Looking back and ahead - Past and future challenges in infection prevention

On June 15, 2023, our online symposium series continued with the theme “Looking Back and Ahead – Past and Future Challenges in Infection Prevention”. The three-hour event was divided into two sessions. The first session was titled "Looking back: The COVID-19 pandemic as a chance - impact on today's infection prevention". During this part of the event, Professor Dr. Johannes Knobloch (Head of Hospital Hygiene Department - Institute of Medical Microbiology, Virology and Hygiene at the University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany), Dr. Jon Otter (Director of Infection Prevention and Control, Guy's and St. Thomas' NHS Foundation Trust, London, UK) and Dr. Alexandra Peters (Scientific Lead for CLEAN HOSPITALS | Infection Control Program & WHO Collaborating Center for Infection Prevention and Control and Antimicrobial Resistance, Geneva, Switzerland) reported on the impact of the COVID-19 pandemic on infection prevention today. The second session focused on "Looking ahead: Future challenges in infection prevention‘’.

In this part of the event, Dr. Milo Halabi (Head of Institute of Pathology, Microbiology, and Infection Diagnostics, Krankenhaus der Barmherzigen Schwestern Ried, Austria), Stefan Krojer (Founder and Managing Director of ZUKE Green, Erkelenz, Germany) and Dr. Jan Schröder (Senior Scientist Formulation Development & Risk Manager, BODE Chemie GmbH, a company of the HARTMANN GROUP, Hamburg, Germany) gave an overview of future challenges and approaches to solutions in infection prevention.

In his presentation, Prof. Knobloch gave an overview of the lessons learned from the pandemic experience at the University Medical Center Hamburg-Eppendorf (UKE). According to his experience, the use of suitable personal protective equipment must be sufficiently trained (fit test). Furthermore, the use of respirators with ear loops has been banned again in the UKE. It is also true that protection can fail even in the case of well-trained personnel wearing high-quality respirators during continuous use. In addition, the transmission of SARS-CoV-2 with surfaces can be considered very unlikely. PCR methods are not suitable for estimating the infectivity of inanimate surfaces. Regarding the use of gloves, it can be classified that they only protect against gross contamination (handling of secretions). Every moment of hand disinfection is also an indication for a glove change. In this context, the 5 moments of hand disinfection should be considered.

Prof. Dr. Johannes Knobloch: „The strongest impact of lessons learnt comes from outbreaks and other transmission events.“

In his presentation, Dr. Jon Otter reported on the importance of language in communicating about nosocomial infections and antimicrobial resistance. For example, the COVID-19 pandemic has influenced the wearing of personal protective equipment and hand hygiene. The pandemic demonstrated that excessive and incorrect use of personal protective equipment results in increased risk to the wearer and increased risk of cross-contamination. In addition, excessive and incorrect use of gloves/gowns impedes hand hygiene and leads to increased cross-contamination [1,2]. For health communication and education to be successful, it is important to speak the same language as the target audience. As a general rule, you should know your target audience and develop a concise message. Furthermore, consultation with stakeholders should be conducted and a persistent approach should be displayed as part of a compelling brand.

Dr. Jon Otter: „The current language needs to change – less technical more meaningful – messages that mean something to the target group are very likely to change behavior.”

Environmental hygiene is a significant lever to reduce the rate of nosocomial infections [3]. But in practice, this area is generally understudied and underfunded. Dr. Peters reports that this is where the CLEAN HOSPITALS project comes in – a cooperation of international stakeholders working to promote and support environmental hygiene in healthcare. For example, since 2020, the importance of environmental hygiene has been highlighted with the annual CLEAN HOSPITALS DAY on October 20th. Part of the CLEAN HOSPITALS project includes scientific publications on environmental hygiene. A recent study highlights how important environmental hygiene is for patient safety [4]. Another study of environmental hygiene at the facility level among 51 facilities showed that 98% were majorly lacking in at least one of the five major componentsof environmental hygiene [5]. Building on these findings, the HEHSAF is currently being developed: a secure online tool for healthcare facilities to analyse and assess their current healthcare environmental hygiene programs.

Dr. Alexandra Peters:„By breaking silos between the public and private spheres we hope to be able to help improve patient safety and reduce antimicrobial resistance.“

In his presentation, Dr. Milo Halabi showed the digital possibilities in the control of healthcare associated infections (HAI). Every year, 4.1 million patients in Europe suffer from HAI. In Europe, this means additional costs of 2-19 billion euros. In this context, digitization can help to track down more HAI. For example, an AI (Artificial Intelligence)-powered software solution already automates parts of the monitoring of HAIs by analysing patient records. The result of this analysis is a timeline of events that serves as the basis for identifying the occurrence of HAI. Automatic identification of potential HAIs is based on the European Centre for Disease Prevention and Control (ECDC) and Hospital Infection Surveillance System (KISS) standard definitions of HAI. Dr. Halabi advocates the use of such technical solutions that collect and provide data, allowing for simplified interpretation by specialists.

Dr. Milo Halabi:„The need of systematic surveillance concerning HAI is undoubted – due to the implication on morbidity, mortality and costs.”

Stefan Krojer, founder of ZUKE Green (Zukunft Krankenhaus-Einkauf), showed in his presentation that the healthcare sector causes 5% of global CO2 emissions. Nevertheless, the topic of sustainability has so far been of marginal importance for hospitals – especially in the German region. For example, only 6% of German hospitals pursue a sustainability strategy. In addition to best practice examples, Stefan Krojer provided strategic recommendations for the successful implementation of a sustainability strategy. In the first place is the creation of a sustainable organisational structure followed by the status quo analysis (CO2 and energy balance, materials analysis).This is followed by the definition of goals, including the incentivisation of employees and the implementation of measures. The final steps are control, communication of the lighthouse projects and certification.

Stefan Krojer: „Communication along value chains between actors is the basis for successful implementation.“

At the end of the virtual symposium, Dr. Jan Schröder gave an overview of the first steps towards sustainable disinfection. In his presentation, he focussed on surface disinfection wipes. The modern requirements include the following elements: microbiological efficacy, no toxicity for humans and the environment, material compatibility, user friendliness and sustainability. Since the pandemic, the need for virucidal efficacy or activity spectra is high. In terms of sustainability, the choice of chemistry in disinfectants is an important issue for the future to avoid toxicity and persistence. Research in material compatibility is key to avoiding downtime and will lead to longer and more sustainable use of medical devices. With a special focus on the sustainability of disinfection, it consists of several aspects: Packaging, compatibility, formulation and efficacy or spectrum of activity. Future developments must take all aspects into account to achieve a more sustainable way of disinfecting surfaces in the medical field and to protect our own environment.

Dr. Jan Schröder: „Regarding sustainability, the coice of chemistry in the disinfectant is the major point and it also includes the toxicity, persistency, and material compatibility.“