ENVI RONMENTAL T RANSMI S S ION
contamination was found to have increased by a mean difference of 115 CFU (colony forming units) at the end of the work period, compared to the start of the anaesthetic administration process.37
It was concluded that there was definite potential for the transmission of pathogenic, multi-drug resistant bacteria within the work area and the intravenous stopcock sets. Therefore, it can be seen within a contained healthcare environment that there is spread of potentially pathogenic bacteria. The potential ramifications of this would be surface contamination contributing to the ever- increasing concern that is MDR nosocomial infections.
Halting environmental transmission It is evident from current and historic literature that the protocols in place for disinfection within the healthcare environment are allowing opportunity for pathogens to contaminate surfaces and act as a reservoir for infection and outbreak. HCWs regularly contact both environmental surfaces and patients and have been identified as having the ability to facilitate the transmission of pathogens between contaminated surfaces and susceptible patients.39
While there is regional advice provided for the infection prevention and control (IP&C) within the healthcare environment by bodies such as CDC, EPA, WHO and the NHS, or advice given by experts or professional societies, there is no guarantee of a standard approach within varying healthcare entities. There is an identified need for standard IP&C
practices, as well as ensuring compliance with these principles. There would also be benefit to designing standard test procedures to determine the effectiveness of disinfection protocols within the healthcare environment. This would further our understanding surrounding the effectiveness of the current standard operating procedures in place, within different healthcare facilities, and identify areas that require improvement. One strong additional parameter that should be considered to enhance the current IP&C protocols in place would be the incorporation of antimicrobial coatings (AMCs). Use of AMCs help to mitigate the risk of contamination between cleaning opportunities. Whereas standard disinfection products can show strong efficacy at the point of application (when applied correctly), their antimicrobial activity is generally short lived and the surface becomes open to contamination once more. This is particularly prevalent within the healthcare environment, where there is a high concentration of people (both staff and patients), alongside a higher-than-average rate of infection among these people. Therefore, the use of an antimicrobial coating, such as Zoono Z-71 Microbe Shield, to help prevent the recontamination of surfaces between cleaning opportunities could aid in drastically reducing the incidence of nosocomial infections within the healthcare environment. Reduction in surface bioburden has been documented with the use of antimicrobial surface coatings.40
For example, preliminary research has been conducted by a teaching
hospital in Europe. After two months of continuous use of Zoono Z-71 within the infection prevention and control strategy, a decrease of up to 77% was seen in Clostridium difficile infection. Further research is now required in this area in order to fully assess the capabilities of AMCs in reducing indirect transmission of pathogens within the healthcare environment.
Conclusion
While there is some scepticism experienced surrounding the role of surface transmission of pathogens within the healthcare environment, there is an abundance of evidence for multiple pathogens and surface types supporting this route of transmission. As has been evidenced, indirect contamination has been shown to play an important role for both viral and bacterial pathogens. The outbreaks and recurrent outbreaks experienced within healthcare environments highlights the gap in the current infection prevention and control protocols. A standardised approach to IP&C needs to be developed, alongside the development of a testing methodology to assess the efficacy of the protocols being carried out.
One technology that could be considered to be incorporated into IP&C strategies moving forward would be the use of antimicrobial coatings. AMCs would offer additional protection between routine cleaning opportunities, and have shown promising results in other high-traffic industries for reducing surface contamination. Reducing levels of clinically important pathogens on environmental surfaces, which is an identified route of transmission within the healthcare environment, would be expected to result in a reduction in nosocomial infections.
References 1 Pickering, A.J., Ercumen, A., Arnold, B.F., Kwong, L.H., Parvez, S.M., Alam, M., Sen, D., Islam, S., Kullmann, C., Chase, C. and Ahmed, R., 2018. Fecal indicator bacteria along multiple environmental transmission pathways (water, hands, food, soil, flies) and subsequent child diarrhea in rural Bangladesh. Environmental Science & Technology, 52(14), pp.7928-7936.
2 CDC. 2015. Guidelines for Environmental Infection Control in Healthcare Facilities (2003) [Online]. CDC.
Once established within the environment, outbreak strains of Acinetobacter spp. can become endemic within certain work areas or institutions. The mortality rate for patients infected with Acinetobacter spp. has been shown to range up to 50%.
DECEMBER 2021
3 Mirhoseini, S.H., Nikaeen, M., Shamsizadeh, Z. and Khanahmad, H., 2016. Hospital air: A potential route for transmission of infections caused by β-lactam– resistant bacteria. American Journal of Infection Control, 44(8), pp.898-904.
4 Boyce, J.M. 2007. Environmental contamination makes an important contribution to hospital infection. Journal of Hospital Infection, 65 pp.50-54.
5 Duckworth, G.J. and Jordens, J.Z., 1990. Adherence and survival properties of an epidemic methicillin- resistant strain of Staphylococcus aureus compared with those of methicillin-sensitive strains.
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