Hygiene and Aged Care: no walk in the park
The COVID-19 Pandemic (COVID) has devastated communities across the world. The aged care sector has been particularly affected with a disproportionately high mortality rate that has hurt families everywhere.
The COVID-19 Pandemic (COVID) has devastated communities across the world. The aged care sector has been particularly affected with a disproportionately high mortality rate that has hurt families everywhere.
In the USA, 17.6% of all COVID related deaths were in aged care facilities. Indeed, most people who died from COVID in the USA and Australia died within a healthcare facility (66% of all COVID deaths in the USA). Around 47% of those died with pneumonia and nearly 10% had sepsis (a bacterial infection). In fact, in the USA, only 5% of COVID related death certificates had no other comorbidities listed with the cause of death from COVID.
Most residents in long-term aged care facilities have multiple health conditions as part of their normal daily lives. The COVID pandemic has primarily affected people in their sixties and older. In the USA 77% of all deaths have been people aged more than 65 years. In Australia, 88% of all deaths have been in people aged 70 years and older.
Initially the focus of transmission was on surface contact. COVID can survive on surfaces only to be picked up by an otherwise uninfected person who can then contract the virus. The initial variant of this virus (the alpha or Wuhan variant) was not particularly efficient at spreading via aerosols and so many people were infected via surface contact. The response globally was a fearful pivot in hyper-hygiene and the so-called ‘hygiene theatre’; the masquerade of improved hygiene with workers in space suits fogging everything with disinfectants. Many aged care homes were locked down while staff tried to stem the spread of infection.
The Delta variant of the COVID virus spreads primarily via aerosols. One study showed that the Delta variant produces 1000x times more virus in the nasal passage compared to the original alpha/Wuhan variant. So now, COVID spreads mostly via aerosols. However, does this mean we should relax our focus on surface hygiene and other standard hygiene techniques?
On the cusp of the pandemic, the CDC in the USA published its latest report on “Antibiotic Resistant Threats in the USA, 2019”. Both the number of urgent threats and serious threats had expanded, and the level of antibiotic resistance displayed by superbugs had increased. More people are likely to die from Antimicrobial resistance (AMR) in the next few years than from all deaths due to the COVID virus.
Data just published on superbug infections and Healthcare Associated Infections (HAI) in the USA (during 2020, amidst the pandemic), indicated HAI infection rates have dramatically risen. This, rather frighteningly, shows that the superbugs have not been on holiday whilst we focused on COVID. Throughout 2020 the rates of most of the key superbug infections rose alarmingly, including the rates for MRSA which rose 33% in the last quarter of the year alone.
Where does that leave us all now? Surface hygiene in combination with Hand Hygiene (HH) remain the two easiest, cheapest, and effective solutions to this problem. Unfortunately, they are also the most poorly conducted interventions within both the health and aged care sectors.
The critical focus for HH is compliance. There are two main aspects to this. The first is the ready availability of a TGA registered Alcohol Based Hand Rub (ABHR). TGA registered ABHR is an OTC Medicine and should only be purchased from a TGA registered supplier. And it can’t just kill the bad bugs, it must also protect the skin on your hands.
The second issue regarding HH compliance is auditing. We need new tools to make compliance auditing a more credible and efficient activity that supports Infection Prevention and Control.
The key focus of surface hygiene must be wiping, and product selection is key. Do you know that there are nine separate variables to consider in wiping a surface? Australian research, published internationally, has shown that when a dry surface biofilm forms on a surface the superbugs within it become even more resistant to disinfectants. A superbug such as MRSA can survive on a surface after 50 wipes if the wrong product is chosen. And MRSA in a dry surface biofilm can resist chlorine up to 20,000 stronger that chlorine used in a swimming pool, let alone a product used in a hospital.
To provide quality assurance, in a scientific manner, that confirms surfaces have improved cleanliness after cleaning interventions requires new audit tools. This will ensure that the cleaning process doesn’t spread bad bugs from one surface to another. There has never been a more important time to revisit surface hygiene and HH.
Whiteley have recently established a training library (Whiteley’s Online Learning Centre) for practical, hands-on training. We encourage everyone in the aged care sector to visit the site, to continue their training, to keep their skills current because that’s what keeps residents safe from the superbugs.
Dr Greg S Whiteley FEHA, MASM, MSHEA is an Adjunct Fellow at Western Sydney University and executive chairman of Whiteley Corporation.
