Disinfection of both surfaces and air became even more complicated with the dawn of the COVID-19 pandemic in 2020. However, one silver lining came as a result of the pandemic – since hospitals and healthcare professionals across the globe were thrown immediately into a high-pressure situation with immediate implications for the care of their patients in the face of a highly contagious novel disease, the cracks in the existing systems became immediately apparent. Seeing where those cracks existed in such a transparent way has allowed professionals to narrow in on areas of need within the field.
A new study, published on Jan. 10, 2024, by the American Journal of Infection Control (AJIC), sounded the alarm on a number of pathogens that surfaces in hospitals tend to harbor that were previously not known or expected to be particularly harmful to patients. New research suggests that those pathogens, including skin flora and environmental bacteria, can cause diseases as severe as meningitis and brain abscess in the right setting. Yet more alarmingly, surfaces that previously were not considered particularly high-risk, like manikins and bed rails, can harbor these bacteria despite adherence to routine disinfection procedures within hospital systems.
Healthcare Purchasing News spoke with two of the study’s authors – Piyali Chatterjee, PhD, Department of Research at Central Texas Veterans Health Care System, and Chetan Jinadatha, MD, MPH, Chief of Infectious Diseases Section at the Central Texas Veterans Health Care System – to address some of the concerns raised by the study, along with possible innovations in the space that point a way forward.
Bugs and bacteria
When asked about the research group’s goals, Jinadatha said, “The group was looking to study the environment around patients and how that impacts infections in patients, and how we can keep the environment clean by using some of the latest technologies that are emerging, in terms of handheld UV devices, whole room disinfection, or new disinfectants.” As this new study makes abundantly clear, there is already a well-known cache of common organisms that are known to cause infection in patients in hospital settings, but there are also bugs and bacteria whose names are not nearly as well-known to either patients or even the workers in the hospitals themselves. The question the research team set out to answer was whether or not those bugs “actually mean something for our patients” and whether or not we need to pay attention to them for “future disinfection purposes.”
Chatterjee further characterized the research group’s goals as “quantitatively looking at or categorizing what types of bugs we see on high touch surfaces” in order to further take the pulse of the “dynamic” environment in hospitals. Indeed, she and the other researchers found that “some of the uncommon organisms were found, in immunocompromised patients or in those who have comorbidities, some of these not-so-well-known pathogens can cause disease.”
Hand hygiene
Sounding the alarm regarding these lesser-known pathogens that nonetheless pose a significant threat to patients in hospitals necessitates a new emphasis on disinfection measures on those high-touch surfaces. Jinadatha highlights the importance of hand hygiene. He commented, “Best hand hygiene practices remain very effective, probably for all the bugs we know of and all the bugs we found in this study.” He also added that diligently washing hands whenever someone switches to a new surface or task is important because the hospital environment is “dynamic, so when you do disinfection, bacteria have the chance to reaccumulate because people are always moving around, touching different things.”
Even having the awareness to simply capitalize on moments of downtime to keep up on surface disinfection can make a huge difference. Reeducation can play an important role in this, according to Chatterjee. “Reinforcing [workers’] education on things like hand hygiene and highlighting that even if you are not touching the patient, but you are touching these high touch surfaces, you may end up bringing that with you to the next room or to the next patient,” she said.
The basics of hand hygiene are vital to continually reinforce, and healthcare professionals can do a lot with a little by simply remaining diligent in washing their hands after interacting with patients and surfaces alike. That said, there are still some exciting technological innovations in this space that are continuing to be tracked. Jinadatha points out whole room disinfection as well as some progress in terms of understanding clean surfaces and how to track them. “However, these are all supplemental technologies, not the replacement for manual disinfection,” he cautions. Diligence and adherence to disinfection policies across hospital workers themselves remains absolutely vital, no matter the technological advancements that supplement disinfection.
Jinadatha also makes note of the fact that COVID exposed the sheer human power necessary in keeping a hospital running. “I urge hospital CEOs to do their best to balance our routine requirements and care with what else we can do to keep on evolving as a sector that deals with patient lives,” he noted.
Where to look now
As far as next steps given the results of this study, Chatterjee believes that a look should be taken at some low touch surfaces that we don’t frequently use. If this research is any indication, indeed, there are lurking threats when it comes to infectious bacteria or pathogens that we may not yet fully understand. She mentions new technologies where hospital workers are able to physically see where they have already cleaned or disinfected an area by way of something color-based that lights up an area after it has been disinfected.
Keeping the surface itself and the hospital environment as a whole clean is so vital partially because it is so much easier to keep the spaces free of bacteria in the first place rather than trying to predict which bacteria will cause disease or infection and when. An unintended side effect is that it can be difficult to decisively prove whether or not certain disinfection or sterilization practices empirically work because of how dynamic the healthcare environment can be. This emphasizes even further the need to take preventive steps.
HPN was also able to speak to current APIC president Tania Bubb, PhD, RN, CIC, FAPIC, and Senior Director of Infection Prevention & Control at the Memorial Sloan Kettering Cancer Center in New York, regarding some of the challenges healthcare workers face in surface disinfection. She said, “The type and complexity of the surfaces that are being cleaned post challenges, as some surfaces can be harder to clean than others.” Plus, some organisms simply “live on the surfaces for short periods of time while others live on surfaces for months.” Adherence to policies in place and a clear line of dialogue between healthcare workers and their infection prevention departments are vital strategies, as well.
Bubb also emphasizes the need for the space to innovate in order to tackle “multi-drug-resistant organisms of concern and even novel organisms” that we have not even discovered yet. She calls on the companies that produce these chemicals to “come up with solutions that are more feasible and accessible for the stuff to use to clean.”
For a Q&A on air disinfection with Michelle Vignari, RN, BSN, CIC, Director of Highland Hospital Infection Prevention, continue reading online here:
