A 2011 study found that out of 52,443 UK NHS hospital patients surveyed, a total of 3,360 were diagnosed with an active healthcare-associated infection (HAI), while 135 patients had more than one infection.1 To make matters worse, the threat of antimicrobial resistance is making these infections increasingly difficult to treat. This is why prevention is becoming a top priority for hospitals around the world.
Today, infection preventionists have two approaches at their disposal: vertical and horizontal. A vertical strategy focuses on preventing or controlling the outbreak of a single profile pathogen and provides great data. However, it is time-consuming, may allow some pathogens to go unnoticed and forces facilities to implement, manage and report the effectiveness of multiple strategies to have a meaningful impact on the HAI rate of the system.
Conversely, a horizontal strategy uses long-term techniques to comprehensively address bioburden throughout the patient environment. While horizontal approaches are often less expensive to initiate, attaining the same level of correlated data that vertical strategies provide can be a challenge.
Vertical vs horizontal is an ongoing debate. Dr John Jernigan at the Centers for Disease Control and Prevention says epidemiological characteristics of the organism must drive the interventions.2 However, as pathogens in facilities continue to increase in number and variety, Dr Richard P Wenzel of the Virginia Commonwealth University says that vertical strategies are inherently flawed.3 In addition, an editorial by Michael B Edmond and Wenzel suggested that the vertical tactic of screening patients in ICUs for MRSA may lack effectiveness.4
Hospitals are increasingly looking at a cleaner patient environment as a strategy that is more cost-effective and provides better overall outcomes
Hospitals are increasingly looking at a cleaner patient environment as a strategy that is more cost-effective and provides better overall outcomes. One product developed in conjunction with NHS infection prevention specialists is the germ-killing Pure Hold door handle. It releases a sterile sanitiser gel, providing convenient hospital hand hygiene.
Disinfecting robots are another innovation used to sterilise a patient room after it has been cleaned by personnel. An example is the Xenex pulsed xenon ultraviolet light robot, which helped the Cooley Dickinson Hospital in Massachusetts, US to experience a 53% reduction in C. diff infection rates.5
Other approaches have leveraged the antimicrobial properties of silver, copper, and other alloys. Preliminary findings of a US Department of Defense study demonstrate that patients treated in ICU rooms fitted with copper and copper alloy products have a greater than 40% reduction in the risk of acquiring an infection.6
Bioburden-fighting soft surfaces
Because soft surfaces make up a large proportion of the patient environment, textiles with antimicrobial properties are also being deployed. These are surfaces that freshly washed hands often come into contact with before touching a patient, inadvertently transporting pathogens. This is common in the case of privacy curtains – high-touch surfaces that are infrequently changed. A 2012 study published in the American Journal of Infection Control examined 43 privacy curtains and determined that 92% showed contamination within one week of being hung.7
A 2012 study examined 43 privacy curtains and determined that 92% showed contamination within one week of being hung
While some antimicrobial textiles rely on chemical coatings and topical treatments, PurThread Technologies’ novel approach incorporates a proprietary antimicrobial agent in the core of the fibres themselves at the raw material stage. This process ensures the fabrics are soft and pliable and that the antimicrobial efficacy will not wear off or wash out.
A study published in the Journal of Infection Control and Hospital Epidemiology found that PurThread privacy curtains in the clinical setting took seven times longer to become contaminated with potentially pathogenic bacteria compared with control curtains. PurThread curtains were also eight times less likely to be contaminated with VRE.8 So far, this double-blind randomised-controlled trial is the first and only peer-reviewed study of its kind.
It is inevitable that patients will contract infections in healthcare settings
It is inevitable that patients will contract infections in healthcare settings due to the large amount of bioburden that hospitals contend with and the increasing number of patients admitted with compromised immune systems.
Hospitals have options for both vertical and horizontal strategies to combat HAIs and it is up to administrators to determine which approach is best. To get rates moving downward, hospitals can incorporate layered vertical and horizontal approaches to infection prevention, while also ensuring high rates of hand hygiene compliance.
References
1. Susan Hopkins (HPA), et al. English National Point Prevalence Survey on Healthcare Associated Infections and Antimicrobial Use, 2011: Preliminary Data. Health Protection Agency. 2012
2. Jernigan, J. (2011). Pro and Con: Strategies to Prevent HAIs: Targeting High-Risk Patient Populations vs. High-Risk Pathogens. Paper presented at the Society for Healthcare Epidemiology of America (SHEA) Annual Scientific Meeting, Dallas, TX
3. Wenzel RP, Bearman G, Edmond MB, (2008) Infection Control and Hospital Epidemiology 29(11):1012-1018
4. Edmond M, and Wenzel R, (2013). N Engl J Med; 368:2314-2315
5. Levin J, Riley LS, Parrish C, English D, Ahn S, 2013. The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital. American J. of Infection Control. Vol 41, 8, 746–748
6. M G Schmidt, BMC Proceedings 2011, 5(Suppl 6):053 (Oral presentation presented at 1st International Conference on Prevention and Infection Control, June 29-July 2 2011, Geneva, Switzerland
7. M Ohl, M Schweizer, M Graham, K Heilmann, L Boyken, D Diekema, (2012) Hospital Privacy Curtains are frequently and rapidly contaminated with potentially pathogenic bacterial, American Journal of Infection Control, Vol 40, 10, 904-906
8. Schweizer, M. et al. (2012) Novel Hospital Curtains with Antimicrobial Properties: A Randomized, Controlled Trial. Infection Control and Hospital Epidemiology, Vol 33, No 11