Hospitals around the world put in place various measures to improve infection control and ensure patient safety, but in the never-ending fight against old and newly emerging microbes, there is a need for an infection control programme that is comprehensive, yet agile enough to adapt to evolving situations or new information.
One way to establish an all-rounded infection control strategy would be to look at three key pillars – prevention, surveillance and risk management – as what Thomson Hospital Kota Damansara (THKD) in Malaysia has done.
Three key pillars of infection control
Ms Nadiah Wan, Chief Executive Officer of Thomson Hospitals Sdn Bhd, shared that prevention measures taken at THKD include setting policies and procedures to minimise body fluid exposure, providing the right PPE and equipment to prevent injuries or exposure, as well as infection prevention and control- related training of healthcare workers.
Surveillance, in the form of regular audits and inspections, or adequate testing and screening, will then be conducted “to ensure prevention measures are being adhered to and that any potential outbreaks are quickly identified and isolated to prevent spread,” said Ms Wan.
Lastly, risk management is undertaken to identify risk areas and proactively put in place mitigation measures. These include looking at ways to improve ventilation and air quality, as well as regular immunisation of employees.
Adhering to strict cleaning and disinfection standards
The importance of hospital cleaning and disinfection cannot be understated, as it is the first line of defence against the threat of Hospital-Acquired Infections (HAIs). Microbes or germs in the hospital setting can cause serious infections in patients, especially those with lower immunity, and can lead to morbidity or mortality. HAIs also pose a financial burden to healthcare resources, with studies estimating that HAIs lead to , and costs exceeding 7 billion euros annually in Europe alone.
At TKHD, Ms Wan noted that policies and SOPs for surface cleaning and disinfection are developed in accordance with evidence-based practices by the World Health Organization and Ministry of Health Malaysia.
For example, disinfectants used at TKHD are those approved by the US Environmental Protection Agency, and are effective against a broad spectrum of microorganisms. Some examples include alcohol wipes containing alcohol, sodium hypochlorite and so on.
The cleaning schedules for different areas in the hospital are set after risk assessments have been carried out. For example, high-touch or heavily-used areas, such as toilets, are classified as high-risk. Thus, more frequent cleaning is carried out for toilets, as compared to administrative offices which are deemed low-risk.
However, Ms Wan noted that such risk assessments are dynamic, and need to be constantly updated according to changes in the wider environment or circumstances. One example is an infectious disease outbreak – the hospital will need to promptly reassess the risk of all areas, and intensify cleaning protocols accordingly.
Importance of training and ensuring compliance
As cleaning and disinfection protocols are constantly fine-tuned based on the best practices of the moment, or when situations evolve, it is important that cleaning personnel receive regular training, and are able to monitor and implement the required procedures.
It can be a challenge, though, to ensure that all protocols are consistently adhered to by all involved, including employees, patients and cleaning service providers. “It is easy to purchase the right cleaning equipment and also relatively straightforward to identify and purchase the correct disinfecting agents or chemicals”, Ms Wan explained, “but the challenge comes in ensuring the proper cleaning techniques are applied consistently all the time.”
“Therefore, we need to conduct regular audits and reinforce compliance. It is also important to communicate the reason why such measures are important to protect everyone’s safety, and for stakeholders to understand the consequences that may result from non-compliance.”
In addition, when appointing the external cleaning vendor, the hospital looks at the experience of its cleaning staff – specifically in handling hospital cleaning and disinfection – as one of the top selection criteria. Outsourced staff will be given orientation and training by the hospital’s own infection control team, to ensure they are equipped with the requisite skills and knowledge.
Hospitals continue to be on high alert as the pandemic rages on in Asia. Setting infection prevention measures should remain at the top of hospitals’ priority list, to avoid further spread of disease and additional burden on already overwhelmed healthcare systems. “It is important to remember that prevention is still better than cure. Guidelines on masking, air ventilation and quality as well as immunisation are critical to ensure that healthcare facilities remain safe during this time,” Ms Wan advised.
Is your hospital truly clean enough? Download this infographic, which summaries the key factors that hospitals need to consider to ensure truly effective cleaning and disinfection.