When you walk into a hospital or healthcare facility, you can't help but notice how the environment has changed over the years. In the last decade, the industry responsible for our health has taken great strides to improve hygiene. Hand sanitizer stations are everywhere, certain rooms are marked with a variety of notices, and signs regarding handwashing are in every public bathroom. This is all part of infection prevention and control, or IPC.
When it was first introduced over 60 years ago, the goal was to prevent the sudden occurrence of infections turning up in otherwise healthy patients. Back then, the phenomenon was known as cross-contamination and the blame was squarely put on the healthcare workers. They needed to be vigilant to ensure patients stayed safe.
But vigilance only can go so far and the rate of unnecessary microbial complications, known as healthcare associated infections (HAI) began to increase. Over time, IPC became more than just a general concept in the back of the minds of healthcare professionals. It was turning into a stark reality in which patients were needlessly forced to deal with longer stays, more antibiotic use, and worse, life-threatening illnesses.
It's why in the 1990s, the landscape changed. Formal committees such as the Healthcare Infection Control Practices Advisory Committee (HICPAC) in the United States and the Division of Nosocomial and Occupational Infections in Canada were formed in order to offer to the best means to keep patients safe. Guidelines to prevent infections such as pneumonia, tuberculosis, and antibiotic resistant bacteria began to appear. Eventually dentists and general physicians were included in the mix. As the 21st century began, guidelines were in place for almost every medical professional and many medical procedures ranging from surgery to the insertion of a catheter. There are also guidelines for cleaning healthcare facilities and equipment.
Yet, while IPC has focused primarily on the healthcare worker, in the last decade, there has been a concern about another source for infectious disease: the visitor. It was never really addressed as the idea of blaming anyone from the general public was not considered a good public relations strategy. Besides, without incredibly good detective skills to identify the source of an infection, guilt would be impossible to prove. So, while the doctors, nurses, and other staff had to bear the brunt of the backlash against the industry, visitors continued to pose a risk.
But that now has changed. Earlier this year, the Society for Healthcare Epidemiology of America took a stand on the problem of infections initiated by visitors. They developed recommendations to minimize the risk of infection spread by non-healthcare workers and/or patients.
Much like guidelines for healthcare staff, there are specific instructions for various conditions. Some of the most troublesome issues are addressed including the spread of antibiotic-resistant bacteria such as Methicillin Resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), Clostridium difficile, and viruses like the flu. Each part of the guidelines stresses the need for visitors to follow the same procedures as healthcare workers. This can include avoiding direct contact with a patient (gloves and gowns), prevention of the formation of droplets (masks), and ensuring patients with the most critical of diseases, such as SARS, are kept isolated from any visitation.
These situations are, however, relatively rare for the usual visitor. But they are not excluded from the guidelines. There are also several general recommendations for everyone who steps into a healthcare facility. Some deal with protection of the patient. Others focus on keeping the visitor safe from infected patients. But the most important of them all is the use of hand hygiene.
For a healthcare worker, there is no better way to prevent an infection than to ensure hands are either washed or sanitized regularly. The World Health Organization has taken the lead in this area and provided what they call the Five Moments For Hand Hygiene. They include before and after patient contact, before and after any interaction with the patient surroundings and after any exposure to bodily fluids. In each and every instance when this occurs, a healthcare worker is asked to clean the hands whether through hand-washing or the use of an alcohol based hand rub.
The same goes for visitors. Before touching the patient, ensure those hands are clean. After all, no one wants to give an infection to an already suffering person. After touching the patient, any transferred pathogens need to be killed. If the visitor is performing a technique, such as feeding, safe hands will keep any wayward germs from causing trouble. Finally, if there is contact with bodily fluids, the risk of any transfer has to be minimized.
While these guidelines are a major step for IPC in the healthcare environment, there is an unfortunate hurdle; they are not legally binding. This means visitors can disregard the recommendations if they wish. But even if the option to ignore is available, for the sake of ensuring the safest healthcare environment possible, they should be followed. After all, no one wants to watch someone unnecessarily suffer. It's best to do everything to help the healing process.
But perhaps there may be a better reason to follow the guidelines. Thanks to advances in microbial detection, outbreaks can be tracked from the patient back to the source. This means a visitor can be identified as the cause for an infection. Although this may not have any legal implications, for anyone who might have caused a loved one even greater troubles the overall effect may be emotionally and psychologically distressing.