Using “health outcomes” as the basis for developing effective and sustainable hygiene interventions – is 2019 the time for a rethink?

This is a guest post by Prof Sally Bloomfield…

For many years, “5 log reduction” (LR) has been the gold standard for disinfectant efficacy despite absence of dose:response data linking it to clinical outcomes.  The family of EN tests now used to support claims for disinfectant products has its origins in the European Suspension Test (5LR, 5 mins, 5 test organisms) where 5 LR was probably chosen because it is the limit of sensitivity in an assay where, traditionally, the initial bioburden is 108 colony forming units.  For soap, detergent or dry wiping procedures, until recently their effectiveness has been assumed – possibly on the basis that they produce visible cleanliness? It is only recently that we have had access to efficacy data based on lab models.  A trial of EN 1699 handwashing test showed a mean 2.76 LR when hands contaminated with E .coli are washed with soap.

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Reflections from Infection Prevention 2015 Part III: Thinking outside the box

think outside the box

For the third and final installment of my blog-report from Infection Prevention 2015, I thought I’d cover some of the more innovative approaches in and around the IPC sphere:

Part I: Beating the bugs

Part II: Improving the systems

Part III: Thinking outside the box

New technology to improve hand and environmental hygiene

I for one am pretty sick of seeing unrealistically high levels of hand hygiene compliance being reported from peer-to-peer manual auditing approaches. One way to get more realistic compliance data is through automated approaches to hand hygiene compliance, reviewed here by Drs Dawson (Warwick) and Mackrill (Imperial College London), who also presented their findings at the conference, and by another group here. Drs Dawson and Mackrill considered issues around product usage, self-reporting, direct observation, perceptions of technology (often viewed, unhelpfully, as a ‘silver bullet’), and staff perceptions of need and benefit. They divided the technology into those that monitored product usage, surveillance systems that monitored individual performance, and systems that monitored both product usage and individual performance. Although automated surveillance systems will always be imperfect and involve a degree of inference, would you rather monitor the 5 moments sporadically / badly or have robust measurements of a smaller number of moments? Automated surveillance methods will not replace manual audits – at least for now – but it’s time to take a long hard look at what is available.

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