How to tackle tough pathogens in the healthcare environment?


Pathogens associated with HAI are causing increased mortality and morbidity and are linked to the transmission of multidrug resistance organisms, one of the biggest global health threats today.


Filed under
Infection Control
April 24, 2023
Share this story
Subscribe to our newsletter

To receive the latest breaking news and stories in Dubai, the UAE and the GCC straight to your inbox.

How to tackle tough pathogens in the healthcare environment?

Healthcare facilities have a diverse set of needs due to the various types of areas and risk that they involve.  The patient environment in healthcare settings has continually proven to harbor a reservoir of potentially harmful pathogens increasing the risk of healthcare associated infection (HAI).  Pathogens associated with HAI are causing increased mortality and morbidity and are linked to the transmission of multidrug resistance organisms, one of the biggest global health threats today.  

To be able to tackle them, we must first understand how they are spread; pathogens are transmitted in a few different ways depending on type.  Implementation and compliance with a set of standard precautions, automatically lowers risk.   These precautions are used by all staff in all healthcare settings; they must be applied to each task, whether infection is known to be present or not.  Transmission based precautions are the second tier of fundamental infection control precautions, used when standard precautions alone are not sufficient to prevent pathogen spread.  

Certain standard and transmission-based precautions are specially linked to the healthcare environment: 

Patient placement

Promptly assess for infection risk factors though adequate screening tools.  Triage potentially infectious patients in separate waiting areas and allocate single rooms as soon as possible to lower the risk of environmental contamination.  For any suspected pathogens transmitted via the airborne route, dedicate rooms with negative pressure airflow: this means that when the door is opened, potentially contaminated air or other dangerous particles from inside the room will not flow outside into non-contaminated areas. 

Management of care equipment

Care equipment is easily contaminated with blood, other body fluids, secretions, which carry harmful pathogens and are a risk to both patients and the environment. Consequently, it is easy to transfer pathogens from communal care equipment during care delivery.  Healthcare facilities must ensure all reusable equipment is placed on cleaning schedules, which require both clinical and non-clinical staff responsibility and accountability. Decontamination protocols should include responsibility for; frequency of; and method of environmental decontamination.

Environmental cleanliness

This relates to both the structure and fixtures of the building, and decontamination practices. Air handling units must be on facility pre-planned maintenance and have daily function checks.  Water quality groups must be established to ensure there is no risk of pathogens such as legionella, or pseudomonas from both supply tanks and outlets.  These environmental controls are especially important in older buildings where risk of rusty pipes or dead leg is present.  Flushing regimes must be in place, especially in low usage but high-risk areas.  

Thorough environmental cleaning reduces the potential of exposure to harmful pathogens. As with care equipment, cleaning of the environment requires frequency, method and process in both routine and contingent schedules.  The first stage of decontamination must always be cleaning, to remove any organic matter from surfaces, achieved by using water or enzymatic products. Methods should always proceed from clean to dirty, top to bottom, in a systematic manner using mechanical action.  Disposable, biodegradable cloths are the safest and most sustainable resource.  For reusable cloths, life/wash expiry must be accounted for, especially in cloths and mops containing microfiber.  All cloths and mops must be changed between each patient zone.  The second stage in the decontamination process is disinfection, this will reduce the number of viable pathogens after the organic matter. Common disinfection solutions include alcohols, chlorine and chlorine compounds, iodophors, peracetic acid, and quaternary ammonium compounds, which have broad-spectrum antimicrobial activity. Correct concentration levels and contact time must be observed.  

On-going challenges related to optimal cleanliness in healthcare environments remain, with research reviewing if traditional surface cleaning and disinfecting alone is sufficient, or if new advances such as UV light disinfection can provide a safer environment.  Most studies conclude that both manual and non-manual disinfection processes used in conjunction with one another, is the gold standard for healthcare cleanliness and to reduce the risk of pathogens. 

About the author:

Natalie Oakes is the Infection Control Manager at American Hospital Dubai.