In our last blog post, we looked at the crucial role cleaners play in breaking the chain of infection in hospitals. But infection prevention and control (IPC) isn’t just down to the cleaners. It is the responsibility of everyone working in the hospital, including doctors and nurses, and of course, the dedicated IPC team.
Here, we summarise the four key factors that are crucial for breaking the chain of infection in hospitals.
1. Isolation and cohort nursing
Isolation of infected patients is an important component in preventing the spread of infection in hospitals. The purpose is to contain the organism and its mode of transmission, rather than the patient.
The Health and Social Care Act 2008 requires that all hospitals provide adequate isolation precautions and facilities, have policies in place for how to allocate patients to isolation facilities, and ensure that they can keep infected patients separate from others.
Individual patients with an infection should be isolated in single rooms or side rooms. When there are not enough single rooms to isolate individual patients, cohort nursing should be undertaken. This is where patients with the same organism, e.g. MRSA, or those displaying similar signs and symptoms, can be nursed together. The cohort may consist of an entire bay of infected patients, in which case the patients should be cared for by designated staff in a dedicated area of the ward.
Isolation and cohort nursing break the chain of infection by containing the organism in specially appointed areas so that it can’t spread to other patients, staff, equipment or surfaces within the hospital.
2. Hand hygiene
Alcohol gel dispensers and signs to wash your hands can be seen all over hospitals – and for good reason. Hand hygiene is the single most important intervention that hospital workers can undertake to prevent the spread of infection. It has been estimated to reduce the spread of hospital-acquired infections (HAIs) by 15-30%.
Organisms present on the skin of infected patients can shed onto nearby objects or equipment, allowing it to be transferred to the hands of hospital staff, where it can survive at least several minutes. If the staff member washes their hands or uses alcohol gel, they kill the organisms before they can transfer them to the next patient, object or equipment they come into contact with.
There are many reasons hand hygiene may sometimes be overlooked by staff. Not least because there are often so many other tasks that demand a staff member’s attention in such a busy hospital environment. Ensuring there are plenty of alcohol gel dispensers, conveniently located within the hospital, is crucial – as well as making sure they are regularly re-filled. Introducing personal bottles of hand gel can also increase hand hygiene significantly. Our recommendations for hand hygiene can be found here.
3. Personal protective equipment
The importance of personal protective equipment (PPE) has been a highly topical subject of late. The shortage of PPE during the coronavirus outbreak in the UK demonstrated just how crucial it is in preventing the spread of infection.
In line with EPIC and NICE guidelines, the selection of PPE should be based on a risk assessment of the risk of transmission to the patient or staff member, and the risk of contamination with blood, body fluids, secretions and excretions or exposure to chemicals. Aprons, gowns and gloves are the most commonly required PPE, as well as surgical face masks and respiratory protection – such as in the case of caring for patients with coronavirus.
Just as important as having the appropriate PPE is using it correctly. The incorrect use of gloves and disposable plastic aprons increases the risk of cross-infection to patients, equipment and the environment.
Putting on PPE is often the first thing healthcare workers do when preparing for a task or patient care, but actually, it should be the last thing they do. This is so that there’s no risk of accidental contamination before they even make it to the patient. Healthcare workers must also not leave a bay or room wearing PPE – unless there is an emergency or they are removing a bedpan.
PPE intended for single-use should also not be reused. This was where a lot of the criticism around COVID-19 came from, as many healthcare workers complained of having to re-use masks and share them between colleagues. Many studies have been done around the effectiveness of decontaminating reusable PPE, including by University Hospital Southampton using the ProXcide hydrogen peroxide technology. The Inivos strategy for decontaminating reusable PPE, including our recorded webinar on the subject, is here.
4. Environmental decontamination
Environmental decontamination also plays a critical role in breaking the chain of infection. There has been a growing body of evidence in recent years to show that contaminated surfaces are a key contributor to the spread of infection from person to person. This is because pathogens and multidrug resistant organisms can easily be shed from infected patients and survive on dry surfaces for hours, days, or even months at a time.
Manual cleaning is an important first step, but, on its own, is not enough to break the chain of infection. In the case of an outbreak, enhanced cleaning methods such as increasing the frequency of cleaning, using extra staff to target ‘high-touch’ surfaces and bringing in teams for ‘high risk’ areas can be beneficial. Disinfection is also equally important, as cleaning alone isn’t effective enough to inactivate certain microbes such as viruses and spores.
But the most effective methods for environment decontamination involve specialist automated technologies. These systems use either ultraviolet (UV-C) light or hydrogen peroxide vapour (HPV) to eliminate pathogens from the environment.
UV-C kills microorganisms by destroying the nucleic acid and disrupting their DNA. UV-C decontamination is most appropriate if a ward is experiencing an extremely high volume of patients, as it can reduce pathogens within 45 minutes and, in some cases, in as little as 3 minutes. HPV kills microorganisms by a process of oxidisation which destroys the cell wall. HPV decontamination is arguably more effective than UV-C but does take longer – up to two hours.
More hospitals are turning to automated decontamination systems for effective infection prevention and control. Used in addition to manual cleaning and disinfection, they give cleaning staff the reassurance that they are delivering the best possible service for patients, visitors and staff.
All these methods work together to break the chain of infection. Isolating infected patients helps to contain the organism and its mode of transmission. Correct use of PPE prevents pathogens from being transmitted from infected patients to other patients, staff and visitors, as well as equipment and objects within the environment. And good hand hygiene and environmental cleaning kills the pathogens to prevent them from being spread between people and surfaces.