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From The CriticsReviewer: Farrin A Manian, MD, MPH (St. John's Mercy Medical Center)
Description: This book on healthcare-associated infections (HAIs) is the latest edition of a work last published in 1998. Its three major sections cover the basics of infection control, specific settings (e.g. intensive care units and dialysis units), and endemic and epidemic hospital infections, which include a variety of nosocomial infections and tuberculosis.
Purpose: Although not necessarily clear from the title, the stated primary goals of this book are to familiarize readers with the epidemiology of infectious complications associated with healthcare rendered inside as well as outside the confines of traditional hospitals, and to propose ways to prevent such complications by adopting a zero tolerance approach. This is a laudable goal, particularly in this era of increasing public scrutiny of healthcare-related complications. However, the book is not unique in this concept, and other similar works are already on the market. For the most part, this book is useful in providing a basic knowledge of the epidemiology and surveillance of HAIs and ways to prevent them.
Audience: The target audience appears to be infection control professionals, hospital epidemiologists, and any healthcare workers closely involved in patient safety and prevention of HAIs. Readers with a general familiarity with infectious diseases and infection control will get the most out of this book. The editor and many authors of the chapters are recognized leaders in the field of nosocomial infections.
Features: The book covers the basics of infection surveillance and control within hospitals as well as specific infectious disease complications associated with healthcare. Highlights of the book are its relatively up-to-date material and current references, with the limitations inherent in a printed publication. Another attractive feature is the coverage of infection prevention in a variety of healthcare settings including larger hospitals, community hospitals, and long-term care facilities. New chapters such as public reporting of healthcare-associated infection rates are particularly welcome in this era of increasing pressure on healthcare facilities to reduce HAIs. However, several shortcomings of the book are readily apparent. First, the index is relatively brief (14 pages) and does not adequately cover the breadth of material in the book. For example, a search for an important subject such as influenza vaccination failed to find an indexed reference under either "Immunization" or "Influenza". Similarly, despite displaying a table on the cause of noninfectious fever in the ICU patient, no reference to this relevant topic could be found under the indexed term "Fever". Second, in this era of evidence-based practice, the educational value of some tables (e.g. "Possible indications for selective decontamination in patients admitted to ICUs", and "Main factors influencing adherence to hand hygiene practices") could have been enhanced by conveniently including pertinent references in the body of the tables themselves. Third, although certain topics are appropriately covered in great depth (e.g. tuberculosis and nosocomial pneumonia), other subjects of interest to many infection control professionals (e.g. construction activity and infection control, and pet animals in healthcare settings) received less than adequate coverage. For example, the only discussion of the potential transmission of infections from animals in healthcare settings is in the chapter on inanimate environment with somewhat undue emphasis on transmission of Q fever from pregnant ewes in research facilities, not particularly relevant to most hospitals or healthcare workers. Fourth, certain points or statements in the book are either inaccurate or at best controversial in their scientific validity. For example, in the chapter on personnel health services, postexposure prophylaxis for pertussis was stated to be "indicated for exposed healthcare personnel who have not received a recent dose of Tdap," without defining "recent" and despite the current lack of scientific evidence supporting the safety of not providing antibiotic prophylaxis to all exposed personnel regardless of their immunization status. In another chapter on the intensive care unit, a table on "Noninfectious fever in ICU patients" lists atelectasis as a cause of fever despite available published evidence to the contrary. Lastly, given the evolving nature of the field of HAIs, an online version of this book with frequent updates would be highly desirable.
Assessment: In many respects, the field of healthcare epidemiology and infection control has changed dramatically during the past decade; this book is, therefore, a necessary revision of the 1998 edition. Although it covers many relevant issues in the field of infection prevention in healthcare settings, its coverage of issues of great interest ranges widely from perfunctory to comprehensive. Readers who want a book that covers some of the recent developments in the field of HAIs will not be disappointed by this one. However, for those who wish to have ready access to a comprehensive work covering all aspects of HAIs and infection control in great depth, there are alternatives.