Book Review

Hospital Epidemiology and Infection Control

N Engl J Med 1996; 335:1773-1774December 5, 1996

Article

Hospital Epidemiology and Infection Control
Edited by C. Glen Mayhall. 1283 pp. Baltimore, Williams & Wilkins, 1996. $160. ISBN: 0-683-05660-3

In this book . . .,” states Dr. Mayhall in the preface, “an attempt has been made to pull together all the information in this field under one cover.” This is indeed an ambitious goal, given that hospital epidemiology is related to microbiology, occupational health, materials management, information systems, and even building engineering. What's more, infection control must be practiced with cognizance of the financial, regulatory, ethical, and human-resource constraints that dictate everyday hospital life. The task becomes ever more complex as patients get sicker, budgets smaller, regulations stricter, and organisms more resistant.

But, in fact, this book succeeds as a one-stop information center for hospital epidemiology. Relevant basic and clinical science from a myriad of disciplines is included, but so are the governmental regulations and professional guidelines that allow translation of the science into rational (or at least consistent) hospital policy. The editor has created a textbook with two uses: as an encyclopedic reference work for infection control and as a how-to manual for the hospital epidemiologist in practice.

The book begins with several superb chapters that review basic principles of epidemiology and biostatistics, including a welcome discussion of indexes used to assess the severity of illness. Subsequent chapters address infection control from multiple perspectives: specific organisms, specific procedures, and specific patient populations. It would be a challenge to name a pathogen of even theoretical nosocomial importance that has not been addressed. Additional sections cover related topics such as disinfection and sterilization, antimicrobial agents, and implementation of an infection-control program. There are abundant figures, and most chapters provide excellent tables that summarize the relevant published literature. In general, topics have been split rather than lumped; Staphylococcus aureus and methicillin-resistant S. aureus, for example, are assigned individual chapters. The end result is a huge breadth of information assembled into concise units around pragmatic themes.

This format does have disadvantages. Since chapters address precise, at times overlapping topics, coverage of some material becomes uneven or fragmented. For example, aspergillus is discussed only in relation to other subjects, even though candida has been given its own chapter (in fact it is the only chapter in the section on fungal infections). Infection of the bloodstream is another subject that suffers from having been decentralized. In some cases, this problem is dealt with by redundancy. Nosocomial pneumonia, for example, is covered in both its own chapter and under “Nosocomial Infections Associated with Respiratory Therapy,” including near-identical tables summarizing guidelines issued by the Centers for Disease Control and Prevention (CDC).

Since hospital epidemiology is influenced by both science and policy, information can become dated very rapidly. This textbook is extremely current, but some regulations relating to tuberculosis protection have already changed, and CDC isolation guidelines that are reported as being in draft form are now in circulation. The noble goal of including up-to-date standards and guidelines will demand frequent updating of the book. This rich and functional first edition will get heavy use from practicing epidemiologists; one hopes that it represents only the start of an ongoing effort.

Kenneth Sands, M.D., M.P.H.
Beth Israel Deaconess Medical Center, Boston, MA 02215