The game-changing research for HAI prevention

We all know the importance of good hygiene in preventing infections, but, until now, nobody has been able to quantify the impact individual hygiene measures have — not just on infection acquisition rates, but on the broader healthcare system.

Professor Brett Mitchell of Avondale University said the major shortage of research in this area matters, because it leaves health services unclear on how to prioritise training, resource allocation and everyday practice.

“For example, we know that substandard urinary catheter hygiene is linked to urinary tract infections (UTIs), but to what extent? Also, how much do catheter-induced UTIs cost financially in terms of antibiotics, hospital stays and GP consultations; and more broadly in terms of patient wellbeing?” Mitchell said.

“If the answer to these questions is ‘very little’, then channelling significant resources into improving catheter practice may not be appropriate — there could be other more impactful infections that warrant this investment. By contrast, if the answer is on the top end of the scale, you could consider more resource-heavy measures.

“Health services have a finite budget, so ‘over-investment’ in one area may mean that significant gains or actions in other areas are missed.”

Risk-benefit analyses

The lack of research surrounding hygiene protocols also makes it hard to perform risk-benefit assessments for infection prevention measures that carry risks of their own.

Having appropriate data around infection risks, such as UTI, can allow decision-makers to weigh up these risks more accurately and invest in areas of greatest need.

“For clinicians who have ever increasing workloads, understanding what practices are most important will help inform their priorities. Strong evidence to inform decision-making is therefore critical for both clinicians and decisions-makers,” Mitchell said.

Incoming evidence base

To address issues like this, Mitchell is building a ‘long overdue’ evidence base for the prevention of hospital acquired infections (HAIs), after being awarded a grant from the Commonwealth Health Minister in 2022.

Currently, HAIs are a major sticking point in Australian healthcare delivery, with more than 165,000 acquired each year. While some are relatively harmless, others have high mortality rates, including pneumonia, which is among the most common.

Before lockdowns, pneumonia (and influenza) were the ninth leading cause of death in Australia, claiming 4124 lives in 2019. Immunocompromised people are especially vulnerable to it.

Mitchell points out that, despite its prevalence, little is understood about which protocols — or lack thereof — play the greatest role in pneumonia transmission within medical settings.

“Generally speaking, practitioners know that good oral hygiene can prevent pneumonia, as it stops pathogens getting into the upper respiratory tract. However, we don’t know exactly what ‘good’ oral hygiene means. There isn’t sufficient high-quality research to inform guidelines for things like how frequently practitioners should be cleaning patients’ teeth, or what dental products work best, for example,” he said.

“We need to build data around this, so that we can quantify the problem and provide an evidence base for the solution,” he added.

Prevention not cure

It is not just people contracting HAIs that bear the health consequences of their existence. Often requiring antibiotics, the treatment of HAIs is contributing to our antimicrobial resistance (AMR) epidemic on a large scale.

AMR — where viruses, bacteria, fungi and parasites learn to outsmart the drugs designed to kill them — is claiming an increasing numbers of lives each year.

Currently, 700,000 people die globally from infections that are not responding appropriately to treatment and this is expected to reach 10 million by 2050. The World Health Organisation has cited AMR as one of the top 10 public health threats currently facing humanity.

With greater pressure on healthcare professionals to minimise the use of antibiotics, Mitchell believes tackling HAIs at the root is important.

“My research looks at the prevention of HAIs as I believe this is where one focus should be. If infections are occurring and the treatment options are losing their efficacy, then it makes sense to channel more effort into prevention research,” he said.

Long overdue data

While Mitchell’s research into HAI prevention is now well underway, he does not understand why the area has been neglected for so long by researchers.

“It’s concerning that one of the greatest health concerns of our time is so under-explored,” he said.

“While infection prevention may seem like a simple area, a commonsense or intuitive approach clearly isn’t working — as reflected in the high numbers of HAIs acquired each year.

“Also, while we often have a good theoretical rationale for doing various hygiene measures, we don’t have high quality designed studies that demonstrate they make a difference.

“I hope my research will change this and help practitioners channel resources into measures that actually work and have the greatest impact.”

Mitchell’s study will be completed in 2027.

Image credit: iStockphoto.com/sorbetto