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

Decontamination in Hospitals and Healthcare

2nd Edition

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


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© Woodhead Publishing 2020
25th November 2019
Woodhead Publishing
Paperback ISBN:
eBook 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