home, and non-respiratory infections. In each category, an extensive number of examples show that inhalation is not the only airborne route by which infections may be transmitted.
Noting that airborne transmission and surface contamination are virtually inseparable, the author emphasizes that both air and surface disinfection, including hand hygiene, are important factors in controlling the transmission of airborne disease. He also proposes a variety of new solutions and technologies, including ultraviolet, ionization, ozone, plasma, and vegetative air cleaning systems. A compendium of scientific and medical information, this book helps hospitals control nosocomial infections and outbreaks spread by the airborne route as well as by direct contact and contact with fomites or contaminated equipment.
Airborne Nosocomial Infections
Introduction
Nosocomial Infection Epidemiology
Airborne Nosocomial Pathogens
Airborne Infection Categories
Infection Control Precautions
Infections in Health Care Workers
Multidrug Resistance
Toward Airborne Infection Control
References
Airborne Nosocomial Epidemiology
Airborne Transmission Routes
Epidemiological Principles
Dosimetry of Airborne Disease
Survival of Microbes Outside the Host
Settling of Microbes in Air
References
Hospital Aerobiology
Introduction
Airborne Levels of Bacteria
Airborne Levels of Fungal Spores
Airborne Virus Levels
References
Airborne Nosocomial Microorganisms
Introduction
Airborne Nosocomial Pathogens
Airborne Nosocomial Bacteria
Airborne Nosocomial Viruses
Airborne Nosocomial Fungi
Database of Airborne Nosocomial Pathogens
References
Airborne Nosocomial Etiology
Introduction
Pathogen Aerosolization
Aerobiological Pathways
Airborne Transmission of Respiratory Infections
Airborne Transport of Fungal Spores
Shedding of Bacteria
Shedding of Clostridium difficile Spores
References
Hospital Facilities
Introduction
Hospital Ventilation and Filtration Systems
Hospital Zones and Rooms
Pressurization Control
References
Ventilation and Dilution
Introduction
Ventilation Dilution
The Steady State Model
Transient Modeling
Multizone Transient Modeling
References
Air Filtration
Introduction
Filters and Performance Curves
Filtration of Airborne Nosocomial Pathogens
HEPA and ULPA Filters
Face Masks and Respirators
References
Hospital Disinfection
Introduction
Cleaning, Disinfection, and Sterilization
Decontamination Methods
Disinfectants and Antiseptics
Disinfection of the Inanimate Environment
References
Hand Hygiene
Introduction
Skin Flora
Etiology of Hand Contamination
Strategies of Hand Hygiene
Skin Antiseptics
Handwashing Protocols
Generic Handwashing Protocol
References
Respiratory Infections
Introduction
Respiratory Tract Infections (RTIs)
Nosocomial Respiratory Infections
Nosocomial Pneumonia
Nosocomial Tuberculosis
References
Surgical Site Infections
Introduction
SSI Microbes
Aerobiology of Operating Rooms
Airborne SSIs
Airborne SSI Etiology
Control of Airborne SSIs
References
ICUs and Patient Rooms
Introduction
Intensive Care Units
Patient Rooms and General Wards
Hospital Laboratories
Other Hospital Areas
References
Pediatric Nosocomial Infections
Introduction
Pediatric Bacterial Infections
Pediatric Viral Infections
Nurseries and Childcare Facilities
References
Immunocompromised and Burn Wound Infections
Immunodeficiency Infections
Burn Wound Infections
Cancer Clinics
References
Nursing Homes
Introduction
Nursing Home Bacterial Infections
Nursing Home Viral Infections
Nursing Home Options
References
Procedural Controls and Guidelines
Introduction
Hygiene and Disinfection Procedures and Controls
Infection Management Procedures
Building and Facility Guidelines
References
Air and Surface Sampling
Introduction
Air Sampling with Settle Plates
Air Sampling with an Air Sampler
Surface Sampling
Virus Detection and Sampling
Air and Surface Disinfection Standards
References
UVGI Air Disinfection
Introduction
Airstream Disinfection
Air Handling Units
Recirculation Units
Upper-Room Systems
Barrier Systems
UV Air Disinfection Field Trials
Combination of UV and Filtration
References
UVGI Surface Disinfection
Introduction
UVGI Surface Disinfection Modeling
Equipment Disinfection
Whole Room Disinfection
Floor Disinfection
Overhead Surgical Site UV Systems
Cooling Coil Disinfection
References
Alternative Air Cleaning Technologies
Introduction
PCO Systems
Ozone
Ionization
Plasma and Corona Systems
Pulsed Light
Passive Solar Exposure
Vegetation Air Cleaning
Material Selectivity
References
Appendix: Database of Airborne Nosocomial Pathogens
Index
Biography
Wladyslaw Kowalski, PhD, PE, has authored numerous articles related to air cleaning technology, biodefense, and hospital air disinfection, and has authored books and contributed chapters on these subjects, including the ASHRAE HVAC Design Manual for Hospitals and Clinics. He consults with hospitals on indoor air quality issues, including mold and bacterial contamination problems, and investigates hospital infection problems using air and surface sampling. Dr. Kowalski designs air disinfection systems for hospitals and commercial buildings and speaks at international conferences on disease control and air cleaning topics. He is also secretary of the Air Treatment Group of the International Ultraviolet Association (IUVA). He is currently engaged in research on ultraviolet germicidal irradiation (UVGI) and is developing new types of UVGI air and surface disinfection systems for the health care industry.