This book aims to fill knowledge gap among healthcare workers about Clostridium difficile (also known as C.difficile and CDI) among aging patients, especially those in long-term care facilities (LTCFs). Written by experts in infectious diseases and geriatric medicine, this book provides comprehensive information on all aspects of CDI pertaining to LTCF settings, including epidemiology, diagnosis, prevention, management and the unique challenges faced by LTCFs with regards to the CDI problem. The book begins by introducing the topic as it relates to aging patients before delving into the various aspects of CDI management. Topics include infection control and prevention, treatment of CDI, and the establishment of antibiotic stewardship programs to reduce inappropriate antibiotic use and reduce CDI rates. The book also features a chapter on probiotics for the prevention of CDI and new strategies to monitor environmental cleaning practices of CDI patient rooms that do not appear in any other resource. Clostridium Difficile Infection in Long-Term Care Facilities is an excellent resource for geriatricians, infectious diseases specialists, long-term care administrators, nurses, pharmacists, researchers, and all clinicians working with infections in long-term care settings.
The first Infection control guidelines for long-term care facilities were published in 1986. Since that time the interest in, and knowledge of, the requirements of infection control programs for long-term care facilities has steadily increased. This document presents the second version and looks at the following points: organizational structure of an infection control program; environmental concerns; departments and services; management of specific care situations; occupational health; and, epidemic investigation and control.
KEY FINDINGS: Data from the National Nursing Home Survey, 2004. In 2004, 8 percent of U.S. nursing home residents had an emergency department (ED) visit in the past 90 days. Among nursing home residents with an ED visit in the past 90 days, 40 percent had a potentially preventable ED visit. Injuries from falls were the most common conditions accounting for potentially preventable ED visits by nursing home residents. Nursing home residents who had a potentially preventable ED visit in the past 90 days had shorter lengths of stay and more medications In 2004, 8 percent of U.S. nursing home residents had an emergency department (ED) visit in the past 90 days. Among nursing home residents with an ED visit in the past 90 days, 40 percent had a potentially preventable ED visit. Injuries from falls were the most common conditions accounting for potentially preventable ED visits by nursing home residents. Nursing home residents who had a potentially preventable ED visit in the past 90 days had shorter lengths of stay and more medications.
The ASCRS Textbook of Surgery of the Colon and Rectum offers a comprehensive textbook designed to provide state of the art information to residents in training and fully trained surgeons seeking recertification. The textbook also supports the mission of the ASCRS to be the world’s authority on colon and rectal disease. The combination of junior and senior authors selected from the membership of the ASCRS for each chapter will provide a comprehensive summary of each topic and allow the touch of experience to focus and temper the material. This approach should provide the reader with a very open minded, evidence based approach to all aspects of colorectal disease. Derived from the textbook, The ASCRS Manual of Surgery of the Colon and Rectum offers a “hands on” version of the textbook, written with the same comprehensive, evidence-based approach but distilled to the clinical essentials. In a handy pocket format, readers will find the bread and butter information for the broad spectrum of practice. In a consistent style, each chapter outlines the condition or procedure being discussed in a concise outline format – easy to read, appropriately illustrated and referenced.
With advances in technology and medical science, children with previously untreatable and often fatal conditions, such as congenital heart disease, extreme prematurity and pediatric malignancy, are living longer. While this is a tremendous achievement, pediatric providers are now more commonly facing challenges in these medical complex children both as a consequence of their underlying disease and the delivery of medical care. The term healthcare-associated infections (HAIs) encompass both infections that occur in the hospital and those that occur as a consequence of healthcare exposure and medical complexity in the outpatient setting. HAIs are associated with substantial morbidity and mortality for the individual patient as well as seriously taxing the healthcare system as a whole. In studies from the early 2000s, over 11% of all children in pediatric intensive care units develop HAIs and this figure increases substantially if neonatal intensive care units are considered. While progress has been made in decreasing the rates of HAI in the hospital, these infections remain a major burden on the medical system. In a study published in 2013, the annual estimated costs of the five most common HAIs in the United States totaled $9.8 billion. An estimated 648,000 patients developed HAIs in hospitals within the US in 2011 and children with healthcare-associated bloodstream infection have a greater than three-fold increased risk of death. While a number of texts discuss HAIs in the broader context of infectious diseases or pediatric infectious diseases (such as Mandell’s Principles and Practice of Infectious Diseases or Long and Pickering’s Principles and Practice of Pediatric Infectious Diseases) no single text specifically focuses on the epidemiology, diagnosis and management of HAI in children. Many infectious diseases texts are organized based on the microbiology of infection and from this starting point then discussing the clinical syndromes associated with the organism of interest. For instance, a chapter on Staphylococcus aureus may contain a brief discussion of the role of S. aureus in surgical site infections in the wider context of all staphylococcal disease. For clinicians caring for children at the bedside, however, the clinical syndrome is typically appreciated and intervention necessary prior to organism identification. We propose a text that details both the general principles involved in HAIs and infection prevention but also provides a problem oriented approach. Such a text would be of interest to intensivists, neonatologists, hospitalists, oncologists, infection preventionists and infectious diseases specialists. The proposed text will be divided into three principle sections: 1) Basic Principles of Infection Control and Prevention, 2) Major Infectious Syndromes and 3) Infections in Vulnerable Hosts. Chapters in the Major Infectious Syndromes section will include discussion of the epidemiology, microbiology, clinical features, diagnosis, medical management (or surgical management as appropriate) and prevention of the disease entity of interest. Chapters will seek to be evidenced based as much as possible drawing from the published medical literature as well as from clinical practice guidelines (such as those from the Infectious Diseases Society of America) when applicable. We intend to include tables, figures and algorithms as appropriate to assist clinicians in the evaluation and management of these often complex patients. Finally, we intend to invite authors to participate in this project from across a number of medical specialties including infectious diseases, infection control, critical care, oncology and surgery to provide a multidisciplinary understanding of disease. It is our intent to have many chapters be co-written by individuals in different subspecialties; for instance, a chapter on ventilator-associated pneumonia may be co-written by both infectious disease and critical care medicine specialists. Such a unique text has the potential to provide important guidance for clinicians caring for these often fragile children.
These guidelines provide recommendations that outline the critical aspects of infection prevention and control. The recommendations were developed using the best available evidence and consensus methods by the Infection Control Steering Committee. They have been prioritised as key areas to prevent and control infection in a healthcare facility. It is recognised that the level of risk may differ according to the different types of facility and therefore some recommendations should be justified by risk assessment. When implementing these recommendations all healthcare facilities need to consider the risk of transmission of infection and implement according to their specific setting and circumstances.
The National Strategy for Combating Antibiotic Resistant Bacteria, published in 2014, sets out a plan for government work to mitigate the emergence and spread of resistant bacteria. Direction on the implementation of this strategy is provided in five-year national action plans, the first covering 2015 to 2020, and the second covering 2020 to 2025. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine evaluates progress made against the national strategy. This report discusses ways to improve detection of resistant infections and estimate the risk to human health from environmental sources of resistance. In addition, the report considers the effect of agricultural practices on human and animal health and animal welfare and ways these practices could be improved, and advises on key drugs and diseases for which animal-specific test breakpoints are needed.
The WHO Guidelines on Hand Hygiene in Health Care provide health-care workers (HCWs), hospital administrators and health authorities with a thorough review of evidence on hand hygiene in health care and specific recommendations to improve practices and reduce transmission of pathogenic microorganisms to patients and HCWs. The present Guidelines are intended to be implemented in any situation in which health care is delivered either to a patient or to a specific group in a population. Therefore, this concept applies to all settings where health care is permanently or occasionally performed, such as home care by birth attendants. Definitions of health-care settings are proposed in Appendix 1. These Guidelines and the associated WHO Multimodal Hand Hygiene Improvement Strategy and an Implementation Toolkit (http://www.who.int/gpsc/en/) are designed to offer health-care facilities in Member States a conceptual framework and practical tools for the application of recommendations in practice at the bedside. While ensuring consistency with the Guidelines recommendations, individual adaptation according to local regulations, settings, needs, and resources is desirable. This extensive review includes in one document sufficient technical information to support training materials and help plan implementation strategies. The document comprises six parts.
Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem with an impact on morbidity, mortality and quality of life. At any one time, up to 7% of patients in developed and 10% in developing countries will acquire at least one HAI. These infections also present a significant economic burden at the societal level. However, a large percentage are preventable through effective infection prevention and control (IPC) measures. These new guidelines on the core components of IPC programmes at the national and facility level will enhance the capacity of Member States to develop and implement effective technical and behaviour modifying interventions. They form a key part of WHO strategies to prevent current and future threats from infectious diseases such as Ebola, strengthen health service resilience, help combat antimicrobial resistance (AMR) and improve the overall quality of health care delivery. They are also intended to support countries in the development of their own national protocols for IPC and AMR action plans and to support health care facilities as they develop or strengthen their own approaches to IPC. These are the first international evidence-based guidelines on the core components of IPC programmes. These new WHO guidelines are applicable for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.
