IHEEM REGIONAL CONFERENCE 2018
Wales, which includes Welsh HBN 00-09 - Infection control in the built environment 2016; Welsh HBN 00-10 – Part C: Sanitary assemblies 2014; Welsh HTM 04-01: Safe water in healthcare premises 2016 Parts A, B and C: Pseudomonas aeruginosa – advice for augmented care units, and WHTM 04-01: supplement, Performance specification For Thermostatic mixing valves 2017. Referring to the latest guidance on clinical hand washbasins, she said they should: n be large enough to contain most splashes.
n be wall-mounted. n have no plug or a recess capable of taking a plug.
n have no overflows, ‘as these are difficult to clean and become contaminated’.
n not have taps aligned to run directly into the drain aperture, ‘as contamination from the waste outlet could be mobilised’.
n ‘not be used for other purposes’, such as emptying of patient bathing water, ‘as this may transfer strains to the water supply system where they can colonise existing biofilms’.
Tracy Gauci also pointed out that, on the topic of clinical washhand basins, WHTM 04-01 Part C: Pseudomonas aeruginosa– advice for augmented care units ‘best practice Do’s and don’ts’ include: n Use such basins solely for hand- washing.
n Do not dispose of body fluids at the clinical washhand basin. Use the slop hopper or sluice in the dirty utility area to dispose of body fluids.
n Do not wash any patient equipment in clinical washhand basins.
n Do not use clinical washhand basins for storing used equipment awaiting decontamination.
n Do not dispose of used environmental cleaning agents at clinical washhand basins.
n Do clean the taps before the rest of the clinical wash-hand basin.
Spread ‘from sink to patient’ She also cited a recent study [Kotay S, Chai W, Guilford W, Barry K, Mathers AJ. Spread from the sink to the patient: in situ study using green fluorescent protein (gfp) expressing – Escherichia coli to model bacterial dispersion from hand washing sink trap reservoirs. Appl Environ Microbiol 2017; 83 (8)]. The study’s findings appeared to back up ‘an increasing number of reports implicating gram-negatives carrying genes of drug resistance from colonised sink traps to vulnerable hospitalised patients’. She acknowledged, however, that the mechanism of transfer from sink trap to patient was still ‘poorly defined’. With growing evidence of potential bacterial spread from sink to sink, she said potential
26 Health Estate Journal October 2018
Tracey Gauci, co-ordinator of the Welsh Branch of the Infection Prevention Society, Patron to the Association of Healthcare Cleaning Professionals, and deputy Clinical director at Gama Healthcare.
solutions included use of chemical disinfectants, automated electro-chemical treatments, and use of heat, UVC, or vibration to discourage biofilm for. A more permanent solution would be to remove sinks from critical care areas altogether, but then alternative methods of water-free working, such as using wipes to remove extensive contamination from hands, followed by the use of alcohol-based rubs, in place of handwashing, would need to be deployed.
Theatre ventilation examined In the day’s final presentation, ‘Operating theatre ventilation and reducing post- operative infection. ‘Is it all just hot air?’, Professor Hilary Humphreys, Professor of Clinical Microbiology and consultant micriobiologist at The Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, focused on operating theatre ventilation and reducing post- operative infection. The Professor reflected on the history and different types of operating theatre ventilation, the key factors that influence bacterial counts during surgery, evidence of the impact of different ventilation systems on post- surgical infection, and the arguments for
and against laminar flow ventilation systems. Study evidence suggested that among the key factors influencing bacterial counts were the type of surgery, the patient’s age, whether the incision made was deep or superficial, and the proximity to organs, the number of staff in the theatre, what ‘stage’ the operation was at – with the infection risk higher pre-incision and post-wound closure, and the temperature in the theatre.
Unidirectional flow
Discussing laminar air flow, the Professor explained that the aim was ‘to create a unidirectional flow of air free of eddies and turbulence, so that what is shed from the operative team is directed away and outwards from the surgical site’. While various studies – the speaker briefly mentioned a number– had produced conflicting evidence on laminar flow’s infection-reducing benefits, one [James M, Khan WS. Nannaparaju MR, Bhamra JS, Morgan-Jones R. Current evidence for the use of laminar flow in reducing infection rates in total joint arthroplasty. Open Orthop J 2015; 9 (Suppl 2): 495-8] stated that ‘due to the extensive evidence gathered in the last 10 years, it no longer seems possible to recommend the use of laminar flow ventilation in joint replacement’. The authors added: ‘Further work is needed to look at the effect of patient warming and theatre lighting on laminar flow, and, in turn, infection’.
Many questions remaining In conclusion, Professor Humphreys said a number of key questions still needed to be asked, including: n Do we need to redefine surgery, and what is an operating theatre?
n Does controlled ventilation reduce SSIs?
n Do UCV operating theatres harm patients; were the original trials on UCV flawed?
n Can human behaviour modification improve practices?
n What level of ventilation do we need for different procedures, and how do we determine that?
Among his conclusions were: n Many infections are not airborne. n Ventilation will not reduce these. n Skin bacteria are reduced. n Some airborne infections will be reduced.
n Further studies or observations are required on the use of UCV and what is optimal for minor surgery.
Professor Hilary Humphreys focused on operating theatre ventilation and reducing post-operative infection.
Professor Humphreys’ presentation brought to an end an interesting and extremely varied first day’s IHEEM 2018 Regional Conference, in which two key themes – fire safety and infection control – took centre stage.
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