Innovations and advanced Technology with multi- faceted strategies lead the healthcare facilities to achieve prevention of infections and help continual enhancement of patient safety within healthcare environments, says Dr Raksha K Bhat Head of Department Consultant Microbiologist Central Laboratory & Infection Control Officer, St. Martha’s Hospital, Bengaluru
Hygiene safeguards
Over time, the vital role of Infection Prevention and Control (IPC) has become evident in the evolving priorities of the World Health Organization’s Member States and their collaborators. This encompasses various areas like water, sanitation, hygiene, health worker and patient safety, as well as preventing specific conditions like antimicrobial resistance (AMR) and sepsis. IPC is essential for ensuring high-quality and safe healthcare, forming the foundation of health emergency preparedness and response. In a recent report from the World Health Organization (WHO) on Infection Prevention and Control (IPC), the focus was on the significant impact of Healthcare-Associated Infections (HAIs) and Antimicrobial Resistance (AMR). It conducted a comprehensive global analysis of the status of IPC programs, gathering data from various international surveys and sources.
As of the 2023 Global Strategy on Infection Prevention and Control (GSIPC) outlined by the World Health Organization, the pervasive nature of Healthcare-Associated Infections (HAIs) remains a challenge for all countries and health systems, regardless of their sophistication. These infections, often stemming from multidrug-resistant organisms, not only pose risks to patients, visitors, and health workers but also impose a substantial burden on health systems, leading to escalated costs. Furthermore, the escalating endemic burden of Healthcare-Associated Infections (HAIs) and antimicrobial resistance (AMR) represents a less visible yet equally urgent concern, impacting patients globally and extending into the community.
Acknowledging the gaps in IPC programs highlighted by the profound effects of the COVID-19 pandemic and the growing challenges associated with infection and AMR in healthcare delivery, a consensus-driven resolution on IPC was presented and adopted during the Seventy-fifth World Health Assembly (resolution WHA 75.13). This resolution, comprising 13 calls to Member States, urges improvements in IPC at national, subnational, and facility levels, aligning with the recommended core components for IPC programs outlined by the World Health Organization (WHO).
Additionally, the resolution mandates the Director-General to develop a comprehensive Global Strategy on IPC, encompassing a global action plan and a monitoring framework, in consultation with Member States and regional economic integration organizations.
A comprehensive approach integrating novel antimicrobials and vaccination strategies is essential for effectively managing infectious diseases, promoting global health, and mitigating the impact of emerging threats.
The overarching vision of the GSIPC is to ensure that, by 2030, everyone involved in healthcare — whether as a provider or recipient — is safeguarded against associated infections. The GSIPC delineates three principal objectives: preventing infection in healthcare, ensuring the implementation of IPC programs, and coordinating IPC activities with other relevant sectors. These objectives are further supported by eight strategic directions that serve as a comprehensive framework guiding country-specific actions for GSIPC implementation. These strategic directions include political commitment and policies, active IPC programs, IPC integration and coordination, knowledge enhancement of health and care workers in IPC, establishment of career pathways for IPC professionals, data utilization for action, advocacy and communications, and prioritizing research and development. The GSIPC is designed to be an aspirational, strategic, and programmatic initiative, to be complemented by an associated action plan and monitoring framework set to be developed in 2023-2024.
The Society for Healthcare Epidemiology of America (SHEA)/ Infectious Diseases Society of America (IDSA)/ Association for Professionals in Infection Control (APIC) Practice Recommendation published in February 2023 also serves as a vital update to a previous set of recommendations titled “Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene,” which was initially published in 2014. The 2023 update emphasizes the foundational nature of certain practices by categorizing them as “essential practices”, underlining their importance for all HAI programs in acute-care hospitals.
These practices include promoting the maintenance of healthy hand skin and fingernails, selecting appropriate products, ensuring the accessibility of hand hygiene supplies, ensuring proper glove use to reduce contamination, taking steps to reduce environmental contamination associated with sinks and sink drains, and monitoring adherence to hand hygiene. Timely and meaningful feedback is also highlighted as a crucial component to enhance a culture of safety within healthcare settings.
The 2023 update provides “additional approaches” that may be considered in specific locations or populations within hospitals during outbreaks or when HAIs are not controlled despite implementing essential practices. These additional approaches include considerations for educating healthcare personnel (HCP) using structured approaches like the WHO Steps for hand washing or hand sanitizing, evaluating HCP adherence to technique, disinfecting sink drains for waterborne pathogens, and encouraging specific hand hygiene practices for certain infections like Clostridioides difficile and norovirus.
The document also delineates practices that should not be considered routine parts of hand hygiene, emphasizing that certain approaches may not contribute positively to infection prevention. These include avoiding the supply of individual pocket-sized alcohol-based hand sanitizer (ABHS) dispensers in lieu of minimum thresholds for accessible wall-mounted dispensers, refraining from refilling or “topping off” soap, moisturizer, or ABHS dispensers intended for single use, and discouraging the use of antimicrobial soaps formulated with triclosan as an active ingredient.
Training and Evaluation
Despite the presence of numerous onsite and online training programs for Infection Prevention and Control (IPC) practices, a significant challenge arises in the subsequent implementation and monitoring of how effectively the acquired knowledge is put into practice.
Strategic investment in focused professional development and leadership initiatives for Infection Prevention and Control (IPC) increases the likelihood of realizing the objectives set by a national IPC training program. Elevating IPC awareness within an organization and fostering clinician involvement at various levels in embracing IPC responsibilities contribute to clearly establishing IPC within the overarching framework of patient and occupational safety.
The GSIPC by WHO underscores the pivotal role of education in enhancing IPC knowledge among healthcare workers, as well as shaping career pathways for IPC professionals. The strategy strengthens the comprehensive approach to IPC by formulating curricula for health and care workers across pre- and postgraduate levels, incorporating in-service training, and establishing linkages with related domains such as water safety and occupational health. It advocates the integration of IPC education throughout the entire health education system, necessitating mandatory in-service training for all healthcare workers. It further emphasizes specialized training for IPC professionals aligned with WHO-recommended competencies and facilitates job offerings. The aim is to develop resources for educating patients and families on IPC measures, ensuring a well-rounded and effective strategy for infection prevention.
Various IPC educators are now embracing innovative approaches to enhance learning outcomes. Utilizing simulation and virtual reality (VR) technologies, healthcare professionals can now engage in realistic scenarios, honing their skills in a controlled environment. Gamification strategies inject an element of fun and competition, motivating learners to apply IPC principles through interactive games and quizzes. Mobile apps provide on-the-go access to guidelines and updates, while collaborative online platforms foster a sense of community, enabling peer-to-peer learning and knowledge-sharing. Role-playing exercises can simulate real-life situations, enhancing communication and teamwork. Continuous reinforcement through case studies, quizzes, and refresher courses ensures ongoing cultural competency.
During my two-year fellowship at Manipal Academy of Higher Education (MAHE) in collaboration with the Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, USA, I have worked on innovative training modules for IPC curriculum. The underlying concept driving this initiative was the recognition that if we are to effectively practice IPC collaboratively, it is only fitting that we learn it together. The role of continued training and evaluation cannot be undermined in IPC implementation.
Innovations in Healthcare
Innovation in healthcare entails the creation of novel processes, policies, products, or programs aimed at enhancing quality, impact, and efficiency within the healthcare system. We are currently seeing a mix of advanced measures to tackle healthcare-associated infections (HAIs) comprehensively from the basics like teaching programs to new technology solutions. Central to these efforts are foundational hand hygiene interventions, now augmented by cutting-edge methodologies integrating smart technologies to both monitor and encourage adherence. Going beyond conventional practices, there is a growing emphasis on incorporating antimicrobial-coated surfaces on healthcare devices and frequently-touched areas, adding an additional layer of defence against pathogens.
With IPC Addressing the threat of antimicrobial resistance (AMR) requires developing new antimicrobials to combat resistant infections. Researchers focus on innovative approaches, including combination therapies and advanced drug delivery, to enhance efficacy and minimize resistance. Simultaneously, strategic vaccine development plays a crucial role in preventing infections and controlling their spread.
IPC programs have also evolved significantly with the infusion of artificial intelligence (AI), enabling more precise tracking and facilitating timely interventions for patient optimization. AI has found further utility in infection tracking software and clinical decision supporting systems, allowing healthcare facilities to conduct real-time surveillance and identify patterns, thereby enabling prompt implementation of targeted preventive measures. In tandem, augmented reality (AR) has been applied to training healthcare professionals, offering immersive and interactive simulations.
Of particular interest are development of many applications dedicated to monitoring hand hygiene practices. Telemedicine and remote monitoring technologies like virtual wards have become integral, mitigating the need for in-person visits and thereby minimizing the risk of infections.
Putting technology to use
As we look ahead to 2024, a comprehensive approach is essential, starting with the implementation of robust ground data collection systems at primary and secondary healthcare levels for materializing the global action plans. Real-time reporting of infectious diseases, coupled with continuous training for healthcare professionals in data collection methods is crucial. A proactive strategy involves regular assessments of infection prevention and control (IPC) scenarios in community and local health centres which are often ignored. Leveraging technology is paramount to modern IPC practices. Integration of efficient data management, telehealth services, and electronic health records not only streamlines communication but also minimizes the risk of in-person transmission. Complementing these advancements is the development of a comprehensive IPC curriculum. Strengthening data surveillance and monitoring, including cross sectorial collaboration, completes the holistic approach as advocated by One Health approach, providing a dynamic and adaptive framework. IPC is always a work in progress with a lot of opportunities to get better.