Healthcare Hygiene magazine May 2020 | Page 30

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