Thoughts on hospital and nursing home infection prevention in the time of COVID-19

The entire world is watching in horror as a mutated strain of coronavirus spreads like wildfire around the globe. The ultimate toll in mortality and long term morbidity will be massive. However, there will be many positive outcomes as a result of all of the awfulness. Human ingenuity will lead to innovation. Humans will adapt with new behaviors. Organizations will adapt to become more resilient.

One particular area that is primed for innovation is the approach to infection prevention in hospital and elder care settings. Hand hygiene and it’s importance to stopping transmission has moved to front and center with the threat of COVID-19. However, while epidemiologists have had the spotlight on hand hygiene since Semmelweis over 100 years ago, real world changes have lagged behind recommendations.

As such, hospital acquired infections in the pre-COVID-19 world already totaled 2 million preventable infections per year and nearly 100,000 deaths. While the entire health care community agrees on the importance of saintly levels of hand hygiene, research has repeatedly shown hand hygiene behavior to be grossly sub-optimal in both hospital and nursing home settings.

COVID-19 has magnified the issue of close contact transmission, with hospitals and nursing homes being the most fertile grounds for spread.

The message has made its way to Marc Andreessen of venture capital firm Andreessen Horowitz. It astounds him that the problem of inadequate hand hygiene in healthcare facilities remains largely unsolved. The science is clear on the importance of hand hygiene in stopping the spread of pathogens. Even more so in healthcare settings like hospitals and nursing homes. Yet, we are constant reminded of the fallibility of humans.

We are more likely to wash or disinfect when there is some threat to ourselves. The higher the ick factor, the higher the probability that we wash or sanitize. Health care workers are most likely to wash after contact with a patient, and especially if they have come in contact with bodily fluids. However, as evidenced by the easy and rapid spread of this new coronavirus, hands that look clean, can be smothered in dangerous bacteria and viruses. Without some rigorous external system of reminders to ensure high frequencies of hand hygiene, hand hygiene events get missed, either forgotten or ignored in the rush of the workflow.

The casualty of any lapses has generally been the most vulnerable. Those with trauma, post-surgical wounds, on chemotherapy, requiring intubation or catheters have their usual immunological defenses impaired. COVID-19 has magnified this vulnerability to extreme levels.

So, what to do? Dangerous pathogens lie everywhere, on every surface. Environmental disinfection procedures reduce the overall exposure risk, but studies show that even scorched earth surfaces are quickly repopulated with viruses, bacteria and mold spores.

Electronic monitoring systems can increase the frequency of hand hygiene events. The drawback with most of these systems is that there is minimal context regarding when hands are washed in relation to any contact with a patient and/or their environment.

SafeContact is a platform being designed to optimize hand hygiene behavior in hospitals and nursing homes. Computer vision enabled smart wearables for HCWs and visitors not only monitor hand hygiene and contact events, they also act as a hand hygiene coach for each individual, providing reminders in real time. By ensuring high levels of hand hygiene 24/7, whether anyone is looking or not, the chain of transmission is interrupted repeatedly and the vulnerable are insulated from infection.

The warnings of Semmelweis have led to half efforts for more than a century and millions suffer injury or death every year around the world. It is possible that the brutal impacts of COVID-19 may have the silver lining of finally bringing hand hygiene out of the dark ages and into the 21st century. As this happens, SafeContact is the one truly modern platform that can lead to objective improvements in safety for our most vulnerable.

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