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Decontamination in Hospitals and Healthcare - 2nd Edition - ISBN: 9780081025659, 9780081025666

Decontamination in Hospitals and Healthcare

2nd Edition

Editor: Jimmy Walker
eBook ISBN: 9780081025666
Paperback ISBN: 9780081025659
Imprint: Woodhead Publishing
Published Date: 25th November 2019
Page Count: 590
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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




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


No. of pages:
© Woodhead Publishing 2019
25th November 2019
Woodhead Publishing
eBook ISBN:
Paperback ISBN:

Ratings and Reviews

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