INFECTION PREVENTION & CONTROL
What can we learn from ‘low resource’ settings?
Giving The Kelsey Lecture at the CSC’s Annual Scientific Meeting earlier this year, Joost Hopman, a Medical director and Consultant Microbiologist at the Radboud University Medical Center in Nijmegen in the Netherlands, considered what hospitals in low resource settings can learn about effective decontamination from those with better resource provision, and vice versa. Among his key areas of focus were the role of the hospital built environment in infection prevention and control and decontamination, and the associated water hygiene risks – and the particular IP&C challenges for healthcare facilities in low and middle income countries.
Introducing the scientific meeting, Central Sterilising Club chair, Jimmy Walker, emphasised the importance of providing access to further training for decontamination professionals, and said that the CSC aims to bring regular education opportunities to the sector. Both the Annual Scientific Meeting (which took place In Newcastle Upon Tyne), and the Annual Study Day (taking place in Liverpool, 16 October), offer ample opportunities to deepen sector knowledge of best practice, the latest research, guidance, and expert opinion. The programme opened with the
Kelsey Lecture on: ‘The challenges of decontamination in low resource settings’, by Joost Hopman – a medical director and consultant microbiologist at the Radboud University Medical Centre, in the Netherlands. Joost Hopman acts as a consultant for Doctors without Borders (Médecins Sans Frontières), Amsterdam, and is an advisory board member of the Infection Control African Network (ICAN). In 2014 and 2015, he was invited to work as an infection prevention and control (IP&C) consultant for the World Health Organization, in the Ebola outbreak response, in Sierra Leone, and this provided him with valuable experience of international outbreaks. He is also a visiting professor at the University of Lagos. Over the years, Joost Hopman has gained extensive experience of the challenges around decontamination and infection prevention in countries with lower resources than our own. However, he also emphasised the fact that high resource settings and low resource settings ‘both need to learn from each other’. IP&C in low and middle-income
countries (LMICs) is particularly concerned with Gram-negative microorganisms. He reported that there is an increase in carbapenemases and extended spectrum beta-lactamases (ESBL). Even within Europe there are geographical differences, however, with greater challenges associated with carbapenemases in the
Mediterranean region compared with the Nordic region. He pointed out that travel is a key factor. Holidaymakers have a 30% increase in risk of picking up resistant genes, so this is also affecting high resource settings.
In addition, carbapenem resistance
is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs.1 “This is why we need to focus on IP&C within healthcare facilities, in LMICs,” he asserted. He went on to discuss five key areas:
n The hospital built environment. n Decontamination – the risk of water sources.
n Improving the quality of decontamination.
n Interventions for LMICs. n The challenges for LMICs.
“In hospitals, efforts have tended to
focus on behavioural factors, but this is not sustainable. With training, you need to do it again and again. There is a very high turnover of personnel at Médecins Sans Frontières; every three months there is a new set of people working at the healthcare facilities,” he commented. Infrastructure is an important area and
‘a risk factor in itself’, he asserted. Joost Hopman explained that he has worked with the WHO on various documents – including Minimum requirements for infection prevention and control programmes (2019), and Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level (2016).2,3 Among the eight core components of
IP&C include ‘a multimodal approach’ and ‘the hospital built environment’. In LMICs,
Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs.
October 2023 Health Estate Journal 37
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