COVID-19 and health care environmental hygiene

AS the COVID-19 pandemic continues to tighten its grip on countries around the world, health care systems are facing unprecedented challenges.

Facility-wide infection control practices are the backbone in effectively navigating a pandemic. As we recently discussed during the inaugural iClean 2020 Conference, hand hygiene, social distancing and environmental hygiene are the three most important pillars upon which health care institutions can protect themselves and reduce transmission. It is crucial that health care institutions properly coordinate their infection prevention and control (IPC) programs and their environmental services into an organised response.

Australia initially did quite well in managing COVID-19, with around 10 500 cases and just over 100 deaths as of mid-July. However, although cases of the disease initially plateaued rather quickly, the recent outbreaks in both Victoria and now New South Wales are evidence that we need to remain vigilant over the long term.

Hospitals and aged care facilities face a clear set of challenges on the road ahead and management teams must be involved in identifying the most appropriate IPC strategies for their institution.

First and foremost, IPC programs should easily translate across different sectors of the health care facility and, in particular, should be applied in the wards, where the majority of care, and subsequently cleaning, is performed. With health care facilities now required to balance routine care with COVID-19 management, including patient influxes, contact tracing and implementation of new protocols, effectively coordinating the activities of those responsible for patient care and environmental hygiene is paramount.

Most importantly, it is crucial to realise that COVID-19 will not simply disappear after a brief lockdown. Although periods with few cases may suggest we are “on the road out” of COVID-19, the disease continues to circulate throughout the global population, and recent weeks have made it clear this is unfortunately not the case. COVID-19 is here to stay for the foreseeable future, and it is therefore important that health facilities are prepared to deal with managing it on an ongoing basis.

This means being aware of the national and international guidelines for infection prevention and environmental hygiene. Health care facilities need to stay updated on the latest recommendations, particularly those of the World Health Organization and the Australian Government Department of Health.

For health care environmental hygiene in particular, both of the aforementioned organisations have a number of clear resources. The Australian Department of Health has published a set of specific recommendations for environmental cleaning and disinfection principles for health and residential care facilities.

Although managing the environmental hygiene aspect of a pandemic is a daunting task, it is important not to forget the key realities. Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is not a particularly difficult virus to kill in the health care environment, as it is an enveloped virus and is naturally quite fragile. Practically all of the products that are currently used in health care facilities are able to kill and/or remove the virus. Good standard procedures for environmental cleaning should therefore be enough to prevent transmission within this environment. Conceivably, the difficult part is not figuring out how to kill the virus, but ensuring these procedures are effectively implemented, which means dealing with the human and institutional aspects of such a strategy.

Health care environmental hygiene is not always seen as the most glamorous of fields, and programs are often understaffed and underfunded. Often, hospitals and long term care facilities cannot see the direct benefit of investing in the health care environment, despite proof that a contaminated environment results in increased health care-associated infections (HAIs). Still, many facilities have difficulty getting the appropriate attention and budgets for their environmental hygiene programs.

As SARS CoV-2 is primarily transmitted through close personal contact and contaminated surfaces, there has never been a more pertinent time for health care facilities to increase focus on their environmental hygiene programs. The benefits of investing in IPC will last far beyond the current pandemic. There are numerous other microorganisms that are responsible for HAIs, and many of these are far more difficult to remove from the environment than SARS CoV-2. If the current pandemic encourages health care facilities to implement organised, efficient and optimised environmental hygiene programs, they will not only help control COVID-19, but will also contribute to lowering HAIs in general.

Each year, more than 180 000 Australian patients develop HAIs. Aside from the human cost of increased morbidity and mortality, prolonged hospital stays also have a significant financial cost for hospitals, increasing hospital bed days by over 2 million bed days annually.

All over the world, people are increasingly familiar with the basics of IPC – social distancing, hand hygiene and environmental hygiene – and, encouragingly, these have become part of the current conversation. We have not seen the last of this pandemic, so it is important to continue to stay focused. If we do this, we will not only be able to work together to better weather the current COVID-19 challenges, but also reduce the global burden of HAIs in health care facilities.

Professor Didier Pittet is the Hospital Epidemiologist and Director of the Infection Control Programme and World Health Organization (WHO) Collaborating Centre on Patient Safety at the University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. He holds Honorary Professorships in London, Hong Kong and Shanghai, and is the lead Adviser of the WHO SAVE LIVES: Clean Your Hands program. Recipient of several national and international honours including a CBE (Commander of the British Empire) for services to the prevention of health care-associated infection in the UK (2007) and Robert Koch award (2017).

Alexandra Peters is the Lead for Research and Educational Program Development for Clean Hospitals, a global network dedicated to making hospitals safer through improved environmental hygiene. Based in Geneva, Alexandra also works in the Infection Control Program and WHO Collaborating Centre for Patient safety at the University Hospitals of Geneva. Her areas of expertise include environmental hygiene, hand hygiene, and her background is in health security. Alexandra is also an avid songwriter, and over the past few years has also been increasingly working on musical projects for public health initiatives such as the COVID-19 pandemic and the WHO World Hand Hygiene Day.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.