Infection control: lessons learned from COVID-19

When infection control strategies aren’t watertight, bacteria, viruses, fungi and parasites can spread like wildfire.

According to WHO statistics, one in 10 patients globally acquire an infection in their receipt of health care, and contagions cause up to two-thirds of deaths among hospital-born infants.

Measures like hand sanitisation, personal protective equipment (PPE) and physical distancing can offer a firebreak from virus or bacteria transmission — but not an infallible one.

A laxly implemented protocol, a clinical governance blind spot or a simple human trip-up can create leaks in any infection control strategy. In the context of a pandemic, this can have a catastrophic fallout.

Rachel Jones (name changed for privacy) recently stayed at a quarantine hotel in Sydney on her return from San Francisco. She described the infection control measures at the quarantine facilities as “stringent”, but probing further exposed some weaknesses in the overarching strategy.

“It was strange because some of the staff my partner and I encountered on our transit to the hotel weren’t wearing PPE,” Rachel said in an interview with Hospital + Healthcare.

“Police escorts and airport staff for example weren’t wearing masks or gloves. We thought this was strange given the potential need for physical contact these professionals may need to have — either with us or our possessions,” she added.

It may be easy to recognise the holes in this virus containment strategy, but often these weaknesses go unnoticed, particularly when there are multiple lines of accountability in a healthcare delivery setting — in this case, military, police and private-sector workers.

“Additionally, we were denied vacuum cleaners at the hotel,” Rachel continued.

“I totally understand the logic. If everyone is handling the same machine then there is a risk of cross-contamination. However, it did mean that there were a lot of skin cells and hairs all over the floor. So much so that we used our old towels to try and scoop up some of the floor dirt,” she said.

A secondary concern is the effect this appeared to have on Rachel’s immune system.

“I developed impetigo on around day five of my quarantine stay and I’m convinced this is a result of the conditions we were living in. I have never had impetigo in the past, nor do I have any other skin conditions,” Rachel continued.

“We were jet lagged, stressed, devoid of exercise, sunlight and the health-conscious diets we would normally choose to eat. We felt disgusting by the end of our stay.”

Had Rachel’s contagion been more serious, it may have impacted her ability to ward off COVID-19, said Professor Brian Oliver of the University of Technology Sydney (UTS). Compounding this is the heightened possibility of COVID-19 exposure, given that viruses and bacteria share many of the same transmission properties.

“A weakened immune system can change the course of a respiratory viral infection from a relatively minor common cold to a severe infection, as we have observed throughout the COVID-19 pandemic,” Professor Oliver said.

“In aged-care facilities, where a large portion of people are immunocomprised, the virus has had devastating effects. In schools, where people normally have functioning immune systems, the opposite has occurred — with the virus instead emerging as a more transient, upper-respiratory infection.”

COVID-19 aside, Rachel’s experience of impetigo could have been more serious if she had an underlying health condition. Episodes of acute rheumatic fever, for example, are believed to be triggered by impetigo.

A further clinical governance oversight was the failure to follow up with Rachel and her partner in the aftermath of their quarantine stay.

“Had I not taken the initiative to let the hotel know I’d contracted impetigo at the facilities, they’d have been none the wiser,” she said.

“I’m assuming they sterilised the facilities after I told them, but I wouldn’t know for sure if they did. Judging by the condition of the carpet when we entered, it didn’t seem as though the premises were being thoroughly sterilised, from top to bottom, as a matter of course.”

Professor Oliver said, in order to be watertight, infection control measures at quarantine facilities must be comprehensive, as well as pre-empting situational factors.

“If people are trapped in a quarantine facility for two weeks, then it’s likely they might start exercising on the floor because they have no other means of doing so. They may also get their towels mixed up with their partner’s or family members’, since hotel towels tend to be uniform in colour.

“If we are really serious about preventing spread of viruses and bacteria, then an infection control strategy must consider these sorts of factors.

“Thankfully, COVID-19 appears to be quite easy to destroy through sterilisation. Bacteria, however, can be far more stubborn, and it could be that an underlying bacterial infection makes somebody more vulnerable to the COVID-19 virus.”

Image credit: ©stock.adobe.com/au/ivector