Tessa Quinn
Hospitals are characterized by a high risk of infection due to patients' compromised immunological conditions, which make them vulnerable to bacterial, viral, parasitological, and fungal infections. The presence of microbes in hospitals is a global public health concern, as they can persist on medical equipment, surfaces, and the skin of patients and healthcare workers. Microbes can spread through the air, surfaces, aerosols, and hands, with hands being a significant transmission route. Various strategies have been developed to reduce microbes in hospitals, including manual cleaning and disinfection protocols, no-touch technologies, environmental design, and the use of metallic silver and copper, which have intrinsic antimicrobial properties. Probiotic-based sanitation is also being explored as a potential solution, with some studies suggesting that replacing pathogens with beneficial microbes may be more effective in reducing infections.
| Characteristics | Values |
|---|---|
| Microbial agents spread through | Air, surfaces, aerosol, and hands |
| High-risk surfaces | Bed rails, mechanical ventilation tubes, bedside tables, call buttons |
| Interventions | Manual cleaning/disinfection, "no-touch" decolonization technologies, isolation, facility design, engineering controls |
| No-touch decolonization technologies | Hydrogen peroxide vapor, UV light decontamination units, steam cleaning devices, ozone generators, multijet cold-plasma units, copper-surfaced objects, antimicrobial surfaces |
| Manual cleaning agents | Detergents, disinfectants |
| Antimicrobial surfaces | Titanium dioxide-based photocatalyst antimicrobial coating, copper, metallic silver, antimicrobial polymers |
| Other strategies | Probiotic-based sanitation, bundling strategies, handwashing stations, one-way human traffic flows |
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What You'll Learn
Probiotic-based sanitation
Hospitals are characterised by a high infection risk due to patients' compromised immunological conditions, which make them vulnerable to bacterial, viral, parasitological, and fungal infections. Healthcare-associated infections (HAIs) are a global public health concern, associated with high mortality rates and antimicrobial resistance (AMR). The hospital environment, including medical equipment, patients' surroundings, and healthcare workers (HCWs), can act as a reservoir for pathogenic microbial strains.
Conventional chemical sanitation methods used in hospitals often fail to prevent recontamination and can even contribute to the selection of drug-resistant strains. Probiotic-based sanitation, on the other hand, has emerged as a promising alternative. Probiotic Cleaning Hygiene System (PCHS) is an ecologically sustainable detergent containing spores of Bacillus probiotics. It has been found to significantly reduce microbial contamination and the incidence of HAIs.
In a study conducted in six Italian hospitals, the PCHS sanitation program resulted in an 83% mean decrease in surface pathogens compared to conventional chemical cleaning. The number of HAIs also decreased from 289 episodes in the pre-PCHS phase to 128 episodes in the post-PCHS phase. Additionally, PCHS was found to be more effective than chlorine-based cleansers, reducing C. difficile by 66.6%.
The Probiotic Cleaning Hygiene System (PCHS) is a probiotic-based sanitation method that has been shown to effectively reduce microbial contamination in hospitals. PCHS uses ecologically sustainable detergents containing spores of Bacillus probiotics, which are thought to compete with and inhibit the growth of pathogenic bacteria. This approach is particularly effective in reducing healthcare-associated infections (HAIs) and has been associated with a reduction in antimicrobial resistance.
Overall, probiotic-based sanitation, such as PCHS, offers a promising approach to reducing microbes and improving infection control in hospitals. By reducing the presence of pathogens and the risk of drug-resistant infections, this method has the potential to save lives and improve patient outcomes. Further research and implementation of probiotic-based sanitation are warranted to enhance hospital hygiene and patient safety.
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Manual cleaning and disinfection
Firstly, the choice of cleaning agents is essential. While detergents can reduce microbial levels, they may be less effective than disinfectants in killing microbes. Disinfectants are more powerful in decreasing bacterial burdens on surfaces. However, it is important to consider their limitations, such as the release of toxic fumes and the potential for allergic reactions among healthcare workers. Probiotic-based sanitation is an emerging approach that has shown promising results in reducing infections and drug-resistant pathogens. These methods take longer to establish stable microbial balance but are cost-effective and suitable for prophylactic use.
Implementing proper cleaning techniques is vital. This includes ensuring thorough physical removal or bioburden before applying no-touch disinfection technologies such as hydrogen peroxide vapour (HPV), UV light, steam cleaning, and antimicrobial coatings. Additionally, specific surface materials can influence microbial transmission. For instance, porous surfaces may be more easily contaminated but less likely to transfer microbes upon touch. On the other hand, metallic silver and copper surfaces, or coatings made from these materials, have intrinsic antimicrobial properties and can help reduce environmental colonisation.
Furthermore, environmental design plays a significant role in manual cleaning and disinfection. Strategic placement of handwashing stations and antiseptic alcohol at the exits of patient rooms, along with one-way human traffic flows, can minimise the spread of microbes. Proper leadership and human factors engineering systems with audit and feedback mechanisms can also enhance the effectiveness of room cleaning and disinfection, reducing bacterial bioburden.
To assess the success of manual cleaning and disinfection practices, it is essential to establish a baseline level of contamination on environmental surfaces and understand the latency of organisms on these surfaces. Studies have shown that patients shed microorganisms into their surrounding environment, with infected patients shedding more than colonised patients. Near-patient surfaces such as bedrails, bedside tables, and call buttons have been found to have higher bioburden, emphasising the importance of frequent cleaning and disinfection in these areas.
In conclusion, manual cleaning and disinfection are critical components of infection control in hospitals. By selecting appropriate cleaning agents, employing effective techniques, considering antimicrobial surface materials, and designing strategic environments, hospitals can significantly reduce microbes and decrease the incidence of HAIs.
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No-touch decolonization technologies
Hospitals are characterised by a high infective risk due to patients' compromised immunologic conditions, which make them vulnerable to bacterial, viral, parasitological, and fungal infections. The potential transmission of biological matter during surgery and the treatment of infected individuals means that hospitals are highly susceptible to the spread of pathogens.
Microbial agents can spread through the air, surfaces, aerosols, and hands. Contaminated surfaces, particularly those near patients, are a significant concern in hospitals. Bedrails, for example, are among the most contaminated surfaces, and mechanical ventilation tubes are frequently colonised by ventilator-associated pneumonia-causing bacteria.
To combat this, hospitals employ various strategies, including "no-touch" decolonisation technologies, which offer an effective and efficient means of decontamination without physical contact. These technologies are especially useful for disinfecting shared items in hospitals, such as toys in paediatric wards, where manual wiping with disinfectant wipes can be time-consuming and challenging due to irregular surfaces.
Ultraviolet (UV) light devices, hydrogen peroxide systems, and self-disinfecting surfaces are some of the commonly used "no-touch" methods. UV light devices have proven effective in reducing healthcare-associated infections (HAIs) caused by pathogens like methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp., and Clostridium difficile. The Altapure High-Level Disinfection Cabinet, for instance, generates aerosolised peracetic acid and hydrogen peroxide.
Another "no-touch" technology is the electrostatic sprayer, which has been found to be easy to use, processing large numbers of items with a spray time of approximately 20 seconds, and items are dry within 10 to 15 minutes, leaving no visible residue.
These "no-touch" decolonisation technologies offer hospitals a valuable tool in their ongoing battle against microbial contamination and the spread of infections.
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Hand hygiene
Handwashing Techniques
Proper handwashing techniques are essential for effective hand hygiene. Hospital staff, including healthcare workers and medical employees, should be trained in correct handwashing procedures. This includes wetting hands with clean water, applying soap, lathering for at least 20 seconds, and rinsing thoroughly. Drying hands with single-use towels or air dryers is also crucial to prevent the spread of microbes.
Hand Sanitizer Usage
Alcohol-based hand sanitizers are often placed at strategic locations throughout hospitals, such as near patient rooms and at nursing stations. They serve as a convenient alternative when handwashing facilities are not immediately available. Proper usage involves ensuring that the sanitizer covers all surfaces of the hands and rubbing them together until the sanitizer dries.
Timing of Hand Hygiene
The timing of hand hygiene is vital. Healthcare workers should perform hand hygiene before and after direct patient contact, after removing gloves, after touching blood, body fluids, or contaminated surfaces, and between patient procedures or activities. Adhering to these timings helps break the chain of infection and prevent the spread of microbes.
Monitoring and Compliance
Hospitals should implement monitoring systems to ensure compliance with hand hygiene protocols. This can include direct observation of handwashing practices, feedback from staff and patients, and the use of electronic monitoring devices or sensors. Regular audits and feedback help identify areas for improvement and reinforce the importance of proper hand hygiene.
Skin Care and Hand Hygiene
Frequent handwashing and the use of disinfectants can be drying and irritating to the skin. Hospitals should provide moisturizers and skin protection products to maintain skin integrity. This is important because damaged skin can harbour more microbes and increase the risk of transmission.
By implementing these hand hygiene practices, hospitals can significantly reduce the spread of microbes and decrease the risk of healthcare-associated infections (HAIs). Hand hygiene is a simple yet powerful tool in maintaining a safe hospital environment for patients, visitors, and healthcare workers alike.
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Antimicrobial surfaces
Hospitals are characterised by a high risk of infection, due to the vulnerable immunologic conditions of patients. Microbial agents can spread through the air, surfaces, aerosols, and hands. In fact, surfaces near patients are frequently contaminated with pathogens.
Antimicrobial coatings (AMC) are an emerging technology that can be used to reduce the presence of microbes on surfaces in hospitals. AMC can be applied to plastics and other synthetic polymers, making them less attractive to microbes and more deadly to them. The use of microbial-based sanitisation products has been shown to reduce the presence of common pathogens on hospital surfaces, including Enterococcus faecalis, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, and Candida albicans.
The efficacy of AMC technology may decrease over time due to mechanical abrasion or the eluting of biocidal substances. Therefore, it is important to consider other properties of the coating, such as stability and the risks of antimicrobial resistance emergence.
The human microbiome may be influenced by the diversity of microorganisms present on environmental surfaces. Thus, the use of antimicrobial surfaces in hospitals could help to stabilise the hospital microbiome and reduce the concentration of pathogens.
Overall, the use of antimicrobial surfaces in hospitals is a promising strategy to reduce the spread of microbes and improve patient outcomes. However, more research is needed to fully understand the potential benefits and risks of this technology.
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Frequently asked questions
Microbes can spread through air, surfaces, aerosol, and hands.
Hospitals can use manual cleaning and disinfection protocols, "no-touch" decolonization technologies, isolation through facility design, and other engineering controls.
Hydrogen peroxide vapour, UV light decontamination units, steam cleaning devices, ozone generators, multijet cold-plasma units, copper-surfaced objects, and antimicrobial surfaces.
Hospitals can implement handwashing or antiseptic alcohol stations at the exits of patient rooms and one-way human traffic flows to minimize exposure to healthcare workers and other patients.
Hospitals can use human factors engineering systems models with audit and feedback to increase effective room cleaning and disinfection, decreasing bacterial bioburden in patient rooms.
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