Infection Control in the ICU Environment provides the details of the most common infection control problems facing intensive care units. Authors include noted scientists, intensivists and epidemiologists from the United States and Europe as well as infection control experts from the Centers for Disease Control and Prevention. Acinetobacter, methicillin resistant staphylococcus aureus and vancomycin resistant enterococci are examined in detail. This volume also includes cutting edge information regarding the potential for prophylactic and pre-emptive therapy of fungal infections in intensive care units. Innovations in vascular catheter care and prevention of bloodstream infections are discussed in this volume as well as the newest information in mathematical modeling to understand the epidemiology and control of infections in intensive care units.

This guideline defines ventilation and then natural ventilation. It explores the design requirements for natural ventilation in the context of infection control, describing the basic principles of design, construction, operation and maintenance for an effective natural ventilation system to control infection in health-care settings.

Intensive care is a rapidly changing area of medicine, and after four years from the 2nd edition the volume editors and authors have deemed necessary to update it. In the recent years, in fact, five new randomised controlled trials and five new meta-analyses demonstrate that selective decontamination of the digestive tract [SDD] is an antimicrobial prophylaxis to prevent severe infections of not only lower airways but also of blood. Additionally, SDD has been shown to reduce inflammation including multiple organ failure and mortality. An intriguing observation is the evidence that SDD using parenteral and enteral antimicrobials reduces rather than increases antimicrobial resistance. Moreover, a new chapter on microcirculation had been added. The volume will be an invaluable tool for all those requiring in depth knowledge in the ever expanding field of infection control.

With advances in technology and medical science, children with previously untreatable and often fatal conditions, such as congenital heart disease, extreme prematurity and pediatric malignancy, are living longer. While this is a tremendous achievement, pediatric providers are now more commonly facing challenges in these medical complex children both as a consequence of their underlying disease and the delivery of medical care. The term healthcare-associated infections (HAIs) encompass both infections that occur in the hospital and those that occur as a consequence of healthcare exposure and medical complexity in the outpatient setting. HAIs are associated with substantial morbidity and mortality for the individual patient as well as seriously taxing the healthcare system as a whole. In studies from the early 2000s, over 11% of all children in pediatric intensive care units develop HAIs and this figure increases substantially if neonatal intensive care units are considered. While progress has been made in decreasing the rates of HAI in the hospital, these infections remain a major burden on the medical system. In a study published in 2013, the annual estimated costs of the five most common HAIs in the United States totaled $9.8 billion. An estimated 648,000 patients developed HAIs in hospitals within the US in 2011 and children with healthcare-associated bloodstream infection have a greater than three-fold increased risk of death. While a number of texts discuss HAIs in the broader context of infectious diseases or pediatric infectious diseases (such as Mandell’s Principles and Practice of Infectious Diseases or Long and Pickering’s Principles and Practice of Pediatric Infectious Diseases) no single text specifically focuses on the epidemiology, diagnosis and management of HAI in children. Many infectious diseases texts are organized based on the microbiology of infection and from this starting point then discussing the clinical syndromes associated with the organism of interest. For instance, a chapter on Staphylococcus aureus may contain a brief discussion of the role of S. aureus in surgical site infections in the wider context of all staphylococcal disease. For clinicians caring for children at the bedside, however, the clinical syndrome is typically appreciated and intervention necessary prior to organism identification. We propose a text that details both the general principles involved in HAIs and infection prevention but also provides a problem oriented approach. Such a text would be of interest to intensivists, neonatologists, hospitalists, oncologists, infection preventionists and infectious diseases specialists. The proposed text will be divided into three principle sections: 1) Basic Principles of Infection Control and Prevention, 2) Major Infectious Syndromes and 3) Infections in Vulnerable Hosts. Chapters in the Major Infectious Syndromes section will include discussion of the epidemiology, microbiology, clinical features, diagnosis, medical management (or surgical management as appropriate) and prevention of the disease entity of interest. Chapters will seek to be evidenced based as much as possible drawing from the published medical literature as well as from clinical practice guidelines (such as those from the Infectious Diseases Society of America) when applicable. We intend to include tables, figures and algorithms as appropriate to assist clinicians in the evaluation and management of these often complex patients. Finally, we intend to invite authors to participate in this project from across a number of medical specialties including infectious diseases, infection control, critical care, oncology and surgery to provide a multidisciplinary understanding of disease. It is our intent to have many chapters be co-written by individuals in different subspecialties; for instance, a chapter on ventilator-associated pneumonia may be co-written by both infectious disease and critical care medicine specialists. Such a unique text has the potential to provide important guidance for clinicians caring for these often fragile children.

Critical care units are high-risk areas which contribute to increased health care costs and increased patient morbidity and mortality. Patients in critical care units are commonly confronted with existing and the potential to develop infections. Critical care practitioners play a crucial role as initial providers to critically ill patients with infections through the delivery of timely and appropriate therapies aimed to prevent and treat patient infections. The responsibility of critical care practitioners include prudent delivery of care to treat current infections as well as ensuring the delivery of care does not increase the development of new infections. Aggressive infection control measures are needed to reduce infections in critical care settings. Dissemination of scholarly work on the topic of infection in critically ill patients can play a role in improving patient outcomes. The information provided on infections in this issue of Critical Care Nursing Clinics promotes the dissemination of current literature on a series of timely and relevant infection topics in critical care environments.

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/

Presents best practices for infection prevention and control in advanced practice Emphasizes team approach for infection control Case study provided for each chapter This professional reference combines research on the best practices for infection control in clinical settings with essential information for advanced practice nurses and physician assistants. The book is organized by healthcare settings, and the coverage ranges from small practice offices to large hospitals and medical institutions. Each chapter is prefaced by a case study which is then incorporated into the theoretical material of the chapter as a continuing illustration. This format provides a reader-friendly instructional resource for advanced practice certifications and staff development. From the Foreword "At last is published a long-needed text for advanced practice nurses (APNs), providing them with the information essential to the care of essentially every patient they will encounter. Infection Control for Advanced Practice Professionals fills a void in the literature and recognizes the importance of a team approach to the prevention of infections in the variety of care settings in which APNs are practicing. The book is particularly timely and relevant because it appropriately places infection prevention solidly within the larger patient safety movement and affirms that preventing infections is everybody's concern. In acute care settings, for example, infection control has occasionally been relegated to the infection prevention specialist (e.g., infection control nurse or hospital epidemiologist) or the infection control committee. This has shown to be ineffective in any setting. It is those who "touch" the patients and oversee their care who must assume the responsibility for preventing untoward events such as infections. While not all infections are preventable, there is indeed room for improvement. This comprehensive reference is a first and essential step in that direction!" Elaine Larson, PhD, RN, FAAN, CIC Anna C. Maxwell Professor of Nursing Research Associate Dean for Research School of Nursing Professor of Epidemiology Joseph Mailman School of Public Health Columbia University Editor, American Journal of Infection Control TABLE OF CONTENTS Foreword Preface List of Contributors 1. Principles of Infection Control Joan Hebden 1.1. Case Presentation 1.2. Essential Content for Infection Control Skills 1.3. Creating and Sustaining a Culture of Safety 1.4. The Measurement of Performance 1.5. Team-led Performance Initiatives 1.6. Monitoring and Feedback 1.7. Creating an Action Plan for Performance Improvement 1.8. Making a Business Case for HAI Prevention 1.9. Interpretation/Application of Infection Control Data 1.10. Patient Safety and Health System Issues 1.11. Summary Points 1.12. References 2. Safe Infection Control in the Workplace Carol Patton and Denise M. Korniewicz 2.1. Case Presentation 2.2. Essential Content for Safe Infection Control in the Workplace 2.3. Employer Standards for Bloodborne Pathogen Precautions 2.4. Personal Protective Equipment (PPE) 2.5. Sharps Injuries 2.6. Designing Programs of Healthcare Worker Safety 2.7. Surveillance and Behavioral-based Performance of Healthcare Workers 2.8. Creating a Culture of Safe Infection Control Practices 2.9. References 3. Patient Safety and the Chain of Infection Joan Hebden 3.1. Case Presentation 3.2. Essential Content for Infection Control Skills 3.3. Interpretation/Application of Infection Control Data 3.4. Patient Safety and Health System: Infection Control Practices 3.5. Summary Points 3.6. References 4. Essentials of Epidemiologic Measures and Data Interpretation Maher M. El-Masri and Davy Tawadrous 4.1. Case Presentation 4.2. Measures of Disease Frequency 4.3. Measures of Disease-exposure Association 4.4. Statistical Probability (P. Value) 4.5. Clinical Versus Statistical Significance 4.6. Summary Points 4.7. References 5. Infection Control in Acute Care Settings Jeanne Hinton Siegel 5.1. Case Presentation 5.2. Essential Content for Infection Control 5.3. Hand Hygiene 5.4. Engineering Controls 5.5. New Monitoring Techniques 5.6. Use of Isolation to Prevent the Spread of Infections 5.7. Review of Healthcare Environments 5.8. Advanced Practice Professionals' Roles in Public Health 5.9. References 6. Infection Control in Critical Care Settings Mary Wyckoff 6.1. Case Presentation 6.2. Essential Content for Infection Control 6.3. Hospital Acquired Infections in Critical 6.4. Attributable Cost of Hospital Acquired Infections 6.5. How to Effectively Process Change 6.6. Conclusion and Summary Points 6.7. References 7. Infection Control in the Emergency Department Settings Michelle Wright 7.1. Case Presentation 7.2. Essential Content for Infection Control Skills 7.3. Precautions 7.4. Unknown Illness 7.5. Biochemical Agents 7.6. Trauma 7.7. Travel 7.8. Equipment Sharing 7.9. Patient Mobility 7.10. Overcrowding 7.11. Empirical Antibiotic Therapy 7.12. Novel Approaches 7.13. Summary Points 7.14. References 8. Infection Control in Primary Care Settings Carol Patton and Denise M. Korniewicz 8.1. Case Presentation 8.2. Essential Content for Infection Control Skills 8.3. Creating the Culture of Infection Control in Primary Care Settings 8.4. Strategies for Best Practices for Infection Control in Primary Care Settings 8.5. Summary Points 8.6. References 9. Infection Control Principles for Long-term Care Environments Judith Seltzer and Denise M. Korniewicz 9.1. Case Presentation 9.2. Essential Content for Infection Control Skills 9.3. General Environmental Issues (Wheelchairs, Hand Rails, Walkers, Cleaning Rooms) 9.4. Regulatory Measures 9.5. Summary Points 9.6. References 10. Infection Control in the Home Jeanette Adams 10.1. Case Presentation 10.2. Essential Content for Infection Control Skills 10.3. Health Care Providers 10.4. Multidrug-Resistant Organisms 10.5. Interpretation/Application of Infection Control Data 10.6. Discussion about Patient Safety and Health System Issues Related to ICP 10.7. Summary Points 10.8. References 11. Infection Control Practice in Mental Health Settings James Weidel 11.1. Case Presentation 11.2. Environment of Care of the Psychiatric/Mental Health Facility 11.3. Limited Access to Supplies 11.4. Linen and Clothing 11.5. Provider-Patient Interaction 11.6. Food Safety 11.7. Patient Handling of Food 11.8. Sanitation and Housekeeping 11.9. Risk Factors Associated with Infection Among Psychiatric Patients 11.10. Isolation 11.11. Transmission Based Precautions 11.12. Restraints and Infection Control 11.13. Conclusion 11.14. Summary Points 11.15. References 12. Infection Control in Ambulatory Surgical Centers Judith Seltzer 12.1. Case Presentation 12.2. Essential Content for Infection Control in Ambulatory Surgical Settings 12.3. Regulatory Influences 12.4. Infection Control Monitoring 12.5. Active Participation 12.6. Long-term Infection Control Principles in Ambulatory Surgical Settings 12.7. Summary Points 12.8. References 13. Infection Control in the Community Jeanette Adams 13.1. Case Presentation 13.2. Essential Content for Infection Control Skills 13.3. Food Borne Infections 13.4. Prevention of Infectious Diseases 13.5. Methicillin Resistant Staphylococcus Aureus (MRSA) 13.6. Clostridium Difficile (C-diff.) 13.7. Human Immunodeficiency Virus (HIV) 211 13.8. Interpretation/Application of Infection Control Data 13.9. Discussion about Patient Safety and Health System Issues Related To ICP 13.10. Summary Points 13.11. References 14. Infection Control for Emergency Mobile Health Units Michelle Wright 14.1. Case Presentation 14.2. Essential Content for Infection Control Skills 14.3. Vector Borne Illnesses 14.4. Overcrowding 14.5. Personnel Safety 14.6. Medically Trained Volunteers 14.7. Untrained Volunteers 14.8. Interpretation/Application of Infection Control Data 14.9. Patient Safety and Health System Issues 14.10. Summary Points 14.11. References 15. Future Issues in Monitoring for Safe Infection Control Practices Denise M. Korniewicz 15.1. Case Presentation 15.2. Essential Content Infection Control of the Future 15.3. Future Engineering Controls 15.4. Safety Through Knowledge 15.5. Future Patient Participation, Public Awareness and Patient Advocacy 15.6. Summary Points 15.7. References Index