Major update to infection prevention and control guidelines

The National Health and Medical Research Council (NHMRC) has released the 2019 edition of the Australian Guidelines for the Prevention and Control of Infection in Healthcare, marking their first update since 2010.

According to the NHMRC, there are over 165,000 healthcare associated infections in Australian acute healthcare settings every year, making them the most common complication for hospital patients.

To combat this, the NHMRC, in collaboration with the Australian Commission on Safety and Quality in Health Care, has updated the Guidelines based on the latest national and international evidence.

NHMRC CEO, Professor Anne Kelso AO, said: “The Guidelines are one of NHMRC’s most frequently requested resources. They are used every day by clinicians in all healthcare environments to help develop protocols and inform policy at the state and territory level.

“The Guidelines provide a nationally accepted approach to infection prevention and control, focusing on core principles and priority areas for action. They provide a basis for healthcare workers and healthcare facilities to develop local protocols and processes for infection prevention and control.”

While users will immediately notice the Guidelines’ move to an interactive, online platform — where information can be updated in real time and new information can be quickly and easily identified by coloured labels — there are more changes than meets the eye.

Key changes in the new Guidelines

A patient-centred approach

One such change is the recommendation for a patient-centred approach. According to the Guidelines, healthcare facilities need to take an organisational approach to involving patients in their own care.

This includes teaching patients how to prevent spreading infections in healthcare settings, encouraging them to practise hand hygiene, involving them in decision-making processes and empowering them to ask questions.

Emerging disinfection methods

While new disinfection technologies and strategies are being developed, there is currently insufficient evidence to support their efficacy or routine use for infection prevention and control. New disinfection technologies include hydrogen peroxide vapour, ultraviolet light and antimicrobial surfaces — such as copper, silver, light-activated antimicrobial coatings and surfaces with altered topography to prevent bacterial growth.

The Guidelines suggest that “hydrogen peroxide vapour and ultra-violet light may be considered in high risk settings and during outbreaks when other disinfection options have been exhausted”.

Additionally, any emerging disinfectants should always be used on top of standard cleaning practices.

Chlorhexidine use

While the 2019 Guidelines still advocate the use of chlorhexidine in hand hygiene, oral care or skin prep solutions, impregnated dressings and settings with at-risk populations, they suggest that healthcare workers should consider limiting its use — as long as it does not impact patient health. This is to prevent bacterial chlorhexidine resistance or adverse reactions in patients.

Antimicrobial resistance

Antimicrobial resistance has been identified as a key global public health priority by the World Health Organization. As a result, the Guidelines suggest healthcare facilities use surveillance systems to record the presence of all multi-resistant organisms (MROs).

While most of the guidelines for MRO management remain the same, healthcare professionals should be aware of additional recommendations, such as advice to separate patients infected or colonised by MROs of the same species but with different resistance mechanisms or phenotypes, rather than cohorting them. The Guidelines also recommend giving priority to patients requiring airborne precautions when single isolation rooms are limited, unless the Infection Control Team suggests otherwise.

Norovirus management

The 2019 Guidelines now suggest that cohorting patients with known or suspected norovirus in closed bays may be a more efficient way to manage norovirus than closing an entire ward or unit. However, if this method is used, it needs to occur promptly, within three days of the first patient becoming ill and in conjunction with other infection control strategies.

Additional changes

Changes have also been made in relation to the replacement of peripheral intravenous catheters, immunisation for healthcare workers, clinical handover, wound management and infection control basics, according to the NHMRC’s summary.

In terms of wound management, the Guidelines state that using antimicrobial sutures can help reduce surgical site infection (SSI) rates.

Ethicon, part of the Johnson & Johnson Medical Devices group, provides triclosan-coated sutures in Australia and “strongly supports” the Guidelines’ updates.

“These Guidelines provide a unique opportunity for Australian healthcare facilities to adopt proven evidence-based practices to address SSI, a common and costly complication to the Australian healthcare system that can lead to longer hospitalisation for patients and in some cases even death,” they said.

The Guidelines also now flag protozoa as a cause of healthcare associated infections and highlight six elements of infection rather than three — being the causative agent, reservoir, portal of exit, means of transmission, portal of entry and a susceptible host.

This list is by no means exhaustive and healthcare professionals should review the updated Guidelines to ensure their knowledge is up to date and in line with best practices.

The 2019 Guidelines can be found via MAGICapp or the NHMRC website.

Image credit: ©stock.adobe.com/au/Kheng Guan Toh