Cover Story: Healthcare & Infection - A Balancing Act

Having an effective infection control system can help healthcare facilities stop spreading infection in the premises. While this is common knowledge, implementing such a system is not an easy feat. Rashmi Karanjekar, Assistant Editor, Clean Middle East, speaks to infection control experts in the healthcare sector about the control measures and best practices adopted in the UAE.

The healthcare industry across the world serves as a driving force for any economy. Thus, health institutes consistently strive to offer the best treatments and world-class facilities. In addition, they have to have in place an infection control plan for avoiding any cross contamination or spreading of infections for the well-being of the patients, visitors and their staff. Healthcare facilities need to have policies and plans in place for early identification of patients suffering from highly contagious diseases; the ability to immediately isolate such patients; and proper management (e.g., training, health education and availability of resources) to prevent transmission.

Smitha Aaron, Infection Control Practitioner, Quality Department, Ain Al Khaleej Hospital, says, “At most health facilities, infectious disease practitioners play a leadership role in infection control and prevention, promote hand hygiene, advocate for staff wide vaccinations, oversee equipment sterilisation and conduct infection surveillance. On the other hand, hospital administrators who think the value of infectious disease expertise is not a priority are missing out on a significant opportunity; they also risk losing their institution's money and reputation.”

Major challenges

Healthcare Associated Infection (HAI) refers to any infection that an individual (patient or healthcare workers) acquires during his/her stay at a hospital. According to Dr. Prashant Nasa, Head - Prevention and Control of Infection, Head - Department of Critical Care Medicine, NMC Speciality Hospital Al Nahda, Dubai, “The impact of these infections on patient outcome and cost of treatment is a major concern for hospitals as increasingly insurance companies are refusing to bear the burden of these infections.” “Infection control has a major role in the prevention of these infections,” he says.

The current burning issue surrounding the prevention and control of infections is also intrinsically linked with the prudent use of antimicrobial agents and adherence to antibiotic protocols. The increasing prevalence of antimicrobial resistance amongst hospitalised patients continues to pose a challenge for healthcare practitioners. Shaheena Surani, Manager Infection Control, Medcare Hospital, explains, “The spread of multidrug resistance organisms (MDROs) is also the outcome of an irrational use of antibiotics and has become a safety concern for patients across the continuum of patient care globally.”

Hand hygiene

Dr. Nasa reiterates, “Hand-washing is the most effective tool in the prevention of HAI. Despite its proven advantages, there is poor compliance rate of hand washing among healthcare workers. The challenge is to develop systems of continuous surveillance and feedback for hand hygiene practices.”

The Centers for Disease Control and Prevention (CDC) based in the US states that practicing hand hygiene is a simple yet effective way to prevent infections. Cleaning hands can prevent the spread of germs, including those that are resistant to antibiotics and are becoming difficult, if not impossible, to treat. On an average, healthcare providers clean their hands less than half of the times they should. On any given day, about one in 25 hospital patients contracts at least one healthcare-associated infection.

Dr. Neesha Nair, Senior Manager - Medical Affairs, Quality (Aster DM Healthcare),
agrees, “Hand hygiene compliance in hospitals is still a struggle area for many organisations as the culture of hand hygiene is still not embedded at all levels. Continuous efforts are required at the organisational level to improve practices and enhance compliance. Hospital waste management also requires equal attention as it can impose an adverse effect on the environment and safety of the patients, staff and visitors. Proper waste management and segregation methodology should be adopted by the healthcare organisation to promote safe and healthy environment.”

Common hospital-acquired infections

According to the World Health Organization, an increasing rate of multidrug-resistant gram-negative organisms in the hospital is a major public concern and requires new treatment options. These gram-negative infections are the most common organisms causing nosocomial and HAIs in hospitalised patients. “It is associated with poor outcomes including increased resource utilisation and costs, morbidity and mortality. Contact isolation precautions should be taken for all the patients infected and colonised with multidrug gram-negative organisms to control the spread of infections to other patients in the hospital,” says Dr. Nair.

“While no single surveillance system can provide estimates of the prevalence of HAIs across acute-care patient populations, a recent prevalence survey published in the March 2016 issue by The New England Journal of Medicine reveals important insight for healthcare providers in their efforts to combat HAIs. The list ranks the most common healthcare-associated infections stating pneumonia (21.8 per cent) as the highest of all HAIs and systemic infection (0.2 per cent) being the lowest. Apart from this, the most commonly reported pathogen was clostridium difficile, causing 12.1 per cent of HAIs. Infections resulting from the use of a device, (i.e., central-catheter-associated bloodstream infections or urinary tract infections, and ventilator-associated pneumonia) accounted for 25.6 per cent of infections,” informs Aaron. Adding to this, Dr. Nasa says that Catheter-Associated Urinary Tract Infection is the most common HAI prevalent in recent times.

Precautionary measures

The use of standard precautions regardless of patient diagnosis should be the mandatory requirement of the infection control program and strictly observed by all the healthcare staff at all times. Standard precautions are considered a primary strategy for reducing the transmission of blood-borne pathogens and other infections. “In addition to this, transmission-based precautions should also be practiced for the patients suspected or confirmed to be infected with specific micro-organisms. There are three categories of transmission-based precautions as per the route of transmission (airborne, droplet and contact precautions). Protective isolation precautions in the hospital to protect the patient from getting the infection from others should also be considered,” says Dr. Nair.

In addition to the precautionary measures the physical design and infrastructure of a hospital is also an essential component of infection control measures. Aaron avers, “Today, with a more progressive outlook, it is the fundamental requirement to adopt a holistic view of the design and management of hospitals. Designing hospitals to be open, public spaces can make it difficult to control the spread of infectious diseases. Additionally, the ease of travel and transportation today helps people cross borders easily. They can harbour, carry or catch infectious agents readily.”

Latest technologies

New technologies are increasingly being developed for the prevention of HAIs and marketed to the healthcare organisations worldwide. For instance, no-touch environmental UV disinfection systems are available to reduce the environmental contamination. “This advance system destroys bacteria, spores, and viruses and quickly reaches areas that are difficult to target and disinfects them using traditional cleaning practices. Adenosine triphosphate (ATP) methods and fluorescent markers also have been used to assist and monitor the cleaning practices in the hospitals. Several antimicrobial coatings are also used to surfaces in healthcare facilities to decrease bio-burden on surfaces and reduce the environmental contamination,” explains Surani.

Advances are also being made in the hand hygiene monitoring system around the world. “Technologies have emerged with a wide range of capabilities; fully automated hand hygiene monitoring systems are available to detect hand hygiene events as healthcare workers enter and exit patient room, and in some cases, may monitor all 5 of the WHO Moments of Hand Hygiene,” she adds.

Consequently, consistent use of best practices and clarity of roles should be emphasised. Use of technologies such as microfiber monitoring systems, and whole-room disinfection after cleaning are increasingly becoming the community standard of care. Additionally, technologies like environmental fogging and UV disinfection are also been used in stopping outbreaks.

Going ahead, fully automated cleaning and sterilisation; automated disinfection systems like UV Robots are revolutionising the terminal cleaning of patient rooms and operation theatres. Laboratory automation has not only helped in early detection of microbes but also better detection rates and point of care testing. Automated softwares attached to laboratory microbiology systems help in early detection of outbreak alerts in surveillance of MDR organisms and preparation of daily or periodical antibiogram reports


The essence of infection control is the provision of effective education and training on infection control practices to all healthcare personnel. Infection control experts advise indepth knowledge and understanding of infection control issues will greatly assist health care workers in the prevention, management, and control of healthcareassociated infections. As far as patient and families are concerned, they should be actively involved in the infection control plan as their engagement and partnership in self-care will reduce the chances of adverse events.

Lastly, it is imperative that healthcare institutions across the world work in collaboration and share insights about the local epidemiology to facilitate adequate preparedness to deal with common problems like antimicrobial resistance, emerging and remerging infections.

The standard precautionary measures to be considered for infection control include the following important elements:

• Hand hygiene according to the WHO ‘5 moments’ (One of the important component of standard precautions and effective mechanisms to prevent the spread of microorganisms).
• Appropriate use of personal protective equipment (PPE): usage of PPE should depend upon the anticipated contact with blood and body fluids, or pathogens.
• Use of aseptic technique where required: (This practices will limit the spread of microorganisms and prevent the contamination. It should be observed while performing wound dressing, administrating the medication, insertion of invasive devices etc.)
• Appropriate disinfection and sterilisation of patient care equipment and instruments
• Safe handling and disposal of sharps and potentially infectious material
• Use of safe injection practices
• Safe linen and waste management
• Environmental controls including cleaning and spills management.

Source: Medcare Hospital


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