While hand
hygiene remains
the most im-
portant infection
prevention and
control mea-
sure, the role
of the care
environment in
preventing the
transmission of
harmful patho-
gens is becoming
increasingly
clear.”
In an abstract of an article in the
American Journal of Infection Control
titled “Infection Prevention Technician:
A new role to support enhanced hospital
environment-of-care rounding,” published
in June 2019, Eichelberger and Zirges
noted: “Healthcare-associated infections
(HAIs) are a significant cause of morbidity
and mortality. Studies suggest that envi-
ronmental contamination plays a role in
the transmission of pathogens. Several
common pathogens, including Clostridium
difficile (C. difficile), Methicillin-resistant
Staphylococcus aureus (MRSA), and
vancomycin-resistant Enterococcus (VRE),
can survive for prolonged periods in the
environment, and infections are associated
with surface contamination in hospitals.”
In 2015, J. Hudson Garrett Jr., PhD,
MSN, MPH, FNP, PLNC, CSRN, CHESP,
VA-BC, FACDONA posted a blog: “Re-
cent scientific evidence shows that the
clinical environment of care can serve as
a reservoir for growth of pathogens and even more often
becomes transiently contaminated, facilitating the spread of
pathogens. While hand hygiene remains the most important
infection prevention and control measure, the role of the
care environment in preventing the transmission of harmful
pathogens is becoming increasingly clear.”
Unfortunately, the healthcare community has been
slow to invest in EVS personnel, time, training and tools in
the efforts to reduce HAIs in the healthcare environment,
notwithstanding continual and on-going recognition that
the healthcare environment plays in infection prevention
and control.
Now, the SARS-CoV-2 pandemic has unfortunately taken
the world stage. As of April 27, 2020, hospitals world-wide
are facing the challenges of treating more than 3 million
known cases, which includes a hospitalization rate of 4.6
per 100,000 population in the United States. As a whole,
healthcare facilities have been reluctant to recognize, much
less financially invest in addressing the healthcare environ-
ment and the essential contribution of EVS. Yes, multiple
millions of personal protective equipment (PPE) items have
are being injected into US hospitals representing hundreds
of millions of dollars. But healthcare cannot continue to
have a parochial view of the expansive needs of EVS and IP
departments to maintain hygienic environments for patients,
staff, and visitors.
In a very enlightening online article in Facility Executive
dated April 1, 2020, Weber and Rutala highlight the findings
relating to a contaminated environment being a significant
aspect of patient exposure to HAI’s. “Unfortunately, many
studies have shown that disinfection of surfaces is sub-optimal
and that effective disinfection requires not only an effective
product but also effective practice.” Effective practice includes
on-going training, sufficient time allocation to accomplish as-
signed duties properly, and the proper tools that are effective
for the tasks at hand. (https://facilityexecutive.com/2020/04/
covid-19-surface-disinfection-as-prevention-strategy/)
30
Getting Back to Basics
It is painfully evident that one of the primary mechanisms
of disease transmission is via the hands of the healthcare
providers and the effect of a contaminated environment.
Training of nurses, physicians, and other “clinical” staff on
the importance of hand hygiene has seen the infusion of
millions upon millions of dollars. In providing hand sanitizing
gels, liquids, foams, and aerosols in the fight against HAIs,
multiple millions of dollars, and perhaps billions world-wide,
are expended. Yet what are we seeing?
Johns Hopkins Medicine reports that healthcare workers
only wash their hands 40 percent of the time. According to
the CDC 2002 Guidelines for Hand Hygiene in Healthcare
Settings, as few as 40 percent of U.S. healthcare workers
adhere to hand hygiene practices. It should be painfully
clear that hand washing and sanitizing alone is not going
to bring home the victory.
Why is it not being recognized by regulatory authorities,
epidemiologists, infectious disease physicians, infection
prevention professionals, and healthcare administrators that
proper handwashing and hand sanitizing in not enough to stem
the increase in HAIs? When will these professionals expand
their horizons and understand that a contaminated patient
environment is a significant aspect of patient exposure to HAIs?
We must ask the question: “Where do the germs that
cause HAIs come from?”
The question is too complex to arrive at with such simple
answers such as:
• “They come from the patient;” or
• “They come from the healthcare worker;” or ‘They
come for the visitors;” or
• “They come in with the packages and belongings
visitors bring in;” or
• “They come from an overuse of antibiotics,” or “They
come from the patient environment.”
We must look at the whole picture of the interaction of
the patient (including family and visitors), the provider, and
the patient’s healthcare environment.
Why the emphasis shifts so dramatically toward hand hygiene
and away from decontamination or disinfection of the patient
care environment? When did the importance, and yes value, of
the role of those responsible for cleaning and tending to the
healthcare environment become so diminished that resources
are diverted to clinical research and “patient-care staff?”
When did the paradigm of “patient care” shift to include
only physicians, nurses, therapists, and other licensed profes-
sionals and exclude other professionals involved in patient
care and the reduction and prevention of contamination from
harmful bacteria from the patient environment?
Correlation or Causation?
Is a reduction of EVS resources (size, budgets, training) and
the failure to invest in the expansion of Infection Prevention
departments over the past decade and the rise in the number
of HAIs a correlation or causation?
Is the absence of infection preventionists in long-term care
facilities and the lack of a sufficient number of trained EVS
staff a correlation or causation for/of the excessive numbers
of deaths attributed to COVID-19?
may 2020 • www.healthcarehygienemagazine.com