Growing concerns about the spread of antimicrobial resistance mean that healthcare workers must use every technique and tool at their disposal to protect lives and prevent infections. Despite many pharmaceutical and technical advances, good hand hygiene and surface disinfection remain central to all infection prevention programmes. This is because they are the simplest and most effective way to break the chain of infection.
The discovery of antibiotics in the first half of the last century gave doctors a powerful weapon against common infections for the first time in human history. Simple, often naturally occurring, compounds had the power to destroy many common infections that until that time had been life-threatening and hard to defeat. They saved and transformed countless lives in the following decades.
However, it soon became clear that many of the pathogens so easily treated with antibiotics were beginning to develop immunity. Even the simplest and smallest lifeforms have a tremendous ability to adapt and change to ensure their survival. It’s an arms race. Pathogens develop resistance and scientists and drug companies try to develop new antibiotics. But it’s a battle that is hard to win. It often seems that the microbes are faster at adapting than we are at developing weapons against them. This may explain, in part, why no new class of antibiotics has been introduced in the past three decades.
Many pathogens that were easily killed by the commonest – and least expensive – antibiotics have developed resistance. This means illnesses and infections that were easy to treat just a few decades ago have become life-threatening once again. According to the European Centre for Disease Prevention and Control (ECDC), about 33,000 people in Europe die each year due to infections caused by antibiotic-resistant bacteria. This is almost 2.5 times higher than in 2007. The burden of antibiotic-resistant infections is almost as great as the total risk of influenza, tuberculosis and HIV.
The World Health Organisation says that antimicrobial resistance “is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country…[and is] is a major threat to public health.”
Some sources suggest there will be an additional 10 million deaths worldwide over the next 30 years. This will cost £66 trillion in economic output.
Although antibiotics offered – and still do – new ways of killing dangerous pathogens of concern, many conventional infection prevention techniques are just as important today. Hand hygiene in conjunction with new methods of surface disinfection helps to break the chain of infection. It is simple, effective and generally less expensive than alternative approaches and techniques.
The reasons for this are easy to understand. The majority – perhaps up to 80% or four in five – of infections are spread by hand-to-hand contact or touching a contaminated surface. This is why hand hygiene and surface disinfection form the backbone of all infection prevention regimes. People reduce the chances of infection if they keep their hands and surfaces they touch as clean as possible.
This is not to say that “traditional” techniques have not evolved thanks to better research and understanding. The WHO has promoted its “five moments of hand hygiene” for many years. Local initiatives and global awareness campaigns with this simple message are making a big difference to people all over the world.
Studies have shown that simple handwashing with soap and water is more effective than doing nothing at all. The simple mechanical action of washing removes enough pathogens to reduce the risk of infection although there is no disinfection involved. Other studies have shown that concentrating on the fingertips is also more effective than general hand cleansing. This, incidentally, is part of the thinking behind the TMED approach.
Modern hospitals often require a more rigorous and disciplined approach. Hand hygiene formulations used in healthcare must be effective, of course. But they should also support the frequent use called for in initiatives such as the “five moments”. To do this they need to be pleasant to use without causing any damage to delicate skin. At the same time, advances in dispenser design aim to maximise product availability and reduce (or ideally eliminate) the risk of running out. They do this with a range of features including bigger pack sizes, making visual checks easier, emitting warnings when running low, and even allowing remote checks over the Internet.
The latest thinking in the healthcare sector builds on the “five moments” with the Targeted Moments of Environmental Disinfection (TMED). This builds on the simple “five moments” message but instead focuses on the surfaces that people are most likely to touch. As with the “five moments” it is simple to explain and replicate. Together, the “five moments” and TMED offer the prospect of greatly improved infection prevention outcomes with relatively little additional cost or effort.
Other advances have focused on the type of surface disinfectants used in healthcare settings. There is some evidence that conventional disinfectants containing chlorine as their active ingredient can enable antimicrobial resistance because of the way they work at the biological level. Innovative active ingredients containing Accelerated Hydrogen Peroxide kill pathogens in a different way which may mean there is a reduced risk of them becoming resistant.
Products containing AHP are effective against a wider range of pathogens than chlorine-based alternatives. They are simple and easy to use in a wide range of applications. We refer to this as “broad-spectrum” performance. It would need numerous conventional alternatives to achieve the same level of efficacy. This can be complex, time-consuming and expensive.
To be effective, surface disinfection processes must be simple and accessible so that they can be completed whenever needed. They must also be acceptable to healthcare workers and visitors. This means, for example, that disinfectants must be non-hazardous and non-irritating. Finally, processes must be fast because anything that adds time or becomes a burden is less likely to be done.
Diversey is participating in the Annual Infection Prevention and Control Conference, organised by Knowlex and the NHS. The event takes place in Birmingham on 13 February 2020.