Infection prevention and control (IPC) is a key function in healthcare facilities, and for good reason.
“There’s a much greater risk of infection moving from one person to another, and actually causing a serious problem, in our hospitals than there is out in the street,” says Mr Martin Kiernan, Clinical Director at GAMA Healthcare who has three decades of experience in the field. “Patients have intravenous lines and urinary catheters placed into them, and surgery performed on them. We spend a lot of time with our medical interventions breaching the body’s natural defences so that means people at more risk of infection.”
Importance of isolation in IPC
IPC involves a whole range of activities, from hand hygiene to environmental disinfection, all aimed at preventing the spread of infection. Mr Kiernan highlights isolation, or the segregation of infected persons away from the uninfected, as the “cornerstone” of IPC practice.
“You can interrupt transmission through good hand hygiene, but people shed the organisms that they carry into their local environment,” Mr Kiernan explains.
“So if I carried MRSA (an infection caused by staph bacteria) for example, studies have shown that over 70% of the surfaces close to me are contaminated with that organism. It’s very easy for somebody to touch one of these surfaces and go to another patient, and transmit the organism for one person to another.”
In that case, a single room would help contain the environmental contamination, as opposed to multi-bedded bays, where six or even eight patients become susceptible to infection in one room.
Challenges of ensuring isolation capacity
However, hospitals often struggle to provide sufficient isolation capacity. Facility designs made a few decades back did not anticipate the rise in antibiotic resistance and the resulting high demand for isolation space.
This means that healthcare providers today “have to make decisions every day, as to which patient presents the most risk and therefore who gets the isolation room,” says Mr Kiernan. “And that can be quite confusing for staff. One day a patient will be in an isolation room, but the next day they’re taken out, because somebody is coming in with an even more important infection.”
“Most hospitals were having to make decisions that meant they had to compromise infection prevention principles because they did not have the isolation space available.”
To increase isolation space, some hospitals have turned to converting some areas of their hospitals to single rooms, but that usually means a drop in overall capacity. A six-bedded bay could be converted only to about three single rooms, due to facilities required in each room. Also, the construction work would require shutting down a whole area and a loss of bed capacity during that period, which is very disruptive to hospital operations.
Temporary isolation rooms as an alternative
A more flexible alternative would be portable isolation rooms, which are tent-like structures that can be placed around the patient within about five minutes and taken down within about 10 minutes.
“If you saw an increase in norovirus infections, you could transform a six-bedded bay into six isolation rooms, and, as soon as the outbreak is over, you’ve got a six-bedded bay functioning normally again,” notes Mr Kiernan.
Studies assessing the Rediroom portable isolation rooms* have found that they meet the most relevant infection control guidelines, and hospital staff have found these functional, with no increase in time or change in processes needed to complete their usual clinical activities.
In addition, the Rediroom has a number of “infection prevention by design” features, such as a foot-operated, hands-free door – removing the need to touch, which is a potential route of transmission; and placement of alcohol hand rub at the point of care, so staff do not have to walk to the sink to decontaminate their hands.
The incorporation of such features in medical devices and products is so “we make it easy for people to do the right thing and make it more difficult for them to do the wrong thing,” says Mr Kiernan.
He notes that most medical device makers today are starting to design them with infection prevention in mind.
“They make surfaces smoother… and make them easier to clean and compatible with a range of disinfectants. The first question an infection prevention practitioner would ask about a new piece of equipment should be, “How can I clean this?”
“The mantra should be: If you can’t clean it, don’t buy it.”
Changes in IPC post-pandemic
The COVID-19 pandemic, unprecedented in modern history, has changed the way healthcare providers think about isolation and IPC, providing valuable learning points for healthcare moving forward.
Mr Kiernan points to risk assessment as one of the key lessons. When hospitals are dealing with many COVID-positive patients, it is actually “a little bit easier from the IPC point of view”, as they don’t have to be isolated from one another. However, when numbers go down, hospitals have to make the difficult decisions, such as whether the COVID patient, or the patient with a severe bacterial infection, gets the isolation space – or they may risk a rise in other infections, such as multidrug resistant bloodstream infections, as seen in some countries during the pandemic.
Another area would be more focus on hospital design, in particular hospital ventilation systems.
“One thing we have learned during the pandemic is that this virus is spread by air a lot more than we thought it was at the beginning. And many hospitals don’t have great ventilation,” adds Mr Kiernan.
“That’s something that I think will come in hospital design, to bring better ventilation in with fresh air rather than recirculating and using air conditioning.”
Lastly, Mr Kiernan was happy to see more multidisciplinary work between IPC professionals and other fields, and views this as a silver lining in this pandemic.
“Now we’re working with air scientists and fluid dynamics scientists who we wouldn’t have worked with previously before the pandemic, but we’ve learned so much from them, and they learn from us as well.”
A poll of UK infection control teams revealed that 90% felt an improvement in their relationship with the rest of hospital staff, which bodes well for future collaborative work in strengthening IPC across healthcare.
“I think staff were recognising that the infection control teams were doing their best to keep them safe,” says Mr Kiernan.
“So I’m hoping that these better relationships prove fruitful going forward, when we try and look at other infections like healthcare-associated pneumonia or urinary catheter-related infections.”
* Download this whitepaper to read more about isolation needs in healthcare, and how Rediroom, a temporary isolation solution, can augment isolation capacity.
Hospitals in UK’s NHS have used Rediroom flexibly. Here are a few examples:
University Hospitals of Derby and Burton NHS Foundation Trust, said: “As a Trust, we’re absolutely committed to delivering safe patient care. Patients have said that they feel reassured being cared for in the Clinell Redirooms, knowing they won’t be exposed to other patients with COVID-19*. We have Clinell Redirooms across our two acute hospital sites and they are utilised on a number of wards.” Their experience was captured on BBC news.
The Evelina London (part of Guy’s and St Thomas’ NHS Foundation Trust), said: “The Redirooms provide additional space to safely treat and isolate patients with coronavirus* and other infections, such as the flu, mumps and meningitis.
Southport and Ormskirk Hospital NHS Trust, said: “The rooms are very easy to store and also can be deployed within a matter of minutes, which gives us great flexibility in being able to isolate vulnerable patients at this time.”
Guys and St Thomas Foundation Trust, said: “They (Redirooms) allow patients with contact precautions like MRSA, VRE, complex wounds and stool infections like C. diff and Norovirus to be effectively treated outside the side room.”
*Rediroom is used for COVID-19 patients based on the hospital’s own risk assessment.
About Martin Kiernan
Martin Kiernan has worked in the field of Infection Prevention and Control (IPC) for 30 years, most recently in the NHS as Nurse Consultant in Infection Prevention. He has Masters Degrees in both Public Health and Clinical Research. He is also a visiting Clinical Fellow the Richard Wells Research Centre, University of West London.
Martin has been involved with many government initiatives, IPC groups and advisory boards including the Department of Health (England) Advisory Committee on Antimicrobial Resistance and Healthcare-associated Infection (ARHAI) and is a past president of the UK Infection Prevention Society.
Martin has presented at many conferences, both in the UK and internationally, and has published over 50 papers and articles in peer-reviewed journals. He now is employed as Clinical Director by GAMA Healthcare who believe that, through careful research and partnerships with healthcare practitioners, we can produce innovative solutions to everyday infection control issues and help to reduce Healthcare-associated infections.