By Rick Mullen, Maintenance Sales News Associate Editor
Dr. Katie Pisciotta
Dr. Katie Pisciotta, epidemiology consultant at IEHA (The Indoor Environmental Healthcare and Hospitality Association, a division of ISSA) presented data, statistics and tips on how to control infections in a facility during her presentation, which was part of the 2020 ISSA Show North America Virtual Experience.
“Today we are going to be talking about infection control, specifically surveillance, identification and containment,” she said, while introducing her educational session titled “Understanding Infection Control: Surveillance, Identification & Containment. “Infections can be monstrous. The responsibility of controlling the spread of infection is one that is shared among everyone in the workplace, whether it is a health care facility, school, you name it, everyone involved has to play a significant role.”
Many of her remarks and observations were aimed specifically at health care facilities and environmental services staff, as her session was part of IEHA’s educational health care track. However, she also offered some general statistics and infection control methods that can benefit all cleaning industry facilities, including jan/san distributors.
In addition, her insights into the inner workings of health care facilities and environmental services offer distributors a more in-depth understanding of their customers in those fields.
“While the privacy, dignity and well-being of all residing in a health care facility of any kind is of upmost importance, we need to fully communicate all necessary details in the event of an infectious outbreak of any magnitude,” Pisciotta said. “Our biggest concern is health care associated infections (HAIs). Very often, in health care facilities, there are a lot of people experiencing HAIs, whether you know it or not. They creep up and can spread very quickly.”
Pisciotta offered the following statistics concerning HAIs:
■ If you are admitted to a hospital, you have a 5 percent chance of contracting an HAI;
■ Your length of stay in a hospital increases by 17.6 days if you get an HAI;
■ 1.7 million people a year get an infection during a hospital stay;
■ 98,987 people in the U.S. die annually from HAIs;
■ 9.4 percent of total impatient costs are HAI-related;
■ More than two-thirds of HAIs affect people with Medicare or Medicaid; and,
■ HAIs kill more people each year than breast cancer and prostate cancer combined.
“Due to the preventable nature of many infections, it is important to consider your role in the infection control process,” Pisciotta said. “HAIs are important causes of morbidity and mortality in the United States. They can occur in all types of settings, including acute care, hospitals, ambulatory surgical centers, dialysis facilities, outpatient care and long-term care facilities. Studies have concluded that a major component of reducing negative outcomes is improvement in educational efforts of environmental services staff.”
Pisciotta offered some ways to potentially reduce infections and improve outcomes, including program development and implementation; interagency collaboration; increased compliance; and improving education and training incentives.
“Successful program implementation relies on interagency collaboration in an effort to improve outcomes and reduce the number of individuals with health care associated infections each year,” Pisciotta said.
Infections are classified by organisms. Pisciotta explained that understanding the organism in which an infection forms will help in the identification of the types of infection.
“We like to think we know a lot about infections, because we all get sick. With the emergence of COVID-19, a lot more people are learning about infection control measures, including how to identify, treat, and ultimately eradicate infections,” Pisciotta said. “There are six different types of infections: bacterial, fungal, viral, protozoan, parasitic and prion.
“Bacterial infections can live in most environments, and, therefore, much of earth is made up of bacteria, making it the most common form of infection.”
Bacterial diseases include tuberculosis, cholera and dysentery. A more common one is pneumonia, Pisciotta said.
“Bacterial infections include food poisoning, gastritis, sinusitis, urinary tract infections, STDs, upper respiratory tract infections, and skin infections,” Pisciotta said.
Fungal infections include athlete’s foot, ringworm and some eye infections.
“Fungal infections can cause systemic diseases that can affect the entire body,” Pisciotta said.
Viruses, including COVID-19, are a major concern in facilities and pose a challenge for control efforts, Pisciotta said.
“Due to the nature of viruses, they often cannot be treated, making it a ‘waiting it out process,’ while we treat the symptoms and not necessarily the disease,” Pisciotta said. “Viral infections can target specific age groups and can remain dormant for a long period of time.
“Viral infections include the common cold, encephalitis, skin infections and gastroenteritis. Due to the severity of some viruses, a great deal of media focus, in regards to health care, is aimed at viral conditions, including Zika virus, HIV, hepatitis C, influenza and Ebola. It is easy to forget about other viruses, as most of our attention is on COVID-19.”
Protozoan infections are commonly transferred by feces and, therefore, are a major issue within health care facilities, Pisciotta said.
“Parasitic infections are specifically transmitted by parasites. While not all parasites cause disease, those that do can affect all living organisms,” Pisciotta said.
One of the most well-known parasitic/protozoan diseases is malaria.
“Prion infections are rare. Many of you likely have never heard of a prion infection,” Pisciotta said. “Prion infections progress rapidly, therefore, they must be properly identified at an early stage.”
A prion is a type of protein that can trigger normal proteins in the brain to fold abnormally. Prion diseases can affect both humans and animals and are sometimes spread to humans by infected meat products.
“Typically, prion infections are harmless, however when folded into an abnormal shape they can affect the brain and other parts of the nervous system through degenerative diseases such as bovine spongiform encephalopathy (BSE) and Creutzfeldt-Jakob disease (CJD),” Pisciotta said. “On a larger scale, researchers have linked some cases of Alzheimer’s disease to prion infections.
“Understanding the type of infections guides efforts to control the spread. Different products are used for the purpose of controlling infections.”
When it comes to the transmission of infections, there are two primary modes: direct and indirect, Pisciotta said.
“Direct transmission includes direct contact between reservoir and host, as well as droplet spread,” Pisciotta said. “Direct transmission includes skin-to-skin contact. Droplet spread can occur over a few feet, and lead to infection spread. Direct transmission is exactly why we wear masks.”
Indirect transmission falls under three primary categories: airborne, vehicleborne and vectorborne, Pisciotta said.
“Airborne infection occurs when any of the types of infectious agents are carried by dust or droplets in suspended air,” Pisciotta said. “Vehicleborne transmission occurs through an infected seed, water, or a biological agent, such as blood. It involves mosquitoes, fleas and ticks that may carry an infectious agent and spread the infection to an individual.
“Understanding modes of infection and transmission helps better direct control efforts and ensure proper containment protocols are followed.
“With an understanding of both types of infections and modes of transmission, control methods can be discussed in greater detail in a way that allows for implementation and environmental services protocols to aid in the reduction of infections prevalent within a facility.”
In discussing infection control, Pisciotta offered four primary methods: personal protective equipment (PPE), hand hygiene, contact precautions and avoiding contaminating surfaces.
“It is very interesting to know how many people in the general population have never really thought about infection control methods,” Pisciotta said “We need a lot of education as to how to properly follow control methods.
“PPE is something we are all very familiar with right now. PPE includes gloves, isolation gowns, face protection, masks, face shields, goggles, respiratory protection and boots.”
Pisciotta explained there is a significant difference between proper hand hygiene and the use of alcohol-based hand sanitizers.
In battling COVID, much of the discussion centers on hand sanitizers, while emphasizing the importance of, and the proper way, to wash hands have somewhat been lost in the shuffle.
“It is important to remember that successful infection control will involve adequate handwashing procedures,” Pisciotta said. “We have heard about sanitizers much more often than proper hand washing.”
Contact precautions include isolating patients and careful attention to not touching eyes, nose, mouth and hands, Pisciotta said.
“With new information and, hopefully, an increased understanding of infection control, all facilities are encouraged to develop and implement standards that will reduce the frequency and severity of infections,” Pisciotta said. “Implementation of strategies known to prevent HAIs, advance development of effective prevention tools and exploring new prevention approaches are ongoing.
“A public health program that focuses on the involvement of health care personnel would lead to greater success and make a greater impact in efforts to reduce the number of individuals with HAIs each year.
“Developing a program that aims to improve education and understanding of infections among the health care environmental services population would lead to better results and reduce morbidity and mortality.”
Pisciotta outlined five steps of standardizing infection control practices: communication development, ensure accessibility of information, ensure staff compliance through accountability protocols, consistency in control measures and evaluation.
■ “Communication development is often the downfall, especially if a facility has many different departments,” Pisciotta said. “Interdepartmental collaboration is a very challenging topic, and one on which health care education focuses.
“Developing facility-specific codes for communication between health care and environmental services staffs is a major component of communication development. Developing specific codes allows everyone involved to speak the same language. With the codes, there is no longer environmental services jargon, nursing department jargon or administration jargon. Codes allow there to be a universal language within your facility.”
■ To ensure accessibility of information, Pisciotta suggested using index cards.
“Index cards can act as cheat sheets for all necessary information regarding the presence of any infection within a facility,” she said. “Some people have better memories than others, so it is really important to establish a universal way to provide information to everyone.”
Pisciotta said compliance is a major component of implementing regulations and initiatives.
■ “Accountability protocols can be a useful tool. Checklists have proven beneficial for this goal, by requiring an individual to attest to the conclusion of a task,” Pisciotta said. “The accountability of saying, ‘I have been assigned this task. I have completed it and I know it is up to standards,’ will help to improve compliance and accountability protocols to ensure that we actually are protecting everyone within our facility.
■ “In addition, consistency is a key component for success in any endeavor, and infection control is no exception. Assigning the same individuals to complete tasks for the duration of an infection will help to improve outcomes through consistency, control measures and ensuring compliance protocols.”
In passing off a task mid-stream during an infection outbreak, it is very difficult to communicate all the information gleaned by the original worker to the person taking over, Pisciotta said.
“If one person is assigned to a specific task, he/she should see that task through,” she said. “Consistency — the person who starts performing a task should finish it.”
■ Documentation of control measures, successes and failures, aids in program evaluations, Pisciotta said.
“To best understand the needs of your facility, it is important to acknowledge past mistakes and amend regulations accordingly,” she said. “For example, it is my suggestion that every long-term care facility should engage in a needs assessment at least quarterly.
“It is really important to determine what your facility needs for improvement; where the gaps are and how to fill them; and to work as an interdepartmental team.
“Right now, many of you are experiencing COVID-19 in your face 24/7. However, we must remember, although COVID-19 is the greatest threat currently, there are still 1,400 new infections every day that can spread rapidly and without warning, especially if we are focusing elsewhere. Often we cannot control our surroundings, but we can control our level of commitment and attention to detail.”
The Indoor Environmental Healthcare and Hospitality Association (IEHA), a division
of ISSA, focuses on the healthcare, hospitality and other environmental services
sectors of the cleaning industry. For more information, visit IEHA.org.