About healthcare-associated infection (HAI)
Everyone has heard of healthcare-associated infections (HAIs), but most people don’t know exactly what they are, so it’s important to start with a definition. HAIs are infections that patients acquire while in hospital or other healthcare settings.
While some infections are easily treated, others can have a significant impact on a patient’s well-being, prolonging their hospital stay, increasing medical costs and causing considerable distress. Commonly reported healthcare-associated infections include respiratory tract infections, surgical site infections, urinary tract infections, bloodstream infections and gastrointestinal infections. In particular, Clostridioides difficile infections (CDI) account for almost half of all gastrointestinal infections. CDI ranges from mild diarrhoea to severe life threatening infections and is generally, but not always associated with previous use of antibiotics.
Figures from the European Centre for Disease Prevention and Control (ECDC) are alarming because they show the prevalence and impact of these infections: in the European Union and European Economic Area (EU/EEA), there are an estimated 3.5 million cases of HAIs each year, resulting in more than 90 000 deaths and around 2.5 million disability-adjusted life years (DALYs), an economic measure of the total burden of disease expressed as the number of years lost due to illness, disability or premature death. This burden exceeds the cumulative impact of other infectious diseases, such as influenza and tuberculosis, in the EU/EEA.
The burden of HAIs goes beyond the problem of prolonged hospital stays and associated direct costs, as it has a huge impact on public health, resulting in long-term disability, increased antimicrobial resistance of microorganisms, massive additional costs to healthcare systems, high costs to patients and their families, and unnecessary deaths.
The World Health Organisation (WHO) reports that for every 100 hospitalised patients in developed and developing countries, 7 and 10 respectively acquire a healthcare-associated infection (HAI) every day. In addition, 71% of HAIs are caused by antibiotic-resistant bacteria, including bacteria resistant to antibiotics of last resort.
It is estimated that up to 50% of healthcare-associated infections are preventable. The use of infection prevention and control measures in healthcare settings is essential to prevent HAIs (ECDC).
Clostridioides difficile (C. diff) is the leading cause of healthcare-associated diarrhoea worldwide, producing spores that are resistant to commonly used biocides and can persist on contaminated surfaces for months. This has led to increased efforts to maintain strict infection control practises in the hospital environment.
Previous studies have suggested that low concentrations of sporicide may cause chemical changes on the surface of surviving spores, which in turn may affect their ability to adhere to surfaces. However, a recent study has shown that when exposed to three different concentrations of sodium hypochlorite (bleach), the spores of three strains of C. diff not only survived, but also showed no visible damage. In an interview with The Guardian, the researcher responsible for the study, Tina Joshi, states unreservedly that chlorine is not the right biocide to use and that new disinfectants and hygiene protocols need to be adopted that are better suited to the microbial environments that develop in today’s hospital rooms.
The researchers also identified the presence of C. diff spores on multipurpose surgical gowns and new patient gowns. It is very clear that the spores adhere to the fibres,” says Joshi, “so these items should also be considered as favourable reservoirs for transmission.
Most hospital-acquired infections are transmitted by healthcare workers’ hands and direct contact with fomites. Therefore, scrubs and gowns are worn as PPE in hospitals to reduce the transmission of infectious material and to break the chain of transmission but, if used inappropriately, they can act as fomites and contribute to the transmission of C. diff in the clinical environment.
There is an urgent need to review current disinfection and infection prevention guidelines to optimise C. difficile spore disinfection practices and reduce the incidence of CDI worldwide. It also demonstrates the ability of C. difficile spores to tolerate sodium hypochlorite disinfection at the recommended concentrations of active chlorine used.
Figure 1: Healthcare-associated Infections in European Hospitals. Source ECDC
Inadequate disinfection of hospital environments creates conditions favourable to the development and proliferation of bacteria. The most vulnerable patients are the first to fall victim to this situation, as the development of opportunistic infections not only worsens their condition, but also contributes to a more serious phenomenon: antibiotic resistance. These patients include those who have been hospitalised, are over 65, have a weakened immune system or have a history of recurrent infections and are therefore on antibiotics.
Peracetic acid has emerged as a highly effective alternative for the disinfection of healthcare environments due to its broad-spectrum activity, including bactericidal, mycobactericidal, sporicidal, fungicidal and virucidal activity.
Christeyns has a range of products that provide safety and protect patients and healthcare professionals from the risks of contamination by these pathogens. Our Phago range of products has been developed specifically for the hygiene of the most demanding environments such as hospitals. One of the products in this range is Phagospore, a disinfectant detergent for all types of surfaces. This is a ready-to-use, broad-spectrum product that effectively and safely controls the growth of microorganisms in healthcare environments.
Christeyns also offers washing solutions for the treatment of fabrics used in hospitals, such as Peracid Asepsis, whose bactericidal, fungicidal, virucidal and sporicidal properties make it an ally in the fight against infection.
Use biocides safely. Always read the label and product information before use.
Not all biocides are registered in all countries. Please contact your local Christeyns representative about the availability.
References:
- Ahmed, H., & Joshi, L. T. (2023). Clostridioides difficile spores tolerate disinfection with sodium hypochlorite disinfectant and remain viable within surgical scrubs and gown fabrics. Microbiology, 169(11), 001418.
- CDC Report: https://www.cdc.gov/hai/data/portal/progress-report.html
- ECDC- https://www.ecdc.europa.eu/en/healthcare-associated-infections
- Joshi, L. T., Welsch, A., Hawkins, J., & Baillie, L. (2017). The effect of hospital biocide sodium dichloroisocyanurate on the viability and properties of Clostridium difficile spores. Letters in Applied Microbiology, 65(3), 199-205.
- The Guardian – https://www.theguardian.com/science/2023/nov/22/bleach-does-not-tackle-fatal-hospital-superbug-uk-researchers-find
- WHO : https://www.who.int/news-room/feature-stories/detail/the-burden-of-health-care-associated-infection-worldwide
