Decontamination in Hospitals and Healthcare

Decontamination in Hospitals and Healthcare

2nd Edition - November 25, 2019

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  • Editor: Jimmy Walker
  • eBook ISBN: 9780081025666
  • Paperback ISBN: 9780081025659

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Decontamination in Hospitals and Healthcare, Second Edition, enables users to obtain detailed knowledge of decontamination practices in healthcare settings, including surfaces, devices, clothing and people, with a specific focus on hospitals and dental clinics.

Key Features

  • Offers in-depth coverage of all aspects of decontamination in healthcare
  • Examines the decontamination of surgical equipment and endoscopes
  • Expanded to include new information on behavioral principles in decontamination, control of microbiological problems, waterborne microorganisms, pseudomonas and the decontamination of laundry


Microbiology laboratories and Disinfection laboratories, Healthcare workers who use disinfectants, Students in microbiology, Clinicians, Members of Institute of Decontamination Sciences/Central Sterilisation Club and those employed in Central Sterile Services and Departments

Table of Contents

  • 1 The importance of decontamination in hospitals and healthcare 

    J.T. Walker

    1.1 Introduction 

    1.2 Microbial resistance and infection control  

    1.3 Maintaining safe water provision 

    1.4 Issues of prion transmissibility in healthcare 

    1.5 Conclusion 


    Further reading

    2 The history of decontamination in hospitals 

    S.W.B. Newsom, G.L. Ridgway

    2.1 Introduction 

    2.2 Healthcare-acquired infection 

    2.3 Key figures in decontamination control 

    2.4 Heat for sterilization and disinfection 

    2.5 Chemical disinfectants 

    2.6 Testing disinfectant activity 

    2.7 European medical devices directives 

    2.8 Incidents of contamination as a result of human error 

    2.9 Conclusion 



    Further reading 

    3 Quality and supply of water used in hospitals 

    E. Maynard, C. Whapham

    3.1 Introduction 

    3.2 Compliance in the healthcare environment 

    3.3 Water treatment and water purification technology 

    3.4 Water quality monitoring 

    3.5 Specialist departments and their unique requirements for  water quality control 

    3.6 Sustainability and conservation in healthcare water management 

    3.7 Conclusion and future trends 


    Further reading 

    4 Control of Legionella in hospital potable water systems 

    Julianne L. Baron, Laura Morris, Janet E. Stout

    4.1 Introduction 

    4.2 Systemic disinfection methods 

    4.3 Emergency disinfection methods 

    4.4 Selection and validation of disinfection method 

    4.5 Regulatory requirements, standards, and guidelines 

    4.6 Conclusion  000 References 

    5 Waterborne transmission of Pseudomonas aeruginosa 

    M.I. Garvey, C. McMurray, E. Holden, J. Walker

    5.1 Pseudomonas aeruginosa  5.2 P. aeruginosa microbiology and pathogenicity 

    5.3 Epidemiology and infections 

    5.4 Environmental reservoir and nosocomial outbreaks 

    5.5 What clinical settings and patient populations are affected by P. aeruginosa? 

    5.6 What are the potential sources of P. aeruginosa? 

    5.7 What are the potential transmission routes for P. aeruginosa  outbreaks? 

    5.8 What control measures can be implemented to stop P. aeruginosa outbreaks? 

    5.9 Infection prevention measures 

    5.10 Conclusion 


    6 Mycobacteria chimaera infections and their transmission from  heater-cooler units 

    J.T. Walker

    6.1 Introduction and background 

    6.2 Waterborne nontuberculous mycobacteria (NTM) 

    6.3 NTM transmission routes 

    6.4 What is a heater cooler device? 

    6.5 How are waterborne pathogens able to grow within HCUs? 

    6.6 How was M. chimaera transmitted from the HCU to the patients? 

    6.7 Clinical features and diagnosis 

    6.8 Manufacturer’s instructions for the decontamination of  microorganisms in HCUs 

    6.9 Compatibility of manufacturer’s equipment 

    6.10 Decontamination, containment, or relocation of HCUs 

    6.11 Implications for ECMO equipment

    6.12 Summary 


    7 Decontamination of hand washbasins and traps in hospitals 

    David C. Coleman, Emily C. Deasy, Elaine M. Moloney,  James S. Swan, Mary J. O‘Donnell

    7.1 Water and wastewater networks in healthcare facilities 

    7.2 Hand washbasins in the healthcare environment 

    7.3 Nosocomial infection associated with washbasin traps 

    7.4 Approaches used to minimize contamination of washbasin traps 

    7.5 Cleaning of hand washbasins 

    7.6 Outlook 


    8 Infection control in Europe 

    S. Brusaferro

    8.1 Introduction 

    8.2 Data available in Europe 

    8.3 Standards for structures and organizations 

    8.4 Training of personnel 

    8.5 Conclusion and future trends 

    Appendix: Abbreviations 



    9 The role of the nurse in decontamination 

    R. Gallagher 9.1 Introduction 

    9.2 Regulatory standards and decontamination 

    9.3 Key principles 

    9.4 Challenges associated with nursing and decontamination of  the patient care environment 

    9.5 Provision of cleaning services 

    9.6 Management of cleaning services 

    9.7 Decontamination of patient equipment 

    9.8 Conclusion 

    9.9 Sources of further information and advice 


    Further reading 
    10 The role of protective clothing in healthcare and its decontamination 

    K. Laird, L. Owen 1

    10.1 Introduction 

    10.2 Disposable clothing 

    10.3 Reusable clothing 

    10.4 Microbiology 

    10.5 Cleansing and disposal 

    10.6 Conclusions and future trends 


    Further reading

    11 Cleaning and decontamination of the healthcare environment 

    Lisa Hall, Brett G. Mitchell 1

    1.1 Introduction 

    11.2 Pathogens survive in the healthcare environment 

    11.3 Evidence that contaminated surfaces contribute  to transmission of hospital pathogens 

    11.4 Key components of a successful environmental cleaning program 

    11.5 Conclusion 


    12 Biocides and decontamination agents including sporicides for decontamination in hospitals 

    E.S. Gilchrist, P.J. Collier

    12.1 Introduction 

    12.2 Currently available biocides and sporicides for use in healthcare  and their limitations 

    12.3 Testing standards for actives and sporicides 

    12.4 Incidence of resistance and risk to the hospital patient 

    12.5 Strengths/weaknesses of different disinfectants for a range of microorganisms 

    12.6 Future trends 

    12.7 Sources of further information and advice 


    13 The role of antimicrobial surfaces in hospitals to reduce  healthcare-associated infections (HAIs) 

    Michael G. Schmidt

    13.1 Introduction 

    13.2 Relevance of the built environment to HAIs 

    13.3 Antimicrobial surfaces 

    13.4 Antiadhesive surfaces 

    13.5 Nature inspired antifouling surfaces 

    13.6 Nature inspired antibacterial surfaces 

    13.7 Antimicrobial coatings 

    13.8 Antimicrobial coatings—Triclosan 

    13.9 Antimicrobial coatings—Utility of bacteriophages 

    13.10 Antimicrobial coatings—Silver surfaces 

    13.11 Light-activated antimicrobial surfaces 

    13.12 Antimicrobial coatings—Copper surfaces 

    13.13 Continuous microbial debulking of the environment mitigates HAI risk

    13.14 Perspectives—A role for antimicrobial surfaces in hospitals  to reduce hospital-acquired infections  


    Further reading 

    14 Use of gaseous decontamination technologies for wards  and isolation rooms in hospitals and healthcare settings  T. Pottage, J.T. Walker

    14.1 Introduction 

    14.2 Challenges and considerations for gaseous decontamination in a healthcare setting 

    14.3 Validation methods to determine efficacy 

    14.4 Practical use of gaseous decontamination in hospitals 

    14.5 Conclusion and future trends 

    14.6 Sources of further information and advice 

    15 An overview of automated room disinfection systems:  When to use them and how to choose them  

    J.A. Otter, S. Yezli, F. Barbut, T.M. Perl

    15.1 Introduction 

    15.2 Why consider an ARD system? 

    15.3 What level of surface contamination is a risk for transmission? 

    15.4 Limitations of conventional cleaning and disinfection 

    15.5 Overview of ARD systems 

    15.6 When to consider an ARD system 

    15.7 Using, validating, and regulating ARD systems 

    15.8 Sources of further information and advice 

    15.9 Future trends 

    15.10 Conclusions 


    16 Testing strategies and international standards for disinfectants 

    C. Woodall

    16.1 Introduction 

    16.2 Selecting the standards to test against 

    16.3 Design of test procedures 

    16.4 Measuring different applications of disinfectants. Surface, hand, instrument, mechanical action, and zonal disinfection 

    16.5 Europe, Middle East, Africa, and the rest of the world 

    16.6 USA and the Americas 

    16.7 OECD 

    16.8 Canada 

    16.9 Australia 

    16.10 China and India 


    17 The role of standards in decontamination 

    R. Bancroft

    17.1 Introduction 

    17.2 Relationship of standards to law and guidance 

    17.3 Key aims and principles of standards 

    17.4 Types of standards 

    17.5 Vienna agreement 

    17.6 European standards 

    17.7 International standards 

    17.8 How standards are drafted 

    17.9 How to read and understand a standard 

    17.10 Accessing the most relevant standards and guidance documents 

    17.11 Conclusion and future trends 

    Sources of further information and advice 

    Appendix 1: Standards in decontamination 

    18 Decontamination of prions 

    G. McDonnell, E. Comoy

    18.1 Introduction 

    18.2 Prion diseases: Transmissible spongiform  encephalopathies (TSEs) 

    18.3 What are prions? 

    18.4 Clinical transmission risks 

    18.5 Decontamination investigations 

    18.6 Future perspectives 


    Further reading 

    19 Decontamination of dental devices in the hospital and general  dental practice setting 

    Andrew Smith

    19.1 Introduction 

    19.2 Historic background of dental surgery 

    19.3 Evidence of infections associated with dentistry 

    19.4 The role of vCJD in raising standards 

    19.5 Challenges associated with dental instrument decontamination 

    19.6 Instrument decontamination processes for dental surgery 

    19.7 Centralization of dental instrument reprocessing 

    19.8 Quality management systems 

    19.9 Future trends 

    19.10 Conclusion 

    19.11 Sources of further information and advice 


    Further reading

    20 An overview of current surgical instrument and other medical device decontamination practices 

    S. Holmes

    20.1 Introduction and background to central decontamination  units (CDUs) 

    20.2 Purpose of decontamination practice of surgical instruments  in CDUs 

    20.3 Current regulations, standards, and guidance 

    20.4 Risk minimization strategy 

    20.5 Decontamination process 

    20.6 Activities impacting on the decontamination process and the  quality of sterile instruments 

    20.7 Future trends 


    Further reading 
    21 Efficacy of current and novel cleaning technologies (ProReveal) for assessing protein contamination on surgical instruments 

    D. Perrett, N.K. Nayuni

    21.1 Introduction 

    21.2 General principles of protein detection 

    21.3 Current general methods of protein detection (ninhydrin,  Biuret, dyes): Sensitivity, specificity, and validation 

    21.4 Methods of protein detection based on fluorescence 

    21.5 Other possible technologies 

    21.6 Strengths and weaknesses of new technologies 

    21.7 Conclusion 

    22 Decontamination of flexible endoscopes 

    Peter Hoffman

    22.1 Types of endoscopes 

    22.2 Structure of endoscopes 

    22.3 Risk assessment 

    22.4 Flexible endoscope decontamination 

    22.5 Decontamination process 

    22.6 Decontamination of duodenoscopes 

    22.7 Rinse water 

    22.8 EWD selection 

    22.9 Testing 

    22.10 Endoscopy accessories 

    22.11 Tracking and traceability 

    22.12 Documentation 

    22.13 Staff training 

    22.14 Extrinsic recontamination 

    22.15 Intrinsic recontamination 

    22.16 Storage of endoscopes 

    22.17 Design of decontamination facilities 

    22.18 Reasons for decontamination failure 

    23 Sterilization of flexible endoscopes 

    Michael Mikhail, Tony Young

    23.1 Introduction: Key principles of sterilizing flexible endoscopes 

    23.2 Why sterilize flexible endoscopes? 

    23.3 Problems associated with sterilization of flexible endoscopes 

    23.4 Methods used in the sterilization of endoscopes 

    23.5 Testing effectiveness and application of standards 

    23.6 Chemical indicators 

    23.7 Biological indicators (BI) 

    23.8 Using indicators 

    23.9 Example of an “in use” application 

    23.10 Future trends 

    Sources of further information 


    Further reading  

    24 Future trends in decontamination in hospitals and healthcare 

    J.T. Walker

    24.1 Introduction 

    24.2 The future of antibiotic resistance 

    24.3 Decontamination in water systems 

    24.4 Use of biocides in water systems 

    24.5 Use of point of use filters 

    24.6 Use of TMVs and design and use of outlets 

    24.7 Exogenous contamination of water outlets 

    24.8 Role of drains in the spread of infections 

    24.9 Risks from medical equipment such as heater coolers 

    24.10 Microorganisms in the built environment 

    24.11 Control of microorganisms in the built environment 

    24.12 Hand hygiene 

    24.13 Hand contact sites and environmental cleaning 

    24.14 Manual cleaning 

    24.15 Automated decontamination systems in the built environment 

    24.16 Decontamination of prions 

    24.17 Guidance and the rapid detection of protein on surgical instruments 



Product details

  • No. of pages: 590
  • Language: English
  • Copyright: © Woodhead Publishing 2019
  • Published: November 25, 2019
  • Imprint: Woodhead Publishing
  • eBook ISBN: 9780081025666
  • Paperback ISBN: 9780081025659

About the Editor

Jimmy Walker

Dr Jimmy Walker worked as a Scientific Leader in water microbiology and decontamination at Public Health England (PHE), Porton UK. He has 30 years’ experience in public health microbiology with an extensive publication record, and regularly attended national and international scientific conferences. His particular interests were the presence of opportunistic pathogens in hospital water systems and advised hospitals on incidents and outbreaks associated with waterborne pathogens such as Legionella spp., Pseudomonas aeruginosa and Mycobacteria spp. He worked closely with the Department of Health (DH England) and Health and Safety Executive in writing and developing national and international guidance on the microbiology of water and decontamination in healthcare.

Affiliations and Expertise

Former Scientific Leader in Water Microbiology and Decontamination, Public Health England (PHE), Porton, UK

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