Infection control
Rising numbers of HAIs during the Covid-19 pandemic are to be expected, and they mask the fact that measures have achieved some level of success in combatting other infections. “Efforts to reduce many hospital-acquired infections, such as catheter-associated urinary tract infections, central line-associated bloodstream infections, and C. difficile infections, have been successful overall in years prior to the pandemic,” notes Kuhar. “Reasons for decreases in hospital- acquired infections can be different for each individual healthcare-associated infection. “Unfortunately, many healthcare-associated infection rates have increased during the pandemic, potentially due to healthcare system stresses, novel patient care processes for those with Covid-19, such as proning patients on ventilators and risking disrupting the dressing on a central line catheter, as well as modifications to typical infection prevention activities, such as central line catheter maintenance activities.”
Flattening the curve
When under such great pressure, can hospitals do more to reverse the rising trend of HAIs? “Hospitals are doing an incredibly tough job,” says Prakash. But one thing he believes they can do better is helping healthcare workers maintain their regular hygiene regimen. This can take the form of automated systems, which can measure hygiene performance and also provide ‘nudges’ to them in case they forget important activities like handwashing. “Another [improvement could be] using a wider spectrum of tools from infectious disease epidemiology, such as increased testing of both healthcare workers and visitors, which can quickly pick up imported cases too,” he says. Other useful practices suggested by Prakash are “better data modelling and analysis”, in order to implement more targeted measures to detect outbreaks earlier, possibly even among asymptomatic patients, and “genomic surveillance” to monitor trends in circulating variants within healthcare settings. For Prakash, efforts have been reasonably successful so far, though the effectiveness of preventative measures varies between healthcare institutions. He does, however, see room for improvement in using more optimised and systematic measures like data modelling. “With increasing stress from novel pathogens, this is becoming more important,” he remarks. “In general, many hospitals have begun understanding the role of data and models and how they can be used to inform hospital management, including improving workflows. There are also HAI penalties for hospitals for readmission and other things in US law. Hence there are multiple clear incentives for hospitals to do better.”
Practical Patient Care /
www.practical-patient-care.com
What remains to be seen is whether the precautions introduced for Covid-19 will remain in place when the pandemic is over. It is hard to identify what has individually had the greatest impact. Perhaps effectiveness is down to compliance with all robust infection prevention and control practices, throughout any healthcare facility. “It is difficult to say which additional infection control practices that were enacted during the pandemic in healthcare settings will be maintained after the pandemic has ended,” says Kuhar. “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.
An automated hand- sanitising system that nudges healthcare professionals to
maintain their workplace hygiene standards.
“In general, many hospitals have begun understanding the role of data and models and how they can be used to inform hospital management, including improving workflows.”
B. Aditya Prakash
“Processes have definitely been refined, although maybe we should aim for being more nimble in future,” says Prakash. “I think better surveillance and testing of visitors, patients and healthcare workers is here to stay. It is extremely clear now that all hospitals know having a strong infection prevention and control programme is necessary. Understanding the impact of different measures is broadly also an open question and an active area of research, but I believe more passive automated systems, data analysis and mathematical modelling can play an important role in determining these lessons.”
There are lessons to be learned, so the onus is on the healthcare sector to continue its in-depth analysis, even after the pandemic has passed.
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Shutterstock.com
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