AI R BORNE T RANSMI S S ION
Are hand hygiene and cleaning enough?
Carole Hallam argues that the use of air decontamination systems to improve indoor air quality should be considered as part of Trusts’ infection prevention and control strategies. She warns that hand hygiene and surface cleaning are not enough.
The burden of healthcare-associated infections (HCAI) is a major concern across the world with an estimated 8.8 million patients affected across Europe in both acute and long-term care facilities with more than half being preventable.1
Not only does HCAI
result in poor outcomes for patients in terms of morbidity and mortality and but it also has a huge cost to healthcare providers. Modelled annual costs to the NHS are in the region of £2.7 billlion2
extended length of hospital stay of up to 25 days3
and an estimated
– what else could that money be usefully spent on and how else could the hospital beds be better utilised? In addition to the costs and extended length of stay for patients with an HCAI, there is an even bigger concern around the growing incidence of antimicrobial resistance (AMR). One in three microorganisms causing HCAI are resistant to at least one antibiotic making these infections harder to treat.1
an estimated 4.95 million deaths globally4 associated with bacterial AMR in 2019 there has never been a more important time to prevent HCAIs.
Therefore, the principles of infection prevention and control are an essential strategy for preventing infections and the cornerstone in combating the spread of AMR. The SARS-CoV-2 pandemic has seen an increase in HCAI and an overuse of antibiotics increasing the risk of AMR, so they could not be a better time review infection prevention and control practices and to act.
Principles of infection prevention and control Earlier in 2022, NHS England published the National infection prevention and control manual for England5
(NIPCM)
based on the Scottish National infection prevention and control manual. Standards for infection prevention and control are
JANUARY 2023
With
outlined within the NIPCM and include the standard precautions and transmission- based precautions with an aim to “ensure a consistent UK-wide approach to infection prevention and control”.
The standard precautions include the preventative processes to reduce the transmission of infectious agents from patients with identified infection, as well as those with unidentified sources of infection. These standard precautions should be used “by all staff, in all care settings, at all times, for all patients, whether infection is known to be present or not, to ensure the safety of those being cared for, staff and visitors in the care environment”.
Hand hygiene, personal protective equipment (PPE) and cleaning of patient equipment and the environmental surfaces are outlined within the NIPCM but, if over half the HCAIs are preventable, do we need to relook at how we manage infection
prevention and control and consider what are the gaps? Transmission based precautions are categorised into ‘contact precautions’, ‘droplet precautions’ and ‘airborne precautions’ and provide the additional precautions to be taken, dependent on how an identified infectious agent is transmitted. Confusion has arisen with SARS-CoV-2 and whether it should be classed as ‘droplet’ or ‘airborne’. These traditional transmission- based categories are now beginning to be questioned by experts across the globe and has generated some very interesting discussions with Martin Kiernan and Brett Mitchell in their Infection Control Matters Podcasts (definitely worth a listen).
Droplet v. Airborne
Airborne and droplet transmission are usually defined by the size of the expelled aerosols or droplets, with airborne aerosol
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