Special Edition on Infection Prevention & Control | Page 26

Addressing the hospital environment and animal
sectors can reduce human exposure of microbes
and pathogens, and human-focused interventions
can reduce colonization risk.”
and environmental fomites, thereby increasing the indirect
transmission of MDROs.”
Healthcare workers represent another facet of the One
Health framework as it applies to HAI prevention and control,
since studies have indicated up to 40 percent of HAIs may be
spread by contaminated healthcare worker hands—hands that
were contaminated either from direct contact with infected or
colonized patients, or from their environment. Even without
direct patient contact, healthcare workers can serve as vectors
and spread pathogens between environmental surfaces
throughout the hospital. It is also critical to include the many
daily visitors to hospitals who contribute to the microbial
composition of the hospital environment.
Regarding interventions to reduce exposure, the researchers
acknowledge, “The challenge of complex microbial and
pathogen inputs from community sources to the hospital
environment—and the pathogen dynamics among individuals
who are treated, visit, and work within in this setting—requires
an integrative perspective to design interventions to reduce the
risk of human exposure, colonization, and infection. Therefore,
focusing on individuals by themselves or a single type of
MDRO may provide incomplete answers. Microbes, including
pathogens, circulate between the hospital environment and
the larger community, with individuals and animals serving
as mechanical vectors. Most interventions are designed to
target only one sector, but multimodal strategies may be more
successful to break this cyclic feedback loop. Addressing the
hospital environment and animal sectors can reduce human
exposure of microbes and pathogens, and human-focused
interventions can reduce colonization risk.”
Dalton, et al. (2020) report on the interventions from their
literature review that can boost IP&C, and include:
● Hospital interventions
As the researchers explain, “Interventions targeted at the
environmental sector have been shown to have downstream
benefits on the microbial carriage and colonization of humans.”
From their literature search, Dalton, et al. (2020) noted interventions
targeting the hospital environment focused on manual
cleaning and disinfection protocols as well as “no-touch”
decolonization technologies and isolation through facility or
administrative design or through other engineering controls.
● Human interventions
The researchers report that human-centered interventions
evaluated in the literature focused primarily on hygiene,
including patient decolonization, healthcare personnel hand
hygiene, and wearable-fomite decontamination. They also
allude to the adoption of human factors engineering, a discipline
that studies the capabilities and limitations of humans and the
design of devices and systems for improved performance. As
Dalton, et al. (2020) explain, “In the context of hospital infection
control, this deals with designing spaces and opportunities for
individuals to avoid exposure and colonization to pathogens, a
form of administrative control. This has the potential to identify
major underlying causes and contributors to a problem. It goes
beyond education and training, which are often the focus of
infection prevention interventions, to modify an individual’s
context so that default decisions align with healthy and desired
actions. It utilizes environmental design, such as handwashing
or antiseptic alcohol stations at the exits of patient rooms
and one-way human traffic flows, in a way that minimizes
exposure to healthcare workers and other patients to effect
downstream reductions in the contamination of other hospital
surfaces and individuals.”
● Animal interventions
As the researchers explain, “Just as animals have not been
extensively examined in their role as vectors of pathogens and
other microbes, there are also few studies on interventions
in animals in either a hospital or community setting. Just as
intervention programs focus on hand hygiene protocols in HCW
because of their role as vectors of hospital-associated pathogen
transmission between patients and the hospital environment,
therapy and service animals may also fill a similar niche, but
infection control programs that target animals in healthcare
settings are lacking. There are recommended guidelines for
animals entering into the hospital environment (service animals,
therapy animals, personal pet visitations), but the evidence
of the recommended protocols’ effectiveness is based largely
on extrapolation from human data and many recommended
interventions have not been validated in animals.”
The interweaving of the hospital environment, the patients
who are treated there, the individuals who work there, and the
people and animals that visit, creates a microbial ecosystem
that can be evaluated and treated holistically, Dalton says. As
she and her co-authors note, “It has been shown that the
most effective intervention programs are multi-modal and
designed to minimize individual pathogen exposure before such
exposure progresses to colonization and infection. However,
environmental decontamination and human hygiene practices
decrease but do not eliminate the risk of colonization in other
individuals and HAI rates seen in the hospital. A One Health
approach may assist in the development of novel research
and multi-modal intervention approaches by considering the
relationship between the patient, the HCWs, and the hospital
environment, and the role of the community.”
When it comes to how to integrate the One Health
framework into HAI prevention, Dalton says, “The most
practical recommendation I can put forth is emphasizing the
need for advisory boards whose members can lend assistance
in decision-making in regard to infection prevention and
control. And make the boards as diverse as possible, including
infection preventionists, epidemiologists and representatives
from various departments in the hospital and other specialties
outside the hospital, bringing together a variety of viewpoints
and leveraging them in the common goal of patient, visitor
and healthcare worker safety.”
Reference:
Dalton KR, Rock C, Carroll KC, and Davis MF. One Health in hospitals: how
understanding the dynamics of people, animals, and the hospital built-environment
can be used to better inform interventions for antimicrobial-resistant
Gram-positive infections. Antimicrobial Resistance & Infection Control. Vol. 9,
No. 78. June 1, 2020.
26 IP&C Special Edition June 2020 • www.healthcarehygienemagazine.com