What is Pseudomonas and how will it change hand hygiene in hospitals?
Hand hygiene facilities have been a target for infection control improvements in the healthcare environment because of their risk to benefit appeal. It is widely known that practising proper hand hygiene is the key to reducing the spread of infections across the board and remains one of the most cost effective ways to prevent harbouring pathogens. However, often the designs or manufacturing of the facilities required (basins/sinks/handwashing units) are not optimised for the healthcare environment. In turn, this allows a high concentration of healthcare pathogens such as nontuberculous mycobacteria, Pseudomonas aeruginosa, and other Gram-negative bacteria into close proximity to patients and healthcare professionals.
What is Pseudomonas?
Following the definitions set by the Centers for Disease Control and Prevention (CDC) and Public Health England (PHE): Pseudomonas is a type of bacteria that is commonly found in soil and water. Of the many different types of Pseudomonas, the one that is most commonly associated with healthcare associated infections (HAI) is called Pseudomonas aeruginosa (PsA).
PsA is a Gram-negative, opportunistic, bacterium. This means that it rarely presents any problems to healthy hosts and in the rare cases symptoms do develop, they are usually mild.
Who is at risk?
Although PsA rarely causes infection in people who are healthy, the spread of PsA around hospitals can lead to fatalities in patients who are immunosuppressed, or to those that present underlying diseases such as cystic fibrosis. As an opportunistic pathogen, PsA can be extremely harmful in these cases and is often associated with a high mortality in vulnerable populations.
The national library of medicine recently published a Risk Assessment of Pseudomonas Aeruginosa in Water demonstrating how PsA “can cause endocarditis, osteomyelitis, pneumonia, urinary tract infections, gastrointestinal infections, and meningitis, and is a leading cause of septicaemia”. In addition, PsA is also a “major cause of folliculitis and ear infections, and has been recognised as a serious cause of keratitis and a major pathogen in burn and cystic fibrosis”.
The symptoms of PsA can vary depending on the infected area. Ranging from blood (bacteremia), lungs (pneumonia), skin (folliculitis), ear, and eye infection, the most common symptoms include fever, chills, muscle ache, and fatigue.
Changing hand hygiene: alleviating the risk
In common with most bacteria, PsA is often spread throughout hospitals via the hands of healthcare workers (HCW), patients, or by the handling of unclean equipment. Maintaining good hand hygiene is an effective way of combating the spread of PsA. In fact, research has shown handwashing to be one of the most pragmatic methods in effectively mitigating the spread of harmful bacteria.
A good hand hygiene culture should be promoted to help with all infection control measures, but specifically around patients who present weakened immune systems - being more susceptible to infection. Handwashing, therefore, should be carried out before and after contact with the patient and their environment.
The World Health Organisation (WHO) advises that healthcare professionals should wash their hands at five critical points, known as the five moments for hand hygiene:
- Before Touching a Patient
- Before clean/aseptic procedure
- After body fluid exposure/risk
- After touching a patient
- After touching patient surrounding
Hands should be wet before applying liquid soap. The soap should be rubbed vigorously into all areas to produce a lather. The hands should be rinsed under running water and dried thoroughly.
Studies have shown that the risk of contracting PsA increases for patients and HCWs who are confined to a hospital setting for any extended period of time, and by maintaining good hand hygiene, this risk drastically decreases.
By following the five crucial moments for hand hygiene and promoting a healthy hand hygiene culture, infection rates of PsA (and a plethora of other harmful infections) will reduce. Simply - Handwashing can provide a cost-effective and efficient way of alleviating the threat of HAIs.
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