Decon

Healthcare Associated Infections

• Central Line Associated Blood Stream Infection (CLABSI)
• Catheter Associated Urinary Tract Infection (CAUTI)
• Surgical Site Infection (SSI)
• Ventilator Associated Pneumonia (VAP)

CLABSI

A central line (also known as a central venous catheter) is a catheter (tube) that doctors often place in a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests. It is close to the heart and can remain in place for weeks or months and commonly used in intensive care units. CLABSI occurs when bacteria or viruses enter the bloodstream through the central line. Patients who get a CLABSI have a fever, and might also have red skin and soreness around the central line.

CAUTI

It is the most common HAI. According to CDC, 75% of UTI acquired in hospitals are because of urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine.

SSI

A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.

VAP

Ventilator-associated pneumonia is a lung infection that develops in a person who is on a ventilator. A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the neck. An infection may occur if germs enter through the tube and get into the patient’s lungs.

Healthcare Settings

CDC recognizes broadly four kinds of healthcare settings - acute care hospitals, critical access hospitals, inpatient rehabilitation facilities and long term acute care hospitals. CDC provides statistical reports and analysis of the HAI incidences in each of these settings where acute care hospitals show the highest number of incidences primarily from CLABSI and CAUTI.

Organisms in healthcare setting

• Acinetobacter: Bacteria responsible for 80% of the reported infections
• Burkholderia cepacia: Antibiotic resistant bacteria pose more risk to hospitalised patients with weak immune system or chronic lung disease
• Candida auris: Antifungal drug resistant yeast posing risk to hospitalised patients
• Clostridioides difficile: Bacteria causing diarrhea and inflammation of colon
• Clostridium Sordellii: Rare bacteria capable of causing pneumonia, endocarditis, arthritis, peritonitis, myonecrosis and rarely sepsis
• Enterobacteriaceae: Highly antibiotic resistant bacteria, generally a part of human gut bacteria posing risk to patients using ventilators, urinary catheters or IV catheters
• Gram-negative bacteria: Bacteria resistant of many antibiotics cause pneumonia, bloodstream infections, wound or surgical site infections and meningitis
• Hepatitis: Virus causing inflammation of liver primarily as a result of unsafe injection practices, reuse of needles, fingerstick devices, syringes, and other lapses in infection control.
• Human Immunodeficiency Virus: HIV destroys blood cells called CD4+ T cells, which are crucial to helping the body fight disease. This results in a weakened immune system, making persons with HIV or AIDS at risk for many different types of infections. Transmission of HIV to patients while in Healthcare Settings is rare. Most exposures do not result in infection.
• Influenza: Virus primarily occuring in community based settings and occur in healthcare settings if it is also prevalent in the community
• Klebsiella: Bacteria causes pneumonia, bloodstream infections, wound or surgical site infections and meningitis. They are normally found in human intestines and stool. It occurs in hospitalised patients who are already sick and receiving care for other conditions
• Methicillin-resistant Staphylococcus aureus: Life threatening bacteria resistant to certain antibiotics pose risk to hospitalised patients
• Nontuberculous Mycobacteria: Bacteria pose risk to patients with lung disease or depressed immune system
• Norovirus: Virus causes inflammation of the lining of the stomach and intestines, causing an acute onset of severe vomiting and diarrhea. Norovirus illness is usually brief in people who are otherwise healthy. Young children, the elderly, and people with other medical illnesses are most at risk for more severe or prolonged infection. Like all viral infections, noroviruses are not affected by treatment with antibiotics.
• Pseudomonas aeruginosa: Bacteria found widely in the environment; the most common type causing infections in humans is called Pseudomonas aeruginosa. Serious Pseudomonas infections usually occur in people in the hospital and/or with weakened immune systems.
• Staphylococcus aureus: Bacteria does not cause any harm most of the time. These infections can look like pimples, boils, or other skin conditions and most are able to be treated.
• Mycobacterium tuberculosis: Bacteria causes tuberculosis, is very contagious, likely to spread in healthcare facilities if the patient is not isolated or treated and is difficult to treat.
• Vancomycin-intermediate Staphylococcus aureus and Vancomycin-resistant Staphylococcus aureus: Bacteria prone to patients with diabetes and kidney disease
• Vancomycin-resistant Enterococci: Bacteria present in human intestines and female genital tract and are often found in environment. They sometimes cause infections and most of which occur in hospitals.

Hospital Cleaning Areas

Areas with risk of contamination include patient care areas, medication preparation areas and bathrooms. Current cleaning frequency is once daily with exceptions for prompt cleaning in certain situations.

Research Papers

• Microbiological Sensing Technologies: A Review

Sensing Technologies

• Lab on a chip
• Biosensors
• Quorum sensing: cell-to-cell communication system that allows bacteria to act in a coordinate manner. This mechanism is based on the synthesis, release and detection of signal molecules, called autoinducers (AI), whose increase is in a cell-density dependent mode. When AI reaches a threshold concentration due to an increase in bacterial population, the autoinducer activates a transcriptional regulator that controls gene expression of genetic elements under QS regulation.Reference

Challenges

Most of the tech is research based, with limited and restricted instrumentation. Development is expensive. Turnaround time and scope of use vary from paper to paper.

Decontamination Strategies

• Ventilation
• Heating
• Air conditioning
• Humidifiers systems
• High efficiency particulate air (HEPA)
• Ultra-low particulate air (ULPA) filters
• UV lamps and sanitizers (aerosol)