This updated and expanded second edition of Antiseptic Stewardship serves as a comprehensive reference guide to common biocidal active substances and antiseptic agents, examining their antimicrobial efficacy and potential to induce cell tolerance, including cross-tolerance to other biocidal agents, as well as cross-resistance to antibiotics. In addition, the book discusses the appropriate and targeted use of biocidal active substances by balancing their expected health benefits against the likelihood of clinically relevant resistance, including misuse and overuse of some products during the COVID-19 pandemic. This guide, which focuses on human, veterinary and household products, helps readers make informed decisions about disinfectants and antiseptic products based on their composition. Various biocidal active substances and antiseptic agents are used for disinfection and antisepsis in healthcare, veterinary medicine, animal production and household products. However, not all of them provide significant health benefits, especially for some products used in human medicine. Antimicrobial soaps, surface disinfectants, instrument disinfectants and wound antiseptics may contain one or more biocidal active ingredients with comparable antimicrobial efficacy, but with large differences in their potential for microbial adaptation and tolerance. Increased bacterial tolerance has been described for several biocidal active substances and antiseptics, sometimes including cross-resistance to antibiotics. The book is therefore intended to help reduce unnecessary selection pressure on emerging pathogens, including by describing non-biocidal alternatives for specific antimicrobial applications, with the aim of retaining the powerful biocidal agents and antiseptics for those applications where there is a clear health benefit (e.g. reduction of healthcare-associated infections). The book addresses healthcare, industrial and veterinary professionals as well as educated laypersons interested in efficient and controlled disinfection strategies.

Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem with an impact on morbidity, mortality and quality of life. At any one time, up to 7% of patients in developed and 10% in developing countries will acquire at least one HAI. These infections also present a significant economic burden at the societal level. However, a large percentage are preventable through effective infection prevention and control (IPC) measures. These new guidelines on the core components of IPC programmes at the national and facility level will enhance the capacity of Member States to develop and implement effective technical and behaviour modifying interventions. They form a key part of WHO strategies to prevent current and future threats from infectious diseases such as Ebola, strengthen health service resilience, help combat antimicrobial resistance (AMR) and improve the overall quality of health care delivery. They are also intended to support countries in the development of their own national protocols for IPC and AMR action plans and to support health care facilities as they develop or strengthen their own approaches to IPC. These are the first international evidence-based guidelines on the core components of IPC programmes. These new WHO guidelines are applicable for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

The clinical microbiology laboratory is often a sentinel for the detection of drug resistant strains of microorganisms. Standardized protocols require continual scrutiny to detect emerging phenotypic resistance patterns. The timely notification of clinicians with susceptibility results can initiate the alteration of antimicrobial chemotherapy and

Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between £814 and £6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.

Antimicrobial Stewardship (AMS), Volume Two includes the experience of ESGAP workshops and courses on antibiotic stewardship since 2012. It combines clinical and laboratory information about AMS, with a focus on human medicine. The ESCMID study group on antibiotic policies (ESGAP) is one of the most productive groups in the field, organizing courses and workshops. This book is an ideal tool for the participants of these workshops. With short chapters (around 1500 words) written on different topics, the authors insisted on the following points: A 'hands on', practical approach, tips to increase success, a description of the most common mistakes, a global picture (out- and inpatient settings, all countries) and a short list of 10-20 landmark references. - Focuses on the most recent antimicrobial stewardship strategies - Provides a detailed description of laboratory support - Offers a balanced synthesis of basic and clinical sciences for each individual case, presenting clinical courses of the cases in parallel with the pathogenesis and detailed microbiological information for each infection - Describes the prevalence and incidence of the global issues and current therapeutic approaches - Presents the measures for infection control

This Open Access volume provides in-depth analysis of the wide range of ethical issues associated with drug-resistant infectious diseases. Antimicrobial resistance (AMR) is widely recognized to be one of the greatest threats to global public health in coming decades; and it has thus become a major topic of discussion among leading bioethicists and scholars from related disciplines including economics, epidemiology, law, and political theory. Topics covered in this volume include responsible use of antimicrobials; control of multi-resistant hospital-acquired infections; privacy and data collection; antibiotic use in childhood and at the end of life; agricultural and veterinary sources of resistance; resistant HIV, tuberculosis, and malaria; mandatory treatment; and trade-offs between current and future generations. As the first book focused on ethical issues associated with drug resistance, it makes a timely contribution to debates regarding practice and policy that are of crucial importance to global public health in the 21st century.