Infection prevention and control in virtual healthcare settings

Shortly after welcoming the arrival of her second child Josh, Kelly Evans’* blissful ‘post-birth bubble’ burst, much earlier than she had imagined.

Less than 24 hours after returning home from hospital with her newborn, the Sydney-based mother noticed her two-year-old daughter, Milla, had white spots on her tongue.

With doctors suspecting hand foot and mouth disease — a condition that can be dangerous for neonates — her eldest was forced to quarantine at her grandmother’s house for the 10 days that followed.

“It wasn’t the homecoming experience we had been planning, but thankfully the kids had not been in physical contact and there were no signs of the disease having spread.

“Like any two year old, Milla can be quite boisterous and we were careful not to let her handle her little brother right away. Thank goodness we didn’t as a more serious outcome could have occurred,” she recalls.

While Ms Evans is generally happy with the post-hospital care she received, she believes more effort is needed to educate patients on infection prevention and control (IPC) — particularly when managing health care at home, without the watch of professionals.

“I received a lot of support upon my discharge from hospital, but I do feel tips around infection prevention were somewhat lacking. The facts I received also contradict things I’ve read online,” she said.

Stopping the spread

While best practice for IPC does exist, the Australian Commission on Safety and Quality in Healthcare notes that there is often “a gap between what is known to be best practice, and the care that is delivered”.

“Despite the fact that there are guidelines and strong evidence regarding best practice, hand hygiene compliance is not optimal, preventable infections occur, and antimicrobial resistance is an increasing issue,” it notes in a recent report.¹

Indeed, every year in Australia 180,000 patients suffer healthcare-associated infections (HAIs),¹ resulting in prolonged antibiotic usage, increased patient morbidity and reduced quality of life.

HAIs are also costly, with one state finding that excess costs linked to just 126 surgical-site infections totalled more than $5 million.¹

Within virtual health care, the need for epidemiological rigour is heightened — as demonstrated by the COVID-19 pandemic, in which thousands of COVID-19 patients throughout NSW have been treated from their homes.

Kathy Dempsey, NSW Chief Infection Prevention and Control & Healthcare Associated Infections Advisor at the Clinical Excellence Commission (CEC), believes that, while the rise of at-home care is generally a positive development for patients and IPC, there are always opportunities to improve patient safety across the virtual care ecosystem.

“Quite often in the home, infection risks are easier to mitigate against as you don’t have other patients in close proximity — nor lots of physical interactions with workers. That said, we shouldn’t get complacent,” she said to Hospital + Healthcare.

“Homes can introduce new risks that aren’t as prevalent in hospitals — pets, shared washing and eating facilities, and reduced medical surveillance, for example. While these risks are tightly managed by clinics, there is still potential for errors to occur.”

Although a barrage of information is typically handed out when discharging patients from hospital or treating them at home, care must be taken to ensure any facts provided are properly tailored.

“There is a lot of conflicting information online, which can be confusing to patients,” Dempsey said. “A lot of infectious disease physicians, for example, will tell you that letting kids get dirty is part of building immunity. It most certainly is, but we need to be clear with people that a lack of sterilisation is not suitable in some situations. You certainly wouldn’t want to expose a pre-vaccinated newborn to chicken pox, for example; nor a vulnerable adult to a zoonotic virus.”

Indeed, Ms Evans says she was not aware that a different approach is needed when it comes to protecting against viral transmission. Like a large portion of Australian parents, she subscribes to the ‘hygiene hypothesis’ and avoids over-sterilising her home. This theory is based on a growing body of research showing that microbial exposure in early life can prevent conditions, including asthma and allergies.²

“Normally, I’m quite comfortable letting my kids eat stuff that they have just dropped onto the floor or put toys in their mouth that haven’t been sterilised — within reason of course. I wasn’t aware that I needed to stop doing this with a newborn in the house though,” she said.

A multimodal approach

To achieve sustained behavioural change in relation to IPC interventions, the World Health Organization says multimodal strategies are the best way forward. Among the strategies it suggests are active surveillance and ongoing evidence-based education.³

Dempsey agrees that this approach is the best way to cover all bases.

“Knowledge and surveillance will be the sharpest tools in any virtual IPC program,” she concluded.

*Name changed for privacy.

References

1. https://www.safetyandquality.gov.au/sites/default/files/migrated/1.2-Healthcare-Associated-Infection.pdf
2. https://www.nature.com/news/early-exposure-to-germs-has-lasting-benefits-1.10294
3. https://www.who.int/infection-prevention/tools/core-components/facility-manual.pdf

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