Changing face of cleanliness and sterility

The battle against healthcare-associated infections (HCAIs) continues and national targets, backed by legislation and codes of practice, have ensured that infection prevention and control (IPC) remains a top priority for NHS Trusts. The NHS as a whole has made significant inroads in this area over recent years, achieving more than a 60% reduction in MRSA bacteraemias alone for the first three quarters of 2008/09, but the battle is far from over. The importance of the issue has forced healthcare professionals and industries to step back and take a fresh look at all aspects of IPC, from basic cleanliness and sterile services, to better mechanisms for prevention. So how “clean” is clean? Are the cleaning processes currently in place as efficient and effective as they could be? Moreover, just because something is visibly clean, how sure can you be that it is microbiologically clean? What is abundantly clear is that no single technology or agent can work alone to combat infection and keep it under control. An arsenal of antimicrobial weapons is required, combined with a strong emphasis on good hand hygiene, clinical education and recommended practice guidelines, as well as the foresight to recognise the benefits that thorough, proactive prevention can bring.

A higher priority for prevention

Historically, it has been the norm to deal with problems that present themselves rather than taking any kind of preventative measures. But, in recent years, staff, patients and even visitors have been educated about the importance of infection prevention, and it is emerging as a worthy target for long-term investment. Infection prevention focuses on stopping the proliferation of microbiological agents which could cause infection, and covers everything from surface disinfectants and cleaners, through to hand disinfection and wide area total decontamination systems. The need for constant vigilance is potentially a major stumbling block in proactive infection prevention strategies. For example, staff and patients are constantly provided with warnings and educational material regarding hand hygiene – and there are dispensers wherever you look in many clinical settings – but does everyone use them as much as they should? Is the level of attention being paid beginning to flag in the face of the continual bombardment of information? There are also more practical issues which must be addressed to maximise conformity to hygiene guidelines. The formulation of the hand disinfectants, for example, can be a significant factor in compliance, as healthcare workers may stop using them in the correct way if there are long-term detrimental effects on the skin. Most disinfectant hand gels are based on a 70% alcohol formulation, but independent researchers have shown that a 60% to 80% alcohol concentration range is effective, depending on the types of alcohol used in the formulation. Introduction of hand gels with a lower alcohol concentration, but still within the effective range, is a straightforward step which could encourage greater compliance, simply by being kinder to hands.