Pathogens of Epidemiologic Concern

GUIDE TO INFECTION CONTROL IN THE HEALTHCARE SETTING

Clostridium difficile, Salmonella, Shigella, Escherichia coli, Campylobacter, Yersinia enterocolitica, Vibrio cholerae, and V. parahaemolyticus are among the various agents which may cause acute gastrointestinal infections in long-term care facility residents and health care workers. This chapter summarizes how to prevent and manage these infections.

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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.

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Active immunization of the general population is effective to control the transmission of diphtheria, tetanus, and pertussis infections in the community, and the possible risk of infection in the healthcare setting. This chapter summarizes measures to prevent hospital transmission of diphtheria, tetanus, and pertussis interventions to reach high vaccine coverage against diphtheria, tetanus, and pertussis.

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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.

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Enterococci are ubiquitous Gram-positive cocci that are part of the normal flora of humans and animals. Enterococci are common hospital-acquired pathogens, accounting for 7.4% of all healthcare-associated infections. Infections caused by enterococci include urinary tract infections, abdominal-pelvic infections, wound (especially decubitus ulcers and diabetic foot) infections, and endocarditis. Resistance to nearly every known antibiotic has been described for various strains of enterococci and has been more problematic for E. faeciumthan E. faecalis. This chapter summarizes recommendations around the prevention and treatment of enterococcal infections.

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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.

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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.

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The incidence of healthcare associated fungal infections has increased in recent years, and the population of immunocompromised hosts at risk of these infections has also increased. This chapter summarizes measures to prevent nosocomial fungal infections, discusses environmental risk factors and outlines practices around air filtration during hospital construction and renovation.

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Despite progress in global immunization, measles remains a major infectious cause of mortality in under-resourced countries and is responsible for more than 100,000 deaths in children each year. The importance of nosocomial transmission of measles varies substantially from one region to another according to local measles epidemiology and to vaccine coverage. Whatever the local incidence of measles, the hospital represents a critical site for cross-infection.

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Middle East Respiratory Syndrome Coronavirus (MERS) is a new and formidable epidemic that is challenging infection control programs. Although close contact is necessary for transmission most of the time, the possibility exists for coincident transmission via airborne route and fomites. To contain this novel coronavirus, there is no room for error or relaxation of the highest standards of all features of infection control.

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Incidence of Carbapenemase-producing Enterobacteriaceae (CRE) is increasing worldwide. Screening of high risk patients to identify CRE carriers early and physical separation while in the hospital are important CRE control strategies. Modification and adaptation of international guidelines are necessary to control CREs in resource limited settings.

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Nosocomial parasitic infections can be caused by enteric, blood, tissue and ectoparasites. Enteric protozoan parasites, malaria, American trypanosomiasis, toxoplasmosis, scabies (classic or crusted) and myasis are among the most frequent reported nosocomial infections. Patients with AIDS, children and transplant recipients are particularly at risk.

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Streptococcus pneumoniae is increasingly reported as a pathogen causing infections in hospitals, healthcare settings, and nursing homes. These infections are often due to multiple antibiotic resistant pneumococcal serotypes and are likely to appear as small outbreaks. This chapter summarizes infection control measures to prevent endemic and epidemic nosocomial pneumococcal infections.

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Pseudomonas aeruginosa is an important nosocomial pathogen that causes serious nosocomial infections and contributes significantly to morbidity and mortality. Antimicrobial resistance including carbapenem- and multidrug-resistance (MDR) also continues to increase, further limiting therapeutic options.

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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.

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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.

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Streptococcus pyogenes (Group A beta-hemolytic streptococcus) clusters/outbreaks are uncommon, but have been described mainly in two healthcare settings, namely postpartum, and postsurgical populations. There has also been more recent interest in healthcare-associated clusters in the long-term care facility setting, where there have been growing cases identified. This chapter summarizes how to prevent and manage group A streptococcal infections in the healthcare setting.

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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.

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