Have you ever wondered what infection prevention and control (IPC) “looks like” in other parts of the world, and how our challenges compare? In the U.S., most Infection Preventionists (IPs) are budgeted to attend at least one conference per year, and international conferences are typically not within the budget. At least, this was the case when I worked in hospitals. After 24 years as an IP, my dream finally came true! I am eternally grateful to Clorox Healthcare for sending me to the International Consortium on Prevention and Infection Control (ICPIC) in Geneva, Switzerland this September. This blog is dedicated to honor Clean Hospitals Day, celebrated each year on October 20th, to raise awareness and foster engagement among healthcare facilities around the world on the important role of environmental hygiene in IPC.
ICPIC is a unique forum for the exchange of knowledge and experience in the prevention of healthcare associated infections (HAIs) and antimicrobial resistance (AMR). It also happens to be the largest IPC conference in Europe. The 1200+ participants, who traveled from across the globe, were stimulated by the high quality of the sessions offered as well as the expertise and reputation of the speakers. Participants came from a variety of disciplines including but not limited to IPs, infectious disease physicians and researchers, public health professionals, academics, and frontline healthcare workers. Speakers included renown researchers and experts from (among others) academia, the Centers for Disease Control (CDC), the Society for Healthcare Epidemiology of America (SHEA), and the World Health Organization (WHO). In case you are wondering, the conference was entirely in English with the provision of simultaneous translation equipment available at every seat.
The excitement at the ICPIC opening ceremonies was palpable and set the tone for the rest of the conference. In her opening remarks, Celine Gardio, Program Director for the Swiss Federal Office for Public Health, provided a call to action to get IPC back on track following the pandemic. Tedros Ghebreyesus, WHO General Director, reminded participants that “without correct IPC, hospitals can become transmitters of infection.” He stated that “hospitals should be places of health, not harm,” yet a sobering statistic remains that globally, most HAIs are AMR. This was a great introduction to the WHO’s new global strategy on IPC, an operational framework using change theory on those actions needed to reduce HAIs, AMR, and infectious disease outbreaks by the year 2030. Dr. Michael Bell, Deputy Director of the U.S. CDCs Division of Healthcare Quality Promotion echoed the concerns of his international colleagues with the growing threats of AMR. I encourage IPs to review the following tools provided by the WHO.
Over the course of the next two-and-a-half days, I attended a plethora of excellent general sessions, keynotes, and symposiums. The over-arching theme of the conference encompassed moving forward in a post-pandemic world. See Image 1 for topics that trended throughout the week.
One trending topic that seemed to be woven throughout the conference sessions, even more so than hand hygiene, was healthcare environmental hygiene. This important topic was finally given the attention it deserves and was emphasized in multiple sessions by the US and international experts alike. Selected experts, including Dr. Didier Pittet (Switzerland), Dr. Alexandra Peters (Switzerland), Dr. Pierre Parneix (France), Dr. David Calfee (US), and Jon Otter, PhD (UK) from the global Clean Hospitals Initiative led a very well-attended symposium dedicated to this topic. The Clean Hospitals Initiative is a network of experts and industry partners (including Clorox Healthcare) working together to make hospitals safer through improved environmental hygiene through academic research, education and training, and raising awareness (learn more here from my recent interview with Dr. Didier Pittet). I truly appreciate how the experts tied a clean environment to clean hands. You can’t have one without the other. I am sure you have all heard me say over the years that our hands are only as clean as the environmental surfaces around us. In a session titled “Are we prepared for future challenges in IPC”, Vanessa Vazquez, a healthcare IP leader (Spain), reminded participants that “infection transmission is not only about our hands”, while another expert panelist, Dr. Moi Lin Ling, Director of Infection Control, Singapore General Hospital, added that “we must pay more attention to environmental hygiene – much like we also do for hand hygiene.” We know that environmental contamination leads to HAIs and that admission to a room previously occupied by a patient with an AMR pathogen, including C. difficile, significantly increases the risk for the next patient admitted to the room to acquiring that pathogen.1,2 In fact, Dr. Alexandra Peters with the Clean Hospitals Initiative and the Hospital University of Geneva (HUG) reported that over the last 20 years, we are seeing a shift towards outbreaks of gram-negative pathogens which are often found in the healthcare environment. Dr. David Weber (United States), in his session on “no-touch room disinfection,”
, shared that 20-40% of HAIs are associated with either environmental contamination or cross-contamination. But the good news is that “improving cleaning strategies improves patient outcomes” (Dr. Parneix).
To help IPs and environmental services professionals improve their environmental hygiene programs, Clean Hospitals recently released their comprehensive and validated Healthcare Environmental Hygiene Self-Assessment Framework (HEHSAF) – a new tool with the dual purpose of assessing the level of need, but also for improving a facility’s performance by utilizing it as a benchmark for improvement over time. The HEHSAF is based on the Multimodal Improvement Strategy and focuses on both the technical and human elements of healthcare environmental hygiene. This tool, developed by Dr. Pittet and team, follows in the success of a similar tool (“Hand Hygiene Self-Assessment Framework”) developed back in 2010 by this team in collaboration with the WHO. Many IPs reading this blog may be familiar with this tool — I know I employed to improved hand hygiene at my last hospital. I encourage IPs and EVS to work together to complete the HEHSAF which is currently available in 7 languages with more coming.
To end on a less serious note, I would like to share what I learned in a really awesome session titled “Space: The Final Frontier” presented by Dr. Leonard Mermel, a researcher at Brown University (United States). We know that IPs work in a variety of settings, but did you know that even the National Aeronautics and Space Administration (NASA) employs IPs? If you ever find yourself on Mars, here is what you need to know about life (and health) in a zero-gravity setting:
- Humans become immunosuppressed in space.
- In contrast, microbes grow exuberantly, have enhanced virulence, increased drug-resistance, and a lower infectious dose.
- Chronic viruses (e.g., Epstein Barr Virus, Cytomegalovirus, Varicella) are reactivated.
- When an astronaut coughs or sneezes or flushes the toilet, the droplets remain suspended in the air indefinitely posing unique IPC challenges.
In closing, I give the ICPIC conference a 10 of 10. In response to my own question regarding IPC challenges posed at the opening of this blog, it should not have come as a surprise to learn that IPs across the globe struggle with the same challenges that you and I face every day. Whether you practice in a low-resourced country versus a higher resourced country, perhaps you’ll find it reassuring to know that we all face the same issues in getting staff to consistently comply with IPC practices, including hand hygiene. Pathogens don’t respect state or country borders, but when we work together towards the same goal, we can (and do) make a difference. Because the ICPIC conference was so rich in information, please be on the lookout for a second blog sometime in the near future covering some other great content. I will close with one of my favorite quotes of the week regarding the comparison of healthcare errors to the aviation industry:
We can and we must improve.
1. Weber D, Kanamori H, Rutala W. ‘No touch’ technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. Curr Op Infect Dis. 2016;29 (4).
2. Weber D, Anderson D, Rutala W. The role of the surface environment in HAIs. Curr Opinion in Infect Dis. 2013.