25/07/2024
Japan on red alert for streptococcal toxic shock syndrome
Indoor Air Quality and Nosocomial Infections: What are the Consequences in Healthcare Facilities and How Can They Be Prevented?
11 June 2024
Nosocomial infections, also known as healthcare-associated infections, are a significant issue for hospitals and clinics. According to the WHO, they affect nearly 1.4 million people globally, and in France, 1 in 18 patients annually, according to Santé Publique France. However, some of these infections, especially those transmitted through the air, could be prevented. What can we learn from the COVID-19 pandemic? What are the costs associated with these infections? What preventive measures exist to combat them? How can we prepare for a new pandemic? NatéoSanté provides insights.
What Role Does Air Quality Play in the Transmission of Nosocomial Infections?
Nosocomial infections can be transmitted in two main ways:
- Directly related to the care provided in the hospital: especially during surgical procedures in operating rooms (endogenous infections).
- Airborne transmission: This type of cross or exogenous infection is more common during epidemic episodes, particularly in winter.
Air quality plays a crucial role in the transmission of certain nosocomial infections. Due to the high concentration of people, hospitals and clinics are environments where microorganisms (bacteria, viruses, pathogens, germs, etc.) can easily proliferate. Every day, hundreds of sick patients, staff (caregivers, maintenance workers, etc.), and visitors intersect in healthcare facilities. The main transmission risks lie in microdroplets: simply speaking and breathing generates droplets, the lightest of which remain suspended in the air and can be inhaled by others.
Every day, many people cross paths in healthcare facilities.
Au quotidien, ce sont en effet des centaines de patients malades, personnel (soignants, agents d’entretien, de maintenance, etc.) et visiteurs externes qui se croisent dans les établissements de santé.
Les principaux risques de transmission résident dans les microgouttelettes : le simple fait de parler et respirer génère des gouttelettes, dont les plus légères persistent dans l’air, en suspension. Elles sont donc susceptibles d’être respirées par d’autres sujets.
Major Infections Contracted During a Hospital Stay
Aspergillosis
Among the most frequent nosocomial infections is aspergillosis, caused by the fungus Aspergillus. Aspergillosis is a pulmonary infection that mainly occurs in immunocompromised patients, such as those with cancer, organ transplant recipients, or those on immunosuppressive treatments.
Aspergillus spores, present in the air, can be inhaled and develop in the lungs, causing severe infections that can be difficult to treat. Hospital environments, where patients are often vulnerable, are particularly at risk for the spread of this infection. In 2011, the Pasteur Institute reported 50,000 annual cases of invasive aspergillosis in Europe. Effective air filtration systems and rigorous infection control practices are essential to minimize this risk.
The Return of Tuberculosis in Developed Countries
Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, is experiencing a concerning resurgence in some developed countries, according to National Geographic. TB is a serious infectious disease that primarily affects the lungs but can also impact other parts of the body.
While often associated with developing countries, factors such as drug resistance, international mobility, and vulnerable populations (e.g., the homeless and people living with HIV) have contributed to its return in developed countries. TB can spread in hospitals through inhalation of droplets containing bacteria emitted by an infected patient, highlighting the importance of strict infection control and monitoring in healthcare facilities.
The Return of Whooping Cough in France
Whooping cough, also known as pertussis, is a bacterial respiratory infection caused by Bordetella pertussis. According to a Santé Publique France article published on April 18, 2024, despite vaccination significantly reducing the incidence of whooping cough, the disease has been making a comeback in France in recent years.
This resurgence can be attributed to factors such as waning vaccine immunity over time and insufficient vaccination rates. Whooping cough is particularly dangerous for infants and young children but can also affect adults. Hospitals need to be vigilant against this threat, as whooping cough can spread quickly in environments where many people interact and where patients may be particularly vulnerable.
Quels enseignements tirer de la crise de la Covid-19 sur les infections nosocomiales ?
The Evolution of Nosocomial Infections Following the COVID-19 Crisis
Since the onset of the COVID-19 pandemic, this disease has become the primary nosocomial infection in France.
In July 2021, Hospimedia reported that "over 60,000 people contracted COVID-19 in French healthcare facilities, while other nosocomial infections have become less frequent since the start of the pandemic."
Comment l’expliquer ? Comme le détaille Santé Publique France dans son bulletin du 19 novembre 2020, les infections sont très souvent dues au relâchement des gestes barrière, notamment le retrait du masque, que ce soit entre les hospitalisés et les médecins, de patient à patient (problème des chambres doubles notamment), par les proches, ou encore lors des pauses du personnel soignant. D’après SPF, ce dernier cas serait à l’origine de 20% des infections.
The transmission of SARS-CoV-2 occurs mainly through the air.
The WHO highlighted in a July 2020 note that "respiratory droplets have a diameter greater than 5-10 microns. When they evaporate, some generate microscopic aerosols with a diameter less than 5 microns, which remain suspended indoors."
Dans son bulletin du 26 mai 2023, Les Échos reporte qu'en excluant les Covid nosocomiaux, la proportion de patients infectés a augmenté de 7,5 % en 2023. Bien que cette augmentation soit moins prononcée que celle observée en 2017, la question des infections nosocomiales demeure une préoccupation majeure pour les systèmes de santé. Notamment, quatre types de bactéries, dont Escherichia coli et le staphylocoque doré, sont responsables de près de la moitié des cas d'infections nosocomiales à l'hôpital, une proportion pratiquement inchangée depuis 2017.
Selon l'ECDC (Centre européen de prévention et de contrôle des maladies), plus de 3,5 millions de cas d'infections nosocomiales surviennent dans l'Union européenne et l'Espace économique européen, entraînant plus de 90 000 décès chaque année. De manière alarmante, ces maladies nosocomiales constituent 71 % des cas d'infections dues à des bactéries résistantes aux antibiotiques, incluant des souches résistantes aux antibiotiques. Jusqu'à 50 % de ces infections pourraient être évitées grâce à la mise en œuvre de mesures préventives et de contrôle des infections dans les établissements de soins de santé, soulignant ainsi l'importance cruciale de ces actions.
Economic Consequences of Nosocomial Infections
Les infections nosocomiales entraînent des coûts financiers considérables, notamment en raison de l’allongement des séjours hospitaliers, des examens médicaux supplémentaires et des soins nécessaires à la surveillance et au traitement de ces infections.
Nosocomial infections lead to considerable financial costs, mainly due to prolonged hospital stays, additional medical examinations, and the necessary care for monitoring and treating these infections. A report from the OPEPS (Office Parliamentary for Health Policy Evaluation) offers an analysis based on several international studies conducted before the pandemic.
The conclusions are as follows: "Applying an average additional cost range of 3,500 to 8,000 euros per infection to the 750,000 annual nosocomial infections results in expenditure ranging from 2.4 to 6 billion euros. Thus, a 10% reduction in the number of infections would lead to savings of 240 to 600 million euros."
How to Prevent Airborne Nosocomial Infections in Healthcare Facilities?
Surveillance Obligations in Hospitals and Clinics
The importance of protocols implemented by hygienists in hospitals and clinics is crucial for preventing nosocomial infections and ensuring the safety of patients and staff. Hand hygiene, surface hygiene, and air hygiene are essential components of these protocols. For example, hand hygiene is a simple yet highly effective measure to reduce the transmission of pathogens. Similarly, surface and air hygiene helps limit the spread of infections in the hospital environment.
Since 1999, the RAISIN network (Réseau d’Alerte, d’Investigation et de Surveillance des Infections Nosocomiales) has overseen the surveillance of nosocomial infections in French healthcare facilities, both public and private. At the hospital level, Committees for the Fight Against Nosocomial Infections (CLIN) develop specific prevention actions, implemented by Operational Hospital Hygiene Teams (EOHH). This structured organization allows for rigorous monitoring and a rapid response to infectious threats, ensuring a high level of health security within hospitals and clinics.
Air Purification to Reduce Airborne Transmission Risks of Nosocomial Infections
Hygiene is paramount in preventing nosocomial infections, whether in healthcare facilities (hospitals, clinics), among staff, or patients themselves.
Patients and their relatives are potential sources of bacteria and viruses, so they must follow strict rules such as wearing masks, hand disinfection, and physical distancing.
Avec près de la moitié de ces infections attribuées à quatre bactéries majeures, dont E.coli et le staphylocoque doré, NatéoSanté a pensé et fabriqué le purificateur d'air conçu pour cibler et éliminer ces agents pathogènes. Les filtres avancés de l'Eolis Air Manager sont dotés d'une capacité unique à filtrer et à éradiquer ces bactéries, contribuant ainsi à réduire significativement le risque d'infections nosocomiales.
A professional air purifier is particularly suitable for hospitals to rid the air of microorganisms.
DISCOVER OUR SOLUTIONS
Within the hospital itself, teams must pay special attention to the continuous cleanliness of premises, including surfaces and air hygiene, which is also crucial in combating nosocomial infections.
Since these infections are largely transmissible by aerosols, it is highly recommended to equip patient rooms and common areas (reception, waiting room, cafeteria, staff break room, etc.) with professional air purifiers with proven effectiveness in removing viruses, bacteria, and microorganisms from indoor air, thereby minimizing the risk of cross-contamination within the facility.
