Infection control measures could save billions annually

 

The culture surrounding hand hygiene has always been paramount in reducing infection rates, and in this post-pandemic relief, the governing healthcare industry should be seizing the opportunity to mandate long-term improvements to reduce the transmission of future waves of COVID-19, new pandemics, seasonal influenza, and other infectious diseases. 


Infection control measures could save billions annually 

Although the initial impact of COVID-19 may have reintroduced ‘pandemic’ into our vocabulary, healthcare associated infections (HAI) are and have been a prevalent pandemic in and of themselves. 

Reports show that HAI “are responsible for the death of millions of people per year - more than tuberculosis, malaria, and AIDS combined. In Europe, over 4 million patients are affected by approximately 4.5 million episodes of HAIs every year, leading to 16 million extra days of hospital stay, 37,000 attributable deaths and contributing factors to an additional 110,000 deaths, resulting in £7 billion of additional healthcare costs”. 

In 2020, COVID-19 was thought to cost the global economy anywhere in the region of £1.1 trillion in lost income. Since, experts have estimated that the COVID-19 pandemic alone has cost 1-2% of global domestic product (GDP). 

Infectious disease outbreaks challenge healthcare systems in a variety of different ways, impacting everything from resource allocation and staffing, education, politics, and governance, to the systems culture and economics. The recent pandemic has highlighted the threat that infectious disease outbreaks will pose in the future. It has also highlighted the very real need for every country to be better prepared to deal with the effects that an outbreak could have on healthcare systems and society as a whole. 


Investing in preventing cost : the shadow of infection prevention control 

Commissioned in 2021 by the Government's Chief Scientific Adviser, Sir Patrick Vallance FRS FMedSci, set out to identify the measures needed in the UK’s built environment and transport systems to reduce infectious disease transmission. While the report in question notes how crucial it is that buildings and transport systems are “designed, operated, managed, and regulated for infection control”, it also exposes a developmental need in structural and maintenance design due to buildings being “built to previous standards or before standards’ introduction, have been modified over time, or are not operated as originally intended”. An example of this would be the modern improvement of ventilation. Combating the ‘sick building syndrome’, the introduction of improved ventilation has been proven to reduce infection risks, boost productivity, and alleviate asthma and general exposure to air pollutants. It is, however, the culture set and maintained by healthcare workers (HCW) in conjunction with structural improvements that would ensure a positive change for the future. 

It is globally known that maintaining good hand hygiene, either with an alcohol-based sanitiser or by using a handwashing unit, is the most effective and low-cost procedure that limits the spread of infections. For this reason, the importance of hand hygiene was championed throughout the pandemic as preventing nosocomial spread of coronavirus a top priority for healthcare systems around the world. Though all HCWs know the importance of providing and maintaining IPC measures, Didier Pittet, MD, MD, CBE, notes that nurses are “evidently at the front lines with most patient contact. Responsible for daily patient care, while simultaneously being responsible for protecting patients against HAI, if their IPC practices, especially their hand hygiene, are suboptimal, nurses become a source of transmission of infection between patients and to themselves”. 

To help govern this concern, medical experts believe that further investment into IPC facilities and education could help prepare HCW for any future outbreak. Furthermore, it should not be forgotten that IPC measures are currently essential for keeping HCWs healthy and operational. It was recently estimated that the number of HCWs that will be needed by the end of 2030 would be 80 million, with surveys predicting a shortage of 18 million HCW being unavailable. Consequently, in addition to being a workforce that is vital, “any increased strain on the staffing levels of HCWs will undoubtedly have a negative effect on patient outcomes”. 

Establishing a well educated and fundamental principle - that good hand hygiene saves lives - is also dependent on systemic components of the healthcare facility. This change was encouraged during this year's NHS campaign ‘The Gloves are Off!’ and would include (but is not limited to) access to supplies, how nurses are allocated, organised and trained, and how a consistent work culture is promoted/encouraged. 


Changing the culture 

Hand hygiene is the best method of preventing transmission of infections in healthcare, but compliance is usually suboptimal - this needs to change. Medical research has demonstrated how promoting a positive change in the culture surrounding hand hygiene can actively decrease infection rates. The study monitored nosocomial infection rates and attack rates of methicillin-resistant Staphylococcus (MRSA) in relation to the consumption of hand soap/sanitiser. Compliance with the suggested washing frequency and methodology showed a sustained improvement with hand hygiene coincided with a reduction of nosocomial infections and MRSA transmission. In conclusion, the promotion of bedside, antiseptic handwashing facilities largely contributed to the increase in compliance and subsequently the reason for a decrease in the spread of infections.  However, this research also showed that compliance to maintaining good hand hygiene increased amongst nurses, but remained poor amongst doctors, demonstrating that a global cultural change is necessary, for all HCW must comply with hand hygiene regulations to see maximum results.

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