Part 2 of Hospital Acquired Infections in China: How Air-Disinfection Technology Can Help
Read part 1 here.
Three Critical Strategies for Reducing Hospital-Acquired Infection
Given these challenges, any serious plan to control hospital-acquired infections requires a combination of three strategies:
Improving hand hygiene among hospital staff
Proper hand hygiene is essential, as more than 30% of the cases of hospital-acquired infection are spread via hand transmission, according to Wenlong He of TianJin Medical University.
Yet hand hygiene — at hospitals in China and worldwide — is “abysmally low” in the words of the World Health Organization. Even when hand rub is readily available, dispensers are in working order, procedures are posted, and healthcare workers know they’re being observed, nurses and doctors often fail to rub their hands long enough, cover their wrists, or remove gloves properly.
It’s not because they’re lazy. Rather, these dedicated healthcare professionals are focused on caring for patients and, as human beings, by nature engage in automatic, unconscious behaviours.
As the report on Shanghai hospitals noted: “Good knowledge and positive attitude of the physicians was not translated into good hand hygiene compliance.”
Furthermore, a review article on Chinese hospitals concluded: “Studies have shown that 80% of the medical staff do not wash their hands or wear masks before and after sterile operation or treating critical patients; 60% of the medical staff do not follow the six-step hand-washing method, do not wear masks before entering the ward, and do not wash hands after contacting the patients’ case history and personal items.”
These studies may actually underestimate the problem because they rely on self-reports or observations by other people. In studies that use head-mounted cameras to capture doctors and nurses on their rounds — a much more accurate method of evaluation — hand hygiene compliance is as low as 1% to 5%.
Improving surface cleaning protocols
Given the challenges with hand-hygiene compliance, it is especially important that hospitals thoroughly clean all surfaces, medical devices, and surgical instruments. After all, the more contaminated a surface, the more likely healthcare workers and patients will pick up bacteria on their hands.
When hospital patients check out of a room, cleaning staff must disinfect the bedframe, call button cord, trash can lid, closet handles, door knobs, sinks, and curtain rails.
In addition, between patient uses, cleaners must carefully disinfect stethoscopes, glucometers, computer keyboards, telephone handles, blood pressure cuffs, ultrasound machines, ECG leads, and ventilators.
Yet in China, as in other countries, this kind of careful, extensive cleaning is often not done.
Bingwei Sun, M.D., Ph.D., of the department of hospital infection management at Jiangsu University, has noted in Chinese hospitals a “lack of standardized or complete disinfection of surgical instruments, failure to implement surgical standards, failure to consider oxygen humidifiers as an important source of lower respiratory infection, and inappropriate measures of disinfection.”
Stethoscopes are a common source of contamination and are easily disinfected with alcohol, yet the Shanghai hospital survey found that only 29% of physicians disinfected their stethoscopes after each patient and “nearly half of the respondents did not know that stethoscopes and medical pocket watches are also a source of infections.”
What’s more, less than half of doctors and nurses reported laundering their white coats or uniforms twice or once per week. Only clinicians from intensive care units laundered their white coats or uniforms daily, as required by hospital policy.
However, experts note that infections can spread even when hospitals use the best cleaning methods and products and staff follow surface-cleaning protocols.
That’s because can pathogens come right back. In an American study, 36 bed rails were sampled for bacteria just before cleaning and then checked at four intervals afterwards. Within three hours, the bacterial burdens had rebounded to unsafe levels.
“Our study suggests that cleaning approximately every 2 hours would be necessary to maintain the population of this pathogen at the proposed non-detectable level,” the researchers concluded.
Furthermore, some pathogens seem to be impervious to even extreme cleaning methods. One of the hardiest is Acinetobacter baumannii, commonly found in Chinese hospitals, according to a study of infection prevalence at 52 Chinese hospitals.
Another roadblock to optimal surface cleaning: hospitals can’t accurately gauge whether a room or particular surface has been disinfected because most cleaned areas are visually inspected. As a British study demonstrated, an inspector can’t look at a door handle or toilet flush and know, with scientific certainty, whether it’s free of pathogens. A surface can look clean but be heavily contaminated.
Disinfecting the air
To help compensate for the shortcomings of hand hygiene and surface cleaning, hospitals must deploy a third line of defence against the spread of infection: disinfecting the air.
Vomiting, coughing, talking, even breathing can launch infectious microbes airborne. From there, particles can journey throughout the hospital via air currents and settle on any surface, such as a doctor’s lab coat, an IV pole, a stretcher, a supply cart, a bed rail, or a computer keyboard.
One study of Chinese hospitals found that just 26.1% of physicians and 39.5% of nurses said they would put a mask on patients when transporting them for a medical procedure, so it is not surprising that pathogens are often propelled into the air by sick patients. In addition, dangerous microbes are also carried into hospitals via the clothing and bodies of visitors and staff and are swept via air currents into emergency entrances, lobbies, corridors, stairwells, and patient rooms.
It is therefore critical for hospitals to inactivate these dangerous particles before they settle on surfaces and are transmitted to patients. As Wenlong He notes, airborne pathogen transmission “easily” causes infections, and to decrease infection rates, “air quality of the inpatient area should be improved.”
By far the most effective method of air disinfection is low-temperature plasma technology, increasingly used in European hospitals.
Plasma technology cleans air 24 hours a day, destroying airborne pathogens on contact. It is proven to be safe for continuous use around vulnerable patients and does not depend on human compliance. Not only does the technology rid the air of bacteria, viruses and fungi but it also protects patients against pollutants such as volatile organic compounds (VOCs) and fine particulate.
This is particularly helpful on days when outdoor air pollution is harmful, as outdoor pollutants can easily make their way into a hospital and reduce indoor air quality, causing difficulties for patients with respiratory conditions.
Furthermore, VOCs are prevalent in hospitals worldwide, emanating from furniture, cleaning solvents, hand sanitizers, lotions, shampoos, flooring, monitors, test tubes, and incubator parts, among many other sources.
To keep indoor air clean, hospitals must go beyond HEPA filtration. These filters only trap — rather than kill — dangerous microbes, and pathogens caught in a HEPA filter can expose maintenance staff to infection.
In an article on the status of and solutions to hospital-acquired infections in China, Bingwei Sun, M.D., Ph.D., wrote that infection management “in China and worldwide has a long way to go.”
The first step is to clean the air with Novaerus technology.
Cleaner hands and surfaces will save lives, but unless the air is dis-infected too, traditional prevention methods will not stop the pathogens wreaking havoc at hospitals around the globe.