Guide to Infection Control in the Hospital

The field of infection prevention has grown in importance over the last 30 years. The science of infection prevention, like others, is in constant evolution. With the collaboration of international leaders and front line practitioners from around the world, we summarize the most up to date principles, interventions, and strategies for maximizing the reduction of healthcare associated infections.

The chapters herein are intended to facilitate the implementation of effective infection prevention and control measures across different resource levels, improve quality of care, minimize risk, save lives, and reduce costs.

[NOTE: We are uploading chapter summaries and full PDF chapter downloads on a rolling basis. Please check back for new content in the coming weeks!]

  • About the Guide

    The WHO estimates that every year hundreds of millions of people from across the global are affected by often avoidable healthcare-associated infections, a large proportion of which are caused by antibiotic resistant organisms.

    Written by international experts in the fields of infection control and hospital epidemiology, the ISID’s A Guide to Infection Control in the Hospital brings together the most up-to-date principles and interventions that can reduce the rate of infection and the impact of associated consequences for patients, their families, and healthcare systems including: lengthier hospital stays; long-term disability; increased anti-microbial resistance; higher financial costs; and unnecessary deaths.

    As the field of infection prevention grows in importance and the science supporting it continues to evolve, the Guide’s objectives are to facilitate the implementation of effective prevention and control measures across different resource levels to improve quality of care; minimize risk; save lives; reduce costs; and limit the use of antibiotics to fight these often preventable infections around the world.

    The Society’s ambition is to update and re-publish the Guide every two years. We welcome your ideas and suggestions for improving future editions.

    When I was on sabbatical at the London School of Hygiene and Tropical Medicine (1985-86), I became a friend of Jean-Paul Butzler, a distinguished medical microbiologist in Brussels and recent President of ISID. He introduced me to several leading medical microbiologists throughout Europe, convinced me that a Guide to Infection Control in the Hospital would have global interest, and that I needed to edit such a document. I assembled a team of international authors who were enthusiastic supporters of the project, and my only condition was that no author or editor made money from the project and that it would be distributed free to all medical personnel in developing nations. Within a few years, we had increasing requests to translate the Guide into various languages, adding to its value. Our team at VCU supported the Fifth Edition especially, and I am pleased to pass the baton to Dr Gonzalo Bearman.

    Richard P. Wenzel MD,MSc
    18 December 2017

  • Editor Bios

    Gonzalo Bearman MD, MPH, FACP, FSHEA, FIDSA

    Gonzalo Bearman is the Chair of the Division of Infectious Diseases, Richard P. Wenzel Professor of Internal Medicine and Hospital Epidemiologist at the Virginia Commonwealth University Health System. He is a graduate of Colgate University (BA), SUNY at Buffalo School of Medicine and Biomedical Sciences (MD) and Columbia University (MPH). He completed a residency in Internal Medicine and was Chief Resident, both at SUNY at Buffalo. He then completed a fellowship in Infectious Diseases and a residency in Preventive Medicine/Public Health, both at Cornell University. Dr. Bearman is Board Certified in Internal Medicine, Infectious Diseases, and General Preventive Medicine and Public Health.

    Since 2005, Dr. Bearman has worked on the VCU Global Health Program through the Honduras Medical Relief Brigade, a medical relief effort bringing medical and public health assistance to rural Honduran communities. In 2013, Dr. Bearman launched the Medical Literary Messenger, an online magazine for humanities and medicine, where he serves as the Editor in Chief. He serves as a section editor for Current Infectious Diseases Reports and as Editor in Chief of Current Treatment Options in Infectious Diseases. From 2013-2015, Dr. Bearman was the Chair of the Society for Healthcare Epidemiology of America’s (SHEA) Guidelines Committee.

    His areas of research focus on the epidemiology of hospital-acquired infections. Dr. Bearman has multiple peer-reviewed publications in Annals of Internal Medicine, Archives of Internal Medicine, Archives of Medical Research, Clinical Infectious Diseases, Infection Control and Hospital Epidemiology, Journal of Clinical Microbiology, Current Infectious Diseases Reports, American Journal of Infection Control, BioMedCentral Infectious Diseases, Infections in Medicine, Journal of Rural and Remote MedicineJournal of Hospital Infection, and Journal of Infection.

    Michelle Doll, MD, MPH

    Michelle Doll is an Assistant Professor of Internal Medicine at Virginia Commonwealth University (VCU) and an Associate Hospital Epidemiologist for the VCU Medical Center. She is a graduate of Jefferson Medical College and completed her medical residency and chief residency at Temple University Hospital. She went on to complete a clinical Infectious Disease Fellowship at the University of Maryland Medical Center, as well as a Hospital Epidemiology Fellowship and Masters of Public Health at VCU. She has worked as a volunteer faculty preceptor for medical students in Puentes de Salud Clinic in Philadelphia, Pennsylvania and currently at Crossover Clinic in Richmond, Virginia, both of which provide healthcare services to local under-served populations.

    Shaheen Mehtar, MBBS, FRCPath (Eng), FCPath (SAfrica), MD (Lon)

    Shaheen Mehtar is Professor(retired) at the Unit for Infection Prevention and Control (UIPC), Division of Global Health, Faculty of Health Sciences, Stellenbosch University, South Africa. She trained in the United Kingdom in Medical Microbiology, Infectious Disease and Community Health. She was Head of Microbiology at the North Middlesex Hospital and was a Senior Lecturer at the Royal Free Hospital. Following a post as Deputy Director of Public Health in the South Cape Karoo region, she moved to Tygerberg Hospital and Stellenbosch University where she established the Unit of Infection Prevention and Control in 2004. The Unit is well known across Africa and has trained more than 250 students annually ranging from a 5-day basic course to Master’s degree programs in Infection Prevention and Control (IPC).

    Prof. Mehtar is an internationally recognised expert in IPC and has been involved in setting up IPC programmes in India, the UK, Europe, Africa, the Far East, Asia, and Latin America. She has been on the executive committees of several prestigious international organisations. She currently serves on several WHO committees including those for global IPC policies, surgical site infections, WASH, and safety injection global network (SIGN).

    Prof. Mehtar is a founding member, and Chair, of the Infection Control Africa Network (ICAN). Through ICAN, she is extensively involved in establishing and promoting IPC and antimicrobial stewardship training programmes and structures across Africa. She and ICAN supported the IPC programmes during the Ebola outbreak in Sierra Leone. Prof. Mehtar is a highly respected and recognised world expert in Infection Control and is frequently consulted by governments such as Egypt, Namibia, Swaziland and Zimbabwe.

    She has published extensively with over 140 papers in peer review journals to her name. She has authored two books and several chapters in books; she reviews for seven highly prestigious journals on infectious diseases.

    Prof. Ziad A. Memish

    Prof. Ziad Memish is currently a senior consultant in infectious diseases and head of the Research Department at the Prince Mohamed Bin Abdulaziz Hospital in Riyadh, Saudi Arabia Ministry of Health; Professor at the College of Medicine in Alfaisal University, Riyadh Saudi Arabia; Adjunct Professor in the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Georgia, USA; and Adjunct Professor at the Liverpool School of Tropical Medicine, Liverpool, UK.

    Prof. Memish obtained his MD from the University of Ottawa, Canada in 1987 and is Board certified by the American Board of Internal Medicine, the American Board of Infectious Diseases as well as a Fellow of the Royal College of Physicians (Canada, Edinburgh and London) and the American College of Physicians. He is widely recognized as a pioneer in Mass Gathering Medicine and Infection Control and established the WHO Collaborating Center for Mass Gathering Medicine in the Ministry of Health and the WHO Collaborating Center for Infection Control in Saudi National Guard Health Affairs. He was the first Deputy Minister of Health for Public Health, KSA (2009-2014).

    He has presented many abstracts and plenary talks internationally and published more than 550 peer reviewed papers and book chapters. He is the editor-in-chief of two journals: Journal of Epidemiology & Global Health published by Elsevier and indexed in PubMed and the Journal of Health Science, a flagship journal of the Saudi Commission for Health Specialties published by Medknow. He is a recipient of the King Abdulaziz Medal from the First Degree, the highest national award in Saudi Arabia for achievements in the field of infectious diseases and infection control.

    Victor Rosenthal, MD

    Dr. Rosenthal is a specialist in Internal Medicine and Infectious Diseases in Buenos Aires. He completed an Infectious Diseases fellowship at the University of Wisconsin, USA. He is a graduate in Clinical Effectiveness from Harvard University. He is certified in Infection Control and Hospital Epidemiology.

    Dr. Rosenthal is the founder and chairman of the International Nosocomial Infection Control Consortium (INICC), a nonprofit international research center which focuses on healthcare-associated infections. INICC brings together 3,000 researchers in 66 countries, spanning all six WHO regions. The consortium conducts multinational clinical studies with more than 300,000 patients.

    Dr. Rosenthal has collaborated with the US Center for Diseases Control and Prevention (CDC) and currently collaborates with the Microbiology Lab of the US Navy (NAMRU) on international infection control programs. He is a co-author of the Joint Commission International Guidelines to prevent central line associated blood stream infections. He is a Task Force member and reviewer of the Infection Control Guidelines for the World Health Organization (WHO). He has collaborated to develop editions of the Infection Control Guidelines of Argentina, Brazil, Colombia, Peru, Hong Kong, Taiwan, China and several other countries.

    He is an editorial board member and scientific reviewer of several international peer reviewed journals, such as the Lancet, the American Journal of Infection Control (AJIC); Infection Control and Hospital Epidemiology (ICHE); and several others. He is the author of more than 400 scientific publications and book chapters and has received several awards granted at different international scientific meetings, including SHEA, APIC, IFIC, Pan American Meetings, and others.

    Michael Stevens, MD, MPH, FACP, FIDSA, FSHEA

    Mike Stevens is an Associate Professor of Internal Medicine at Virginia Commonwealth University (VCU) where he is also an Associate Hospital Epidemiologist, the director of the medical center’s Antimicrobial Stewardship Program, the Associate Chair of the Division of Infectious Diseases, and the Associate Program Director for Global Health for VCU’s Internal Medicine Residency Program. He is also the director of the medical center’s Travel & Tropical Medicine Clinic. He is a graduate of the VCU School of Medicine (MD) and was a resident and a chief resident in Internal Medicine at VCU where he also completed fellowships in Infectious Diseases and Hospital Epidemiology. He completed a Master of Public Health degree at VCU. He is board certified in Internal Medicine and Infectious Diseases by the American Board of Internal Medicine. He is a Fellow of the American College of Physicians, the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.

  • Open Access Infection Prevention and Control Resources





    Western Pacific

  • Chapter 3: Role of the Microbiology Laboratory in Infection Control


    The microbiology laboratory plays an important role in the surveillance, treatment, control and prevention of nosocomial infections. This chapter summarizes the role of the microbiologist in the hospital infection control committee and antimicrobial stewardship group, the technical revolution taking place inside the hospital microbiology laboratory, and its importance in disease surveillance, notification and outbreak management.

    View full chapter 3

  • Chapter 4: Antibiotic Resistance


    It is estimated that 700,000 people globally die from drug-resistant infections yearly. Unless major actions are taken this number is projected to rise to 10 million yearly by 2050 at an economic impact of 100 trillion dollars per year. This chapter summarizes facts, controversial issues and suggested practices to control the emergence of drug resistance in the healthcare setting.

    View full chapter 4

  • Chapter 5: Waste Management


    Infectious waste has the potential to transmit disease and should be collected, transferred, and disposed of in a manner that decreases the risk of injury to healthcare workers, waste management workers, patients, and the community. This chapter summarizes key steps in waste management in hospitals.

    View full chapter 5

  • Chapter 6: Hand Hygiene


    Hand hygiene is the cornerstone of infection prevention and is associated with decreased disease transmission, reduced infection rates, and reduced antimicrobial resistance transfer. This chapter describes multimodal approaches that improve healthcare worker hand hygiene compliance.

    View full chapter 6

  • Chapter 7: Isolation of Communicable Diseases


    Key factors in achieving effective containment of healthcare associated transmission in all hospitals are the availability of the necessary financial and logistic resources as well as the compliance of healthcare professionals (HCPs) with standard and isolation precautions. This chapter outlines the implementation of standard precautions and summarizes practices designed to contain airborne-, droplet-, and direct or indirect contact transmission.

    View full chapter 7

  • Chapter 9: Reuse of Disposable Devices


    Reutilization of disposable devices is a common and growing practice but can be associated with infections and/or device malfunction. A facility committed to the reuse of single-use devices should have an institution-specific policy and work with clear guidelines to ensure the safety of patients taking into consideration ethical, regulatory and legal implications.

    View full chapter 9

  • Chapter 15: Positive Deviance in Infection Prevention


    Positive Deviance (PD) is based on the observation that in every community there are certain individuals or groups whose uncommon practices enable them to find better solutions to problems than their colleagues despite having access to the same resources. These individuals are known as positive deviants. This chapter summarizes core principles of PD such as the belief that frontline healthcare workers are best positioned to identify challenges and to come up with innovative solutions.

    View full chapter 15

  • Chapter 16: Bundles in Infection Prevention and Safety


    Care bundles include a set of evidence-based measures that, when implemented together, have shown to improve patient care and have a greater impact than that of the isolated implementation of individual measures. Bundles help to create reliable and consistent care systems in hospital settings since they are simple, clear, and concise and contribute to infection prevention, reduce unnecessary antibiotic prescribing, and may limit the development of antibiotic resistance in healthcare facilities.

    View full chapter 16

  • Chapter 21: The Pharmacy


    The pharmacy plays a pivotal role in infection prevention and safety in the hospital. This chapter summarizes the role of the pharmacist in implementing and following procedures to prevent compounded sterile products from microbial contamination and exposure to excessive bacterial endotoxins; in promoting the rational use of antimicrobials in the hospital; and in establishing antimicrobial stewardship strategies for minimizing the development of resistant strains of microorganisms as well as for optimizing therapeutic outcomes in individual patients.

    View full chapter 21

  • Chapter 22: The Operating Room


    Surgical site infections cause significant patient morbidity and mortality and burden healthcare systems with immense costs. This chapter summarizes environmental, surgical and patient-related measures that effectively reduce the rate of surgical site infections across various resource settings and discusses the evidence gaps and controversies around other recommendations.

    View full chapter 22

  • Chapter 24: Emergency Department and Receiving Areas


    Healthcare workers in the emergency department and receiving areas need to be aware of the risks posed by blood and air-borne infections, and take measures to limit exposure through early identification and isolation of high risk patients. This chapter summarizes how the adoption of reasonable healthcare safety precautions can minimize transmission of most contact-related infections in the emergency department.

    View full chapter 24

  • Chapter 25: HIV Infection and AIDS in Low- and Middle-Income Countries


    More than thirty years after it was first recognized in Africa, HIV infection and its consequences are amongst the leading cause of adult deaths in many cities in low- and middle-income countries (LMICs), and have significantly increased childhood mortality. Despite considerable efforts to control the epidemic, HIV continues to spread in under-resourced countries. This chapter summarizes issues around ART access, adherence, monitoring, testing, pre-exposure prophylaxis, and management of co-infections.

    View full chapter 25

  • Chapter 26: Tuberculosis


    Tuberculosis remains one of the leading causes of preventable death worldwide. Nosocomial transmission of tuberculosis to healthcare workers and patients occurs in high-, middle- and low-income countries. This chapter summarizes effective infection control practices that can reduce the risk of TB transmission in hospitals and clinics.

    View full chapter 26


  • Chapter 27: Diarrhea


    A diarrheal disease outbreak in a healthcare facility may affect patients, healthcare workers, and visitors. Surveillance and initiation of prompt infection control management practices reduce morbidity and mortality.

    View full chapter 27

  • Chapter 31: Hospital-Acquired Urinary Tract Infection


    “The decision to use urinary catheters should be made with the knowledge that it involves the risk of producing serious infections”. Even though this statement was formulated by Paul Beeson about sixty years ago, it remains relevant today. Urinary catheters represent the major risk factor related to the acquisition of hospital-acquired urinary tract infections. This chapter summarizes suggested practices to reduce the number of hospital-acquired urinary tract infections.

    View full chapter 31

  • Chapter 32: Pneumonia


    Implementation of guidelines for preventing, diagnosing and treating pneumonia can reduce the associated mortality and morbidity. This chapter emphasizes the importance of implementing various measures at a time (prevention bundles) to reduce the risk of acquisition of nosocomial pneumonia. In clinical trials, this approach has proven to be more effective than isolated single measures.

    View full chapter 32

  • Chapter 33: Mechanical Ventilation


    Tracheal intubation and mechanical ventilation are the most important risk factors for hospital-acquired pneumonia in critically ill patients. This chapter outlines multimodal strategies with different effective infection control measures to prevent ventilator acquired pneumonia.

    View full chapter 33

  • Chapter 40: Infection Control in Obstetrics


    In under-resourced countries, neonatal sepsis and post-partum endometritis continue to cause substantial morbidity and mortality, in both hospital and community settings. This chapter reviews the implementation of simple infection control measures that substantially reduce these infections.

    View full chapter 40

  • Chapter 41: The Infection Hazards of Human Cadavers


    Whether dealing with the recently dead or with old burials, and regardless of which infectious agents may be present, this chapter summarizes practices to greatly reduce the risk to individuals handling the dead of acquiring infection while not compromising the dignity of the deceased and, wherever possible, not interfering excessively with the grieving processes of their relatives.

    View full chapter 41

  • Chapter 43: Staphylococcus Aureus


    Whether dealing with the recently dead or with old burials, and regardless of which infectious agents may be present, this chapter summarizes practices to greatly reduce the risk to individuals handling the dead of acquiring infection while not compromising the dignity of the deceased and, wherever possible, not interfering excessively with the grieving processes of their relatives.

    View full chapter 43

  • Chapter 47: Carbapenem-resistant Enterobacteriaceae


    Carbapenem resistance has increased in all regions of the world over the past decade. Colonization and infection rates are rising and have reached endemic levels in some regions. Although there is little specific evidence for many infection control measures, there is agreement on the general components of an adequate control programme. This chapter emphasizes organizational awareness of the problem of multidrug-resistant organisms and summarizes surveillance, rapid diagnosis, and the implementation of appropriate infection control and antimicrobial stewardship programmes to prevent and manage Carbapenem resistance.

    View full chapter 47

  • Chapter 51: Helicobacter Pylori


    Helicobacter pylori (H. pylori) is the most prevalent chronic bacterial infection in humans, colonizing the stomach of about half the world’s population. This chapter summarizes appropriate reprocessing procedures of endoscopes that are mandatory to avoid nosocomial transmission.

    View full chapter 51

  • Chapter 55: SARS-Associated Coronavirus


    SARS is caused by a novel coronavirus phylogenetically distinct from all previously known human and animal coronaviruses. It emerged in Southern China in November 2002 and caused a large global outbreak. It spreads from person to person by droplets and contact direct or indirect. To contain this virus and other novel coronavirus, there is no room for error or relaxation of the highest standards of all features of infection control.

    View full chapter 55

  • Chapter 56: New Technologies in Infection Prevention


    New technologies to prevent cross-transmission of pathogens in healthcare centers are increasingly available to healthcare centers, though often at significant financial cost and with unique implementation considerations. This chapter summarizes the role for such technologies in existing infection prevention programs, as part of a multifaceted approach.

    View full chapter 56

  • Chapter 61: Ebola Virus Disease

    The cornerstone of infection prevention and control for Ebola is prompt recognition of the disease, deployment of well trained staff to manage patients, isolation of patients, and meticulous and correct use of personal protective equipment. This chapter summarizes key issues, known facts, and suggested practices for the management of Ebola Virus Disease (EBV) in healthcare settings including suggested practices in under-resourced settings.

    View Full Chapter 61

    Select annexes: