hand hygiene
By Robert P . Lee
The Intersection of Infection , Immunity , Therapeutics , Nutrition , Prevention and Data
The healthcare community is focused on treatment , but prevention is equally , and in some instances – such as the COVID pandemic
– more important . There is an amazing array of antimicrobial agents available to treat infections in U . S . healthcare settings .”
Merriam-Webster Dictionary says that infection is “ the state produced by the establishment of one or more pathogenic agents ( such as a bacteria , protozoans , or viruses ) in or on the body of a suitable host . 1 The reaction between the pathogen and a host is critical to the ultimate outcome of any infection . Indeed , it is the host response that results in the symptoms of infection . As a pathogen multiplies , the host ’ s immune system responds to the microorganism and its toxins with the clinical symptoms of infection , e . g ., fever , chills , malaise , etc .
The healthcare community is focused on treatment , but prevention is equally , and in some instances – such as the COVID pandemic – more important . There is an amazing array of antimicrobial agents available to treat infections in U . S . healthcare settings . However , preventive endeavors are both more difficult and time intensive than simply administering a medication . Microorganisms can evolve quickly to antimicrobials , often becoming resistant to these agents through acquisition of genetic factors that inactivate or prevent an antimicrobial ’ s ability to assist the immune system and eradicate a pathogen .
An effective defensive structure against infection might be garnered from our military and their defense of high-value targets . Through the deployment of a series of rings and barriers they attempt to thwart any enemy rather than engage in battle . Is infection prevention the use of the same principles to protect patients ?
The Rings of a Good Defense
Data , accurate and real time , is essential , as early intelligence is the backbone of any defense . Examples might include better public health resources , central databases and dashboards , etc . Critical information can be manipulated and limited but accurate , raw date is often critical to provide healthcare professionals usable and actionable information to initiate the appropriate interventions to both prevent infection and treat patients .
Nutrition can also impact the effectiveness of our immune systems to both prevent and , if prevention fails , treat patients ’ infections . One of the critical components of infection prevention and response to infection is an intact immune system . Patients with immunodeficiency are much more vulnerable to infections , and hence , any intervention that improves immunocompetency can improve resistance to and hence prevention of infection .
Prevention is the third ring of defense . If a pathogen is prevented from reaching the patient , then we avoid both the necessity of treatment as well the risk of morbidity and mortality .. Two critical methods of prevention are hand hygiene and surface cleaning . Hands can provide a mode of transmission of pathogens from a surface or another patient with an infection to another , initially uninfected patient . Surfaces in the patent ’ s environment are often contaminated with microorganisms and may serve as a reservoir of pathogens . Proper disinfection of a surface / area reduces bioburden and consequently prevents a healthcare worker ’ s acquisition of that organism via hand contact with subsequent potential transmission to a new host . Proper hand hygiene is a second critical component of prevention , as it can eradicate or , minimally , reduce the numbers of microorganisms present . Of importance , these two interventions act synergistically to prevent infection .
Vaccines can also effectively prevent infection , but are only available for certain infections , such as common childhood infections such as measles and mumps , as well as other infections that may affect all age groups , such as influenza and COVID . A vaccine is antigenic material that precipitates an immune response specific to that pathogen , but does not harm the host or precipitate the actual infection , resulting in memory cells and antibodies that are available to the host ’ s immune system should the host encounter that specific pathogen in the future . Indeed , vaccines have had the greatest impact on disease prevention and the increasing longevity of populations .
Therapeutics , as noted above , are the antimicrobial agents used to treat established infections and in certain instances , such asd surgical prophylaxis and patients with