
The recent pandemic raised awareness about hygiene and infection control practices among the masses. But for the healthcare sector, hygiene was always quintessential, even before the pandemic. It will also continue to be held at topmost priority years and decades after the pandemic has ceased.
Thorough environmental hygiene is important for the prevention of transmission of infectious diseases within healthcare settings. This encompasses effective cleaning of surfaces using appropriate products, decontamination of medical equipment and devices used in patient-care procedures, safe and appropriate handling of sharps, blood and body fluid spills, waste and linen.
The role of environmental cleaning is to reduce the number of infectious agents that may be present on surfaces and minimise the risk of transfer of microorganisms from one person/object to another, thereby reducing the risk of cross-infection. This concept is here to stay and although it was brought under the scanner by the pandemic, healthcare facilities will always have to keep a vigilant eye on its environmental cleaning processes.
We feature 2 renowned experts from the UAE to shed more light on the need for hygiene beyond COVID-19.
Remya Venugopalan, Director Operations, International Modern Hospital, Dubai
COVID-19 has taught us many lessons and one of the important ones was about “Ensuring Hygiene”. Importance of hygiene in healthcare was always there but COVID has brought this to the forefront. COVID-19 was spreading from one to the other and it was important for one self to keep them safe by following proper hygiene and more particularly hand hygiene.
That being said, communicable diseases such as tuberculosis, chicken pox, and influenza etc. have always existed and hospitals managed to prevent the spreading of these diseases by ensuring proper hygiene and disinfection practices.
Many people have a misconception that housekeeping teams in hospitals are only for cleaning but what they do more than cleaning is controlling the spread of infections. This is done by continuous disinfection of the hospital surfaces which are frequently touched by patients, visitors and staff such as floors, chairs, wheel chairs, stretchers, medical equipment, side railings etc. Hospitals house patients who are sick, recovering from diseases and these patients contaminate all the hospital surfaces that they come in contact with.
Apart from this, hospitals generate medical waste which includes blood, body fluids, sharps, body parts and others. This needs proper segregation and discarding to prevent cross contamination.
One of the most important aspects of disinfection is the use of appropriate chemicals and the contact time. We at International Modern Hospital, use Virex as a regular disinfectant for disinfecting surfaces of buildings and equipment. One thing we have done well, is the training and awareness of our staff related to contact time of the chemical. The contact time of Virex is about 10 minutes which is needed for the chemical to be effective.
At IMH, we have focused a lot on hand hygiene by the staff. In fact we have involved our patients to ask staff if they have washed their hand before touching them, this is achieved through badges worn by the staff which reads “Ask me if I washed my hands”. We follow WHO 5 moments of hand hygiene and have pasted these posters at multiple places in the hospital. We also have silent observers who discreetly monitor staff to see their compliance with WHO 5 moments.
We also have portable HEPA filters which we use in some outpatient clinics (ex: pulmonology, Internal Medicine), emergency and covid patient rooms to continuously keep the air fresh for patients and staff in these respective rooms.
One of the main challenges related to hygiene is staff non-compliance by habit as they think that they won’t get infected. And changing habits takes time. At IMH we have been able to achieve this continuous training, monitoring, and just in time education of the staff who are non-compliant and involving patients in the process, especially hand hygiene. Another challenge is related to contact time as staff like to get done with their work and do not wait for the disinfectant to take action. This we overcame by monitoring and educating the staff.
I would like to conclude by saying that hygiene is not new to healthcare organizations and its staff. Because of the good practices related to hygiene & disinfection followed by healthcare organizations, the spread of infections was controlled in the hospitals and communities. COVID-19 has only made the people and the communities aware of the hygiene and disinfection practices needed to be followed by people to prevent spread of infections. At IMH, we continuously seek the best practices related to infection control to control and prevent the spread of infections. We also have a dedicated, multidisciplinary infection control committee which oversees the infection control function and on the continuous mission of improving the infection control practices for the betterment of patients and society.
Tabrikah Mohammed Ali, BSN, MSC,CIC ,CPHQ, Infection Control OfficerInfection Control Officer, The National Rehabilitation Center, Abu Dhabi
Environmental hygiene is maintaining a clean environment by cleaning equipment between use, disinfecting surfaces, and sterilizing medical equipment according to best practice to remove and destroy potential infectious microorganisms. Proper disinfection of all types of surfaces is one of the most reliable ways to help lower the risk of spreading germs from surfaces by contact and to prevent them developing into a reservoir for pathogens and biofilms.
An example of surfaces: high-touch surfaces such as countertops, bed rails, and tray tables. As there is increasing evidence that the healthcare environment is an important source of healthcare- associated infections and Multi Drug Resistant Organisms. Therefore, environmental hygiene is an important factor to prevent the spread of infections among patients, staff, and visitors in healthcare. Moreover, it is one of the important pillars for effective infection prevention and control (IPC) programs and to have robust IPC program measures, it requires an established, well-managed environmental cleaning and disinfection program, implemented as an essential level of protection within the umbrella of patient safety programs.
During COVID-19 pandemic, hygiene became an essential part of our daily life and the focus is not limited to healthcare institutions but also widespread to schools, hotels, and working places, etc.
Best practices for effective environmental hygiene program are : supportive leadership in term of resources and manpower, multidisciplinary team experts, cleaning protocols, regular cleaning schedules, selecting the appropriate cleaning agents and equipment, monitoring the effectiveness of cleaning procedure, emergency preparedness in an unexpected situations such as outbreaks, natural disasters, back orders on supplies, unavailability of equipment, and staff shortages. In addition, proper education, and training of environmental services personnel upon hire, at regular intervals thereafter, and as needed. New disinfection technologies: No-touch disinfection systems are those that use chemical disinfectants or physical agents to disinfect surfaces and which do not require that the active agent is directly applied to and removed from the surface manually. The most common no-touch disinfection systems include the use of hydrogen peroxide mist or vapour or the use of ultraviolet light to disinfect surfaces. There are a variety of other no touch technologies with pros and cons for each technology (e.g., high-intensity, narrow-spectrum light, quaternary ammonium fogging, alcohol-mist, ozone gas, superoxide water and steam vapour).
In all cases, these technologies were designed as a supplement to, and not as a replacement for, routine cleaning and disinfection by environmental service workers. There are several challenges that should be considered while developing environmental hygiene programs in healthcare facilities such as educational level of the environmental service workers and language barriers, healthcare environment, resistance organisms and emerging -reemerging infectious diseases. Also, the effectiveness of newly innovative products and technology. In conclusion, a successful implementation of any environmental hygiene program in healthcare should be applied by a multidisciplinary team, implementing best practices, and spreading the awareness among community, healthcare institutions and professionals. By this, our healthcare system can face any emerging -reemerging infectious agent.