Elaine Waggott highlights the importance of reducing airborne pathogenic aerosol in the wake of COVID-19 and considers the potential infection risks in hospital facilities.
In the wake of COVID-19, the importance of reducing airborne pathogenic aerosol has been the subject of very high levels of public, media and Government attention. Unacceptable levels of sickness and deaths have become associated with poor hand hygiene, close contact with infected people and inadequate cleaning. In many countries, initiatives addressing education, cleaning and audit, together with compulsory reporting of infections, have brought about benefits leading (in some cases) to the reduction of headline rates of infections, such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. difficile) and Legionnaires’ Disease. It is readily accepted now, that a common mode of transmission is contact between the patient, the staff and the environment. Inappropriate hand hygiene practice has been identified as a significant contributor to numerous outbreaks. Several studies have shown the impact of improved hand hygiene on the risk of healthcare-associated infection and multi-resistant pathogen cross-transmission. To date, most studies have focused on methicillin resistant Staphylococcus aureus
Bacteria present on human skin can be considered as belonging to one of two groups: resident and transient flora. Transient flora colonises the superficial layers of the skin. It has a short-term persistence on skin, but a high pathogenic potential. It is usually acquired by healthcare workers during direct contact with patients or contaminated environmental surfaces adjacent to the patient and is responsible for most healthcare-associated infections and spread of antimicrobial resistance resulting from cross-transmission. Resident flora is attached to deeper skin layers and has a low pathogenic potential unless introduced into the body by invasive devices. It is also more difficult to remove mechanically. Hand hygiene decreases colonisation with transient flora and can be achieved either through hand washing or hand antisepsis.1
Studies have shown that outbreaks can be reduced by improved hand hygiene compliance and better cleaning of the environment. Transmission of infection by the air has often been less well investigated, leading sometimes to a complacency in this mode of transmission
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