Healthcare Acquired Respiratory Infections-Considerations and Strategies for Prevention and Control

Abstract

Abstract This paper provides a critical review of existing procedures and practices, including surveillance methods and systems for identifying patients’ risk of acquiring healthcare associated respiratory infections, in different settings. The burden of healthcare associated respiratory infections afflicting patients and healthcare workers is underappreciated. Infection control measures for TB control have been strictly applied in the United States and have decreased rates of disease acquisition below that of the general population. However, in most other countries healthcare workers are greater risk of acquiring TB and other infections. The principles of these TB and general infection control measures can be applied in resource scarce settings and should reduce the transmission of TB in particular but may provide protection from other respiratory infections as well. As facilities vary widely in the complexity of care they provide, a framework of risk assessment should be used to identify and apply engineering controls, work practice controls, administrative controls, personal protective equipment and finally education. Novel and creative solutions, including use of telemedicine and mHealth solutions should be further explored. As care becomes more complex in resource constrained settings, the necessary infrastructure related to water, energy, medical records, ability to do preventive maintenance and sterilize (reprocess) devices must be put into place so that the benefits of invasive care exceed the risks to the patients. The volume of water available per patient and family in hospitalized patients is a crude indicator of the quality and sophistication of care that can be provided. As we seek improve infection control as much as possible with simple interventions, it is important to realize that once again, limits are reached without a broader system infrastructure strengthening. Safe care does not harm the patient, the provider or the community. Implementation of safe care requires risk assessments and provision of appropriate ventilation and adequate volumes of water. Because the preconditions for a safe environment of care cannot be assumed in resource scarce settings, there may be limitations in the effective application of US infection control “bundles”. Infection control measures will have to be tested prior to implementation. Unlike in the United States, the impact of infection control measures may have to be extrapolated from studies done at sentinel sites. Measures can then be applied to facilities and evaluated with process control measures. Examples of process control measures include compliance with respiratory symptom screening, available volumes of water, hand hygiene monitoring, employee absenteeism, presence of crowds in areas with low air exchanges, ventilation, and indications for treatment among others. Keywords : Tuberculosis; Respiratory Infections; Healthcare settings; Infection Control