Infection control
hygiene and preventative practices might be under stress, again leading to easier spread,” he adds. “HAIs also weaken the natural immunity of a body, serving to increase adverse effects from Covid-19. At the same time, more widespread use of PPEs and other measures introduced for Covid-19 in hospitals can have beneficial side effects for other infections too, and we are seeing some tentative evidence for that in more rural hospitals. I think it is still unclear which dynamic is the main one right now.”
Guidance and compliance
The arrival of the highly- transmissible Omicron variant has put already vulnerable patients at increased risk.
“The CDC has received reports from partners about increases in healthcare-onset SARS-CoV-2 infection, suggesting that transmission in healthcare settings has increased in some areas and facilities during the Omicron wave,” says Dr David Kuhar, who leads the hospital infection prevention team at the CDC. “As community transmission levels have been a strong predictor of transmission in healthcare settings, it is not unexpected that transmission in healthcare settings increased during the unprecedented levels of transmission seen with the spread of the Omicron variant.”
A snapshot of the situation in the UK, using figures from NHS England, shows 2,158 new positive tests in hospitals in England on 3 January 2021. Of those, only 1,635 were infections occurring “in the community”, leaving 523 cases (24%) most likely contracted in hospital – double the proportion recorded at the start of December 2020, when hospital-acquired cases accounted for only 10% of new cases.
“It is conceivable that healthcare settings may make more avid use of strategies such as source control and universal personal protective equipment during periods of increased risk, particularly respiratory virus season.” Dr David Kuhar
“Definitely, Omicron has complicated infection control,” says B. Aditya Prakash, associate professor in the school of computational science and engineering at the Georgia Institute of Technology. “On one hand, large urban hospitals have been slammed in the ER due to the increase in Covid-19 patients, making them overcrowded, leading to greater chances for infections to spread more easily from hospital staff and patients. “Also due to increased load, adherence to usual
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Infection prevention and control procedures to target the transmission of infection through skin contact, surfaces and airborne virus particles in healthcare settings, such as the CDC’s general infection control guidance, are well established and understood. For example, appropriate air handling, use of source control, and respirator use can reduce the risk of transmission of airborne virus particles. Regular environmental cleaning can reduce risks from surfaces, and interventions like personal protective equipment such as gowns and gloves, and hand hygiene can reduce the risk of skin contamination. New variants, however, require incremental changes to account for increased transmissibility. The CDC, for example, updated its guidance in response to the Omicron variant in December and then again in February to include measures for mitigating staff shortages and to establish processes for dealing with exposed and infected healthcare personnel. “Overall, the infection prevention and control recommendations for healthcare settings have not drastically changed, but have expanded in some areas, such as situations in which a respirator may be used by healthcare personnel,” remarks Kuhar. “In healthcare settings, a number of additional infection prevention and control practices have been introduced during the pandemic to help prevent the spread of SARS-CoV-2, such as immunisation of healthcare personnel and patients or residents, the use of source control or masking by everyone in a facility, and implementing measures to reduce close contact between persons in healthcare settings, such as limiting the numbers of persons in healthcare personnel breakrooms, and limiting resident or patient group activities.” More interventions are also being implemented, but it is adherence to these guidelines that is important to best prevent the transmission of infections in healthcare. Compliance is key. “Adherence sometimes takes a backseat to other more pressing matters,” says Prakash, who is leading a team of multidisciplinary scientists exploring ways to use data and mathematical modelling to detect, understand, and control future HAI spread. “But by and large, limiting the spread of Covid-19 inside the hospital is crucial and hospitals have taken steps for that.”
Practical Patient Care /
www.practical-patient-care.com
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