Healthcare organisations, researchers and solutions providers are making tremendous progress in the ongoing fight against healthcare-associated infections (HAIs). One of the latest approaches is to focus on disinfecting surfaces touched most frequently by staff and patients, rather than trying to clean all surfaces all the time. Known as Targeted Moments of Environmental Disinfection (TMED), its aim is to maximise outcomes with better use of time and resources.
The threat from infections caused by antimicrobial resistance is real and present. The most recently available statistics covering England are for 2018/9. There were 83,000 cases of E. coli, Klebsiella spp., P. aeruginosa, MRSA and MSSA bacteraemia, and clostridium difficile (C.diff). These affected 73,000 patients and resulted in more than 12,700 patient deaths. That's around one in six or 16 per cent of infection-cases.
The UK Government has outlined a five-year action plan as part of its wider 20-year vision for tackling antimicrobial resistance. A key target is to reduce drug-resistant infections by 10% by 2025. Other targets include reducing antibiotic use in humans by 15% and reducing gram-negative blood-stream-infections. Stakeholders including hospitals, community health facilities and care homes must act and coordinate their contributions to meet these objectives.
We have covered the link between infection rates, surface disinfection and hand hygiene before. TMED builds on the ?five moments of hand hygiene? promoted by the WHO and other agencies with great success over many years.
Studies suggest that somewhere between 20 and 40 per cent of HAIs arise when a healthcare worker passes on pathogens from one patient to the next. Pathogens can remain on frequent touch surfaces and survive for extended periods, sometimes months. Anyone who touches these surfaces can pass the pathogens on to other people. There is a higher risk of acquiring certain pathogens if a room was previously occupied by a colonised or infected patient. All of this helps explain why effective hand hygiene and surface disinfection are important when aiming to prevent infections.
There is a growing realisation that even with high levels of compliance, the tried and tested methodologies can be improved. It is always important to clean surfaces likely to be touched by patients or staff. But people will probably touch some surfaces more than others during the day. Under these circumstances, the idea of once-a-day disinfection could be inadequate and put patients and staff at increased risk. Studies show that nurses, medical staff, clinical and non-clinical staff and visitors touch each bed rail up to 250 times every day.
With TMED the objective is to adopt a more focused approach. All areas are cleaned and disinfected daily, as before. But extra attention is given to frequent touch and high-risk surfaces. In practice, this means cleaning items such as bed rails, table-tops and light switches more often. Going further, studies suggest that additional disinfection at the point of care (where three elements come together: patient, healthcare worker and care or treatment involving contact with the patient or their surroundings) will help reduce infection rates. This means the five most critical moments for disinfection are:
- Before placing a food/drink on an over-bed table
- After any procedure involving faeces or respiratory secretions within the patient bed space
- Before/after any aseptic practice (wounds, lines, etc.)
- After patient bathing (within bed space)
- After any object used by/on a patient touches the floor
Targeted Moments of Environmental Disinfection aims, in effect, to disinfect on demand. This means cleaning hands and disinfecting surfaces before and after each of these critical moments. Put another way, it is everyone's job to disinfect, but it is not everyone's job to disinfect everything every time. To be effective these processes must be simple and accessible so that they can be completed whenever needed. They must also be acceptable to healthcare workers and visitors. This means, for example, that disinfectants must be non-hazardous and non-irritating. Finally, processes must be fast because anything that adds time or becomes a burden is less likely to be done.
