Infection Prevention and Control
The COVID-19 crisis was a powerful reminder of how infection prevention and control (IPC) strategies are essential in healthcare and aged-care environments to stop the development of infections and antimicrobial resistance. It highlighted the importance of effective cleaning protocols for preventing transmission.
Healthcare-associated Infections (HAIs) result from interactions within the healthcare system that cause harm. Many of these HAIs are preventable, and aside from causing avoidable pain and suffering for patients, carers, and whānau, these adverse events are extremely costly with consequences for the entire healthcare system, including prolonged hospital stays, higher accident and emergency department attendance, long-term disability, increased antimicrobial resistance, and even unnecessary deaths.
According to the World Health Organisation (WHO), antimicrobial resistance (AMR) is one of the top global public health and development threats. Research indicates that this is a global issue, with treatment-resistant bacterial infections being directly implicated in the deaths of 1.27 million people in 2019 and a further 4.95 million associated deaths.1 The WHO warns of an upward trend in AMR-attributed deaths, predicting that the number could reach 10 million per year by 2050.2
While exacerbated by poverty and inequality, AMR does not discriminate and affects all countries, in all regions, and at all income levels, placing many of the gains of modern medicine at risk. It makes treating infections much harder and significantly increases the risk level of other medical procedures and treatments, such as surgeries, caesarean sections, and cancer chemotherapy.
Challenges
The main driver in the development of AMR pathogens is the overuse of antimicrobials in humans, animals, and plants. The COVID-19 pandemic led to an overuse of disinfectants and a heightened demand for antimicrobial materials, and while counterintuitive, this has been shown to increase the risk of antimicrobial resistance and poses a serious public health risk.
Many Healthcare-Associated Infections are potentially preventable adverse events and with effective infection prevention and control (IPC) strategies, it is possible to significantly reduce the rate of HAIs within New Zealand’s healthcare system. It is the collective responsibility of all healthcare professionals to recognise, appropriately manage, and prevent HAIs. It's therefore no surprise that a top priority for all healthcare environments are solutions that help prevent healthcare-associated infections (HAIs) and avoid the increase of antimicrobial resistance (AMR). Managing both is a constant challenge for healthcare facilities.
According to ACC, HAIs are the most common complication affecting New Zealand patients and are increasing in number3, with a rate of approximately 7.7 infections per 100 patients (2021)4 and an estimated annual cost of $226 million in 20215.
Selecting the right flooring for healthcare
Floors are an often-overlooked highway for bacterial spread and highlight a need to improve infection control. While floors are particularly low-touch surfaces, there is emerging scientific evidence that indicates that pathogens can move from the floor and be resuspended in the air with the potential for inhalation, swallowing, or contamination of surfaces or hands, increasing the spread of organisms and making it crucial for easy-to-clean floors, particularly in high-risk areas.
Floor and wall coverings that support good infection control strategies are crucial to the success of all healthcare facilities. Floor and wall coverings must be resistant to chemicals and detergents to ensure they look like new even after years of use. Clinical spaces must be easy to clean and disinfect, and impervious to fluids. Smooth flooring that is suitable for coving and forms perfectly sealed joins between wall and floor will help prevent bacteria and dirt build-up for healthier indoor air quality.
Choosing the right surfaces in healthcare is critical. The first requirement for good healthcare hygiene is that all surfaces, items, and equipment are cleanable. Floor and wall coverings in low-risk areas such as entrances, offices, and service areas will have less of an impact on IPC, but in clinical areas, they should be carefully selected for easy cleaning.
Clinical Area Floor and Wall Requirements:
- Cleanable materials
- Smooth and non-porous surface
- Minimal joints to prevent dirt build-up, which favours the growth of micro-organisms
- Watertight installation with perfect coving and hot-welded joints for greater durability
- Durable and resistant to repeated use of disinfectants such as quaternary ammonium, alcohol, bleach, and hydrogen peroxide
- Easy-to-repair material. In case of damage, fix it on the spot and reseal without changing the whole floor
For area and use-case-specific advice on selecting appropriate floor and wall solutions, refer to our Healthcare Flooring Quick Guide or reach out to your Jacobsen representative.
Cleaning and Maintenance Considerations
A well-maintained environment with an effective cleaning strategy is crucial. Selecting products that are easy to clean and maintain and that require minimal chemical usage helps to support healthy indoor environments. The overuse of disinfectants and antibiotics is suspected of encouraging the development of antimicrobial resistance and therefore posing a risk to human health. However, these biocidal products may not be necessary when the correct cleaning protocols are in place.
Biocides can be a controversial and challenging topic. Viruses are different from bacteria, and just as with antibiotics, antibacterial products are ineffective in their use against viruses. On the contrary, the efficacy of biocides has yet to be proven, and the overuse or misuse of antibacterial agents can encourage and increase the risk of antimicrobial resistance. While there is a range of antimicrobial-impregnated products (e.g., surface coatings, paints, and curtains) available, there is currently no definitive data that supports their efficacy against HAIs. Furthermore, standards, such as ISO 22196, that are often used to explain their use and role are inappropriate for testing antimicrobial surfaces.
With biocides having been identified as a major risk to human health and the environment, Jacobsen is proud to bring you our premium ranges of healthcare flooring and wall solutions from our world-class supplier, Tarkett. Tarkett’s commitment to removing antimicrobial treatments from their flooring goes back to 2013. With concerns over the adverse human and environmental health effects of cleaning and disinfectant products, Tarkett has begun to develop a ‘green’ cleaning methodology. They actively promote the importance of appropriate cleaning methods and recommend the use of disinfectants only when and where necessary, encouraging alternative solutions that are less reliant on chemicals and disinfectants, such as microfibre cloths and steam cleaning.
Effective IPC cleaning and maintenance
According to the CDC (Centre for Disease Control and Prevention), approximately 80% of infectious diseases are transmitted by unclean hands touching contaminated surfaces6. Keeping hands and touch surfaces clean is the most critical factor in infection transmission control, meaning that good hand hygiene and environmental cleaning procedures are vital. Both are standard precautions for infection control. Once the proper surfaces have been installed, it is important to document and implement the right cleaning protocols.
Never forget that the basis of a good protocol is to properly clean all surfaces:
- Dry mopping to remove dust and debris
- Wet mopping with a detergent to clean
- Disinfect after cleaning only when needed
Floors are low-touch surfaces and rarely do they come into contact with the hands of patients, residents, or healthcare providers. Because of this, disinfectant is not usually required, and a thorough clean often suffices.
In clinical areas and other high-risk areas or when outbreaks occur, disinfection – after an effective clean – is necessary. However, it is pointless to disinfect without first properly cleaning since most disinfectants lose their effectiveness rapidly in the presence of organic matter.
“When it comes to flooring, what matters most is keeping it clean and free from soiling and dirt. Disinfection should be restricted to high-risk areas. There is no benefit to using disinfectants in other zones where they often simply soil the flooring.”
-Christine Huddlestone, Senior Health Manager, responsible for cleaning, microbiology technician for 20 years, Douai Hospital, France
For effective cleaning protocols, maintenance advice, or installation support, reach out to your Jacobsen representative.
References:
1.UNEP on Antimicrobial Resistance Global Threat
2.WHO Fact Sheet on Antimicrobial Resistance
3. ACC Guiding Principles on Healthcare-Associated Infections
4.HAI rate was 7.7 infections per 100 patients. NZ stat
5.Infection Prevention and Control
6.CDC Research
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