Decontamination
Exchanging knowledge on infection prevention
The Central Sterilisation Club’s Annual Scientific Meeting brought together leading experts to discuss how the decontamination sector can improve patient safety, increase efficiency, and meet the demand for additional capacity. But what can we learn from low resource settings and what can low resource settings learn from us? The Kelsey Lecture discussed key infection challenges and learning opportunities, across both settings.
Introducing the scientific meeting, CSC’s chair, Jimmy Walker emphasised the importance of providing access to further training for decontamination professionals and commented 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, 16th 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 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 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 to 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:
l The hospital built environment l Decontamination – the risk of water sources l Improving the quality of decontamination l Interventions for LMICs l 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,” commented. Infrastructure is an important area and “a risk factor in itself”, he asserted. Joost 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, this is particularly important – hospitals are an important reservoir of multi-drug resistant organisms. Humans are also an important reservoir, but both
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