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Indian Journal of Medical Microbiology, Vol. 25, No. 4, October-December, 2007, pp. 438-439 Book Review Hospital-acquired infections: Power strategies for clinical practice Kanungo Reba Department of Microbiology, Government Medical College, Puducherry - 605 009 Correspondence Address: Department of Microbiology, Government Medical College, Puducherry - 605 009, India. Email: reba.kanungo@gmail.com. Code Number: mb07129 V Murlidhar, Sumathi Murlidhar Edition and year of publication 2006 Viva Books Private Limited, New Delhi. Price: Rs. 1295 Patient care in hospitals has undergone vast changes in the recent years with the advances in technology and the introduction of newer concepts in management. With increasing awareness regarding prevention and control of infections both in the community and hospital, the health care provider is under greater pressure than ever before to meet the demands of modern medical practice. Litigations and consumer protection acts make practitioners accountable to patients, and any deficiency in good clinical practice renders them vulnerable. Drs. Murlidhar and Sumathi have addressed one of the most important aspects of medical care in this book titled ′Hospital-Acquired Infections-Power Strategies for Clinical Practice.′ Hospital-acquired infections are a major problem in any healthcare setup, taking its toll in the form of increased mortality and morbidity. This book addresses some of these issues. A section aptly subtitled ′Power Strategies for Clinical Practice′ perhaps can be understood as ′good clinical practice.′ They have done a commendable job compiling all the aspects of hospital-acquired infections (HAI). The text is interspersed with pictorial depictions and colorful charts for clarity. Beginning with an interesting chapter on HAI down the ages, with explanations of abbreviations and definitions of terminologies used, they go on to the planning, management, and administrative issues in the establishment and running of a hospital infection control unit. A relevant topic, described in detail, is quality management and improvement. This topic becomes important in view of the accountability and accreditation of hospitals and laboratories. Some of the other issues discussed in the subsequent chapters include safety and risk management, environmental and engineering aspects of construction, and the equipments used in designated areas such as OTs, ICUs, and Central Sterile Services Departments (CSSDs). Elaborating on the working principles and layout of CSSDs would have been of use to hospitals when referring to this book to regulate their setup. On the other hand, details of air circulation, high efficiency particulate air (HEPA) filters, and ventilation have been discussed in detail. This will be very useful to those involved in the designing of dedicated areas. The authors have dwelt at length on specific issues like the surveillance and monitoring of HAI outbreaks and epidemics. Recognition, monitoring, and control measures in an outbreak have been described and a table has been provided that lists some of the viral vaccines for use in hospitalized patients. A section on standard operative procedures (SOPs) outlines the need for a manual its designing and contents. SOP contains a checklist of items which need to be monitored. The most effective measures in the prevention of HAI have been discussed in the chapter on sterilization and disinfection. Care has been taken to mention the most commonly used agents and the drawbacks of each. The authors need to make a note of a few points here. Sunlight has been mentioned as being a process of sterilization by dry heat. This statement needs to be modified in the subsequent editions, especially so because the introductory sentence on dry heat sterilization mentions the temperatures used as being 180°C and 160°C. Concentrations and duration of exposure necessary for some of the disinfectants need to be cross-checked for specificities. HIV-associated issues have been discussed; however some of the NACO guidelines pertaining to prevention strategies could have helped HAI personnel across the country. Hospital waste management is one of the concerns raised by the burgeoning of nursing homes and hospitals, both in the public and private sectors. Drs. Murlidhar and Sumathi have taken care to describe the modalities of waste management, explaining the setting up of the facility and the treatment and disposal of different categories of hospital waste. A subsequent chapter on microbial pathogens discusses the commonly encountered microorganisms and sites of infections. Clinical practice guidelines for prevention of specific infections like urinary tract and surgical site infections, pneumonias, and sepsis in hospitalized patients have been discussed and simple management procedures described. Problems of antibiotic resistance associated with prescribing practices and methods to address the issue by putting in place a policy on antibiotic usage has been dealt with in detail in the chapter on prescribing practices and antibiotic policy. Some data on the prevalent resistance patterns are presented. With improving medical care and therapeutic options, organ and tissue transplantations are being undertaken with increasing frequency. HAI associated with these procedures has been discussed, with reference to the common organisms encountered and the strategies to prevent opportunistic infections. Medical care providers not only need to prevent and control transmissible infections in the hospital but must also protect himself or herself against these. The penultimate chapter of the book takes a look at this issue. The authors have concluded the book with excerpts from interviews with people from various fields related to HAI. A little more attention could have been given to editing certain incongruities; for example, hospital-acquired pneumonia pops up in the midst of a discussion of surgical site infection (SSI) (page 332). To give another example, equipments and inanimate objects have been referred to as being ′infected′; I should think ′contaminated′ would have been the better word. Some of the tables quoted from Centre for Disease Control (CDC) and other sources could have been printed in a larger font (e.g., the table in Dr. Ashok Rattan (page 403) interview. Some of the references listed are not cited in the text. These small errors apart, ′Hospital-Acquired Infections, Power Strategies for Clinical Practice′ by V. Murlidhar and Sumathi Murlidhar is a useful reference book for hospital infection control personnel and policy makers of medical care setups. Priced at Rs. 1295, this book is recommended for individuals as well as medical college libraries. Copyright 2007 - Indian Journal of Medical Microbiology |
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