Effective Surface Decontamination - an important part of HAI prevention - big topic at WFHSS

Professor Martin Exner discusses effective surface disinfection at the WFHSS Congress in Turkey.

The quality of environmental disinfection needs to be a major focus to improve surface decontamination and help minimise healthcare associated infections (HAIs) – according to Professor Martin Exner.

Professor Exner (Institute for Hygiene and Public Health, WHO Collaborating Center for Health Promoting, University of Bonn, Germany) was speaking at the World Forum for Hospital Sterile Supply (WFHSS) Congress in Antalya, Turkey, held between November 6th and 9th.

At this year’s event, surface disinfection, and its role in infection prevention was widely discussed in a number of sessions. There was a consensus among the leaders in infection control and prevention present, that the environment plays a role in the spread of Hospital Associated Infections (HAI) and that improved and effective surface decontamination is needed. Current practices and how they can be improved were discussed by several thought leaders. Training of staff, evaluation of disinfectants and their application, and automated processes for surface decontamination were mentioned as ways forward.

Professor Exner presented on the role of surface disinfection in Infection Prevention. He described the need to consider environmental contamination in HAI prevention. The burden of HAIs is significant, in Germany alone it is estimated that on a yearly basis, around 1 million patients acquire an HAI, leading to 30,000 deaths.

Effective hygiene practices and antibiotic stewardship were described as key to improve the situation. Adjusting protocols according to the risk-level for different areas and types of surfaces was suggested, together with proper evaluation of disinfectants and monitoring of manual practices.

Professor Exner suggested that terminal disinfection of high risk areas will be an important area to focus on going forward to ensure patient safety. “This disinfection aims to ensure that the room can be re-used safely for other patients without posing an infection hazard.” Diffusion of hydrogen peroxide was mentioned as a method to achieve terminal disinfection.

“There are many reports of insufficient and inadequate implementation of existing environmental cleaning and disinfection regimens. Therefore, future activities should focus on improving the quality of and the compliance with environmental disinfection procedure in accordance with a carefully designed set of standards.”

Read a full summary of Professor Exner’s presentation below.

“The Role of Surface Disinfection in Infection Prevention”

Professor Martin Exner

Institute for Hygiene and Public Health, WHO Collaborating Center for Health Promoting, University of Bonn, Germany

Presentation abstract:

Although the relevance of surface disinfection is increasingly being accepted, there are still a number of issues which remain controversial. In particular, in the presentation the following topics will be addressed: Transferral of microbes from surface to patients as a cause of infection, requirements for surface disinfectants, biocidal resistance and toxicity, future challenges.

After discussion and review of current scientific literature there is a broad scientific based consensus that contaminated surfaces contribute to the transmission of pathogens and may thus pose an infection hazard.

Targeted surface disinfection based on a risk profile is seen as an indispensable constituent in a multibarrier approach of universal infection control precautions. Resistance and cross-resistance depend on the disinfectant agent as well as o the microbial species. Prudent implementation of surface disinfection regimens tested to be effective can prevent or minimize adverse effects.

Disinfection must be viewed as a holistic process. There is a need for defining standard principles for cleaning and disinfection, for ensuring compliance with these principles by measures such as written standard operation procedures, adequate training and suitable audit systems. Also, test procedures must be set up in order to demonstrated the efficacy of disinfectants including new application methods such as pre-soaked wipes for surface disinfection.

Presentation topics:

The change of risk assessment
The situation now and in the future
The new risk assessment on the environment and HAI
Aspects of Surface disinfection
the German Guideline on Hospital Hygiene
The real life of cleaning and disinfection
New problems in surface disinfection systems
Environmental monitoring
Testing of surface disinfection

Presentation - Concluding remarks

There is now good evidence that contaminated dry surfaces contribute to the spread of nosocomial pathogens.
It is undisputed that environmental disinfection is necessary in certain risk areas and in outbreak situations.
It is widely acknowledged that proper use of disinfectants contributes to the control of pathogens in outbreak situations as part of a bundle strategy.
There is an urgent need to harmonize test procedures in order to demonstrate the efficacy of disinfectants including new application methods such as pre-soaked wipes for surface disinfection.
Current understanding of toxicity and resistance mechanisms confirms that prudent implementation of surface disinfection regimens can prevent or minimize adverse effects.
There are many reports of insufficient and inadequate implementation of existing environmental cleaning and disinfection regimens.
Therefore, future activities should focus on improving the quality of and the compliance with environmental disinfection procedure in accordance with a carefully designed set of standards.