I have seen a lot of conversations on social media and in print in the last year or so from experts in fields of cleaning supplies, architects, and researchers stating that their way is the best way to stop hospital infections. Even the centers for Medicare and Medicaid have stated they have the solution by stopping reimbursement to hospitals for any infections that they caused. Environmental disinfectant developers state they have the only answer; and clinical researchers state they hold the key. When I hear from the World Health Organization that we declared war on antimicrobial resistant pathogens years ago and not much has been accomplished it is disheartening, as I live with one of these pathogens.
Fighting hospital acquired infection is a collaborative endeavor and when it comes to the healthcare industry, all of the following are worthy of consideration:
Surface Materials
Materials to build hospital surfaces have come a long way. We know wood is porous and should not be accepted and we know sharp corners are impossible to disinfect. Along with being durable and easy to clean, surface materials should also be airtight and resistance to cracks and dents. Yet I have visited many health care facilities and notice many defects in surfaces used. Hospitals and clinics seem loath to take the initiative to replace old and worn surfaces. Plus the fact that there is no federal regulation on what surfaces a healthcare facility must use whether it be in hard surfaces, textiles, or medical devices.
Recent findings on contamination of healthcare surfaces include:
MRSA survives for 11 days on a plastic patient chart, more than 12 days on a laminated countertop, and nine days on a cloth curtain. Pseudomonas lives on hard dry surfaces for up to seven days.
In an investigation of contaminated room door handles in a university hospital setting, 27% of door handles were contaminated by MRSA or methicillin-sensitive Staphylococcus aureus (MSSA). In a hospital culture survey, 42% of hospital privacy curtains were contaminated with Vancomycin-Resistant Enterococcus (VRE) and 22% with MRSA
Environmental Services Staff
Unfortunately, cleaning and disinfection is often sub-par with many studies showing that EVS are cleaning and disinfecting only about 30 to 50 % of the surfaces that they should be. These include toilet handholds, light switches, doorknobs, bedside rails, nurse call buttons, TV remotes, and patient telephones.
Ongoing education, training and monitoring is important to ensure compliance and we need to ensure EVS staff is especially trained and knowledgeable about infections and that they help fight them. EVS should be certified after each training and training should involve uniform care, gloving, and the ability to communicate to healthcare personnel that they have a concern when warranted. EVS play a key front-line role in infection prevention and control.
Lab Personnel
Lab workers are a part of the puzzle also:
Proper Specimen Collection
Accurate Identification and Susceptibility Testing
Laboratory Information Systems for comprehensive information /ordering
Rapid Diagnostic Testing
Rapid reporting of Laboratory Data
Outbreak Recognition and Investigations – Molecular Typing
Maintaining Organism Storage
Maintaining Cultures of Specimens from Hospital Personnel and the Environment
The services that the infection control program can offer to the laboratory include functioning as a liaison to the clinical services to improve the quality of specimens sent to the laboratory and promoting appropriate use of cultures and other laboratory tests. It can also assist the laboratory with its system for monitoring antimicrobial agent susceptibilities by identifying the pathogens that are of nosocomial origin.
Researchers
Research for new methods of tacking ARM’s and new antibiotics is a large part of the puzzle. Some of the latest research has been done on the following and most show promise for conquering some of these pathogens.
CRISPR (pronounced “crisper”) stands for Clustered Regularly Interspaced Short Palindromic Repeats, which are the hallmark of a bacterial defense system that forms the basis for CRISPR-Cas9 genome editing technology. In the field of genome engineering, the term “CRISPR” or “CRISPR-Cas9” is often used loosely to refer to the various CRISPR-Cas9 and -CPF1, (and other) systems that can be programmed to target specific stretches of genetic code and to edit DNA at precise locations, as well as for other purposes, such as for new diagnostic tools. With these systems, researchers can permanently modify genes in living cells and organisms and, in the future, may make it possible to correct mutations at precise locations in the human genome in order to treat genetic causes of disease.
Quorum Sensing
The discovery that bacteria are able to communicate with each other changed our general perception of many single, simple organisms inhabiting our world. Instead of language, bacteria use signaling molecules which are released into the environment. As well as releasing the signaling molecules, bacteria are also able to measure the number (concentration) of the molecules within a population. Nowadays we use the term ‘Quorum Sensing’ (QS) to describe the phenomenon whereby the accumulation of signaling molecules enable a single cell to sense the number of bacteria (cell density). In the natural environment, there are many different bacteria living together which use various classes of molecules, as they employ different languages they cannot necessarily talk to all other bacteria.
Bacteriophage Therapy
A bacteriophage is a type of virus that infects bacteria. In fact, the word “bacteriophage” literally means “bacteria eater,” because bacteriophages destroy their host cells. All bacteriophages are composed of a nucleic acid molecule that is surrounded by a protein structure. A bacteriophage attaches itself to a susceptible bacterium and infects the host cell. Following infection, the bacteriophage hijacks the bacterium’s cellular machinery to prevent it from producing bacterial components and instead forces the cell to produce viral components. Eventually, new bacteriophages assemble and burst out of the bacterium in a process called lysis. Bacteriophages occasionally remove a portion of their host cells’ bacterial DNA during the infection process and then transfer this DNA into the genome of new host cells. This process is known as transduction.
Developers of Environmental Cleaning Agents
Cleaning is essential in the health care industry for environmental surface management and infection prevention and control. The Centers for Disease Control and Prevention (CDC) and Healthcare Infection Control Practices Advisory Committee recommend that all health care settings, regardless of the level of care provided, make infection prevention a priority and those standard precautions, including environmental cleaning, be used as a means to reduce infection transmission.
Every day there are new products created and we need this research and development to continue especially hand in hand with surface developers as they complement one another in efficiency and effectiveness. Products in hand washing, instrument disinfecting and surface disinfecting along and others are an integral key to the infection battle.
Hospital Designers
Hospital designers and architects play an important role by designing a space that has all the aspects of keeping dangerous pathogens out. Newer design models incorporate the patient’s perspective and are based on medical-outcome evidence, patient satisfaction, and patient safety. One of the most important shifts in hospital design in the past few years has been to design patient-care spaces for infection control.
- How HVAC is implemented
- Patient flow
- Room design
- OR and procedure room design
- Floor design
- Green space implementation
Patients
Patients, care givers, and family also play a role in the transmission of infections. You must be your own advocate and if you are unable to communicate it is important doe family to do so.
Some things patients can do consist of asking friends and family to not bring flowers or plants. They are great vectors for pathogens. Ask your doctor or anyone that uses a stethoscope on you to wipe them down as well as asking all to wash hands. Do not lay your eating utensils on your bed. Linens and bed covers hold and can transmit C-Diff and other bacteria.
Have your family bring wipes to cover surfaces that they see EVS miss and ask if the antibiotic you are getting is necessary. Overuse and needless use of antibiotics contributes to the strength and resistance superbugs maintain.
We all need to collaborate and communicate to make sure we win this war. No one solution is the answer and this requires teamwork to defeat a killer that will take out 10 million people by 2050 per CDC estimates.
Mary Millard M. Ed is a public speaker on HAI’s and is an advocate for patients as well as research and funding on ARM’s. She is also a Board Member for the Healthcare Surfaces Summit.
References
American Journal of Infection Control
Volume 43, Issue 5, 1 May 2015, Pages 424-434
Centers for Disease Control and Prevention
Centers for Medicare & Medicaid Services
Calfee DP, et al. Supplement Article: SHEA/IDSA Practice Recommendation Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals. Infection Control and Hospital Epidemiology 2008; 29:S62-S80.
Facilities Guidelines Institute and the AIA Academy of Architecture for Health, with assistance from the U.S. Department of Health and Human Services. Guidelines for Design and Construction of Hospitals and Health Care Facilities, 2001 edition
Hosokawa S, Ole I, Kamiya A. Contamination of room door handles by methicillin-sensitive/methicillin-resistant Staphylococcus aureus. Journal of Hospital Infection, Volume 51, Issue 2, June 2002. Pages 140-143.
Ju Hun Lee, Christopher M Warne, Heung-Wuk Lee
Nature Protocols 12, 1999–2013
All hospitalized patients are susceptible to contracting an infection. Some patients are at greater risk than others, young children, the elderly, and persons with compromised immune systems are more likely to get an infection. Other risk factors are long hospital stays, the use of indwelling catheters, failure of healthcare workers to wash their hands, failure to properly sterilize instruments, and overuse of antibiotics.
Mary Millard M.Ed. 