AMiCI (CA15114). Workshop for Early Career Investigators (ECIs) and Short Term Scientific Missions (STSM) Riga, Latvia, 7th of March 2019

1. Hospital hygiene and infection
control in real-life circumstances –
cleaning and innovative solutions
Workshop for Early Career Investigators (ECIs) and Short Term Scientific Missions (STSM)
Riga, Latvia
7.3.2019

2. Background of the STSM visit
 The Short Term Scientific Mission (STSM) related to
AMICI (Anti-MIcrobial Coating Innovations) -
consortium aimed to prevent infections and
infectious diseases using AntiMicrobial (nano)-
Coatings (AMC).
 Visit to Limerick, Ireland 10th to 14th April
2017
• University of Limerick (host professor Colum
Dunne, Director of Research, Graduate Entry
Medical School, University of Limerick,
Ireland)
• University hospital of Limerick (host Professor
Nuala O’Connell, AMiCI COST Action
member)
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http://www.worldeasyguides.com

3. Aims of the STSM visit
 During the visit working alongside Prof
Nuala O’Connell and her team at the
hospital (>440 beds)
 Observe infection prevention and control
practices
 Observe hygiene and cleaning procedures
 Interviews, tours, other observations
 The visit aided participants’ doctoral
research of copper as an antimicrobial
solution in varying real-life circumstances
(incl. hospital in Finland)
 Doctoral thesis “Microbiological effects of copper and other
abiotic factors in drinking water and touch surface
environments” available on request (finished October 2018)
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Photo by Nick Rabbitts

4. Hospital infection control,
Limerick University Hospital
 “Infection Prevention and Control” team
 routine (daily) check for hospital-acquired infections (HAI),
measures to prevent possible infections of spreading.
 Assistant director of nursing, two medical microbiologists, two
surveillance scientists, three operational nurses
 “Hygiene” group, two workers
 Safety of patients is a sum of:
 Good hand hygiene  multimodal approach, training,
monitoring
 Antibiotic prescriptions  antimicrobial pharmacists are
checking the antibiotic prescriptions to patients
 Environmental hygiene  guidelines available, hygiene group
 This presentation focuses to environmental hygiene
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5. Hospital infection control,
Limerick University Hospital
 Overall safety of patients is guaranteed by HIQA standards by the Health
Information and Quality Authority (HIQA) (the Authority) - independent
organisation that was set up to improve the safety and quality of Ireland’s health and
social care services.
 All hospitals are routinely check by HIQA authorities and the reports are public.
 More detailed guidelines are provided by the Health Service Executive (HSE). HSE
is the main provider and funder of health and social care services in Ireland.
 Hospital has many IT-systems to control infections:
 IC-NET  only isolated infections as “alerts”, patients in the same room as “contacts”
 iPims  patient location and infectious diseases
 iLab  laboratory results
 Q-pulse (database for guidelines to all hospital staff)
 Bacteria findings in the hospital are reported to EARS-NET, which is European
Antimicrobial Resistance Surveillance Network by European Centre for Disease
Prevention and Control.
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6. Hospital cleaning practices,
Limerick University Hospital
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 HSE guidelines are available for cleaning
 Monthly visual audits performed for hygiene
(cleaning, hand wash, environment)
 Occasionally UV-pen is used for quality check for cleaning
 Fails requires quality improvement plan (QIP)
 Neutral cleaning detergents used for normal daily
cleaning
 In case of infection or patient discharge, stronger
detergent (incl. chlorine) is used
 Emergency cleanings
 Similar practices in Finland

7. Challenges observed in hospital
infection control
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 Challenges in overall infection control
 Infection control measures are not considered
that important over other issues (hurry)
 The hospital is constantly full (cross-
contamination, inefficient isolation)
 Poor management
 Money (lack of qualified personnel e.g. contract
cleaners)
 Slow antibiotic resistant bacteria carriage testing
 Lack of sinks and hurry  poor hand washing

8. Challenges observed in hospital
cleaning practices
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 Challenges in cleaning
 Poor quality of cleaning, inefficient training
 Cleaners might be unaware of the importance
of cleaning
 Changing personnel  change in motivation
(contact cleaners)
 Cleaning supervision low or person-biased
 Lack of environmental data
 Cleaners’ observations ignored

9. Hospital and antimicrobial materials
 Hospital did not contain any antimicrobial touch surface materials
to prevent infection from environmental surfaces
 knowledge is available but the standards and guidelines lack any
information on these
 Reasons/worries to use antibacterial materials in hospital:
 Hurry, implementing antibacterial materials require human
resources
 Visually unappealing products (e.g. copper tarnishing)
 Antibiotic resistance worries
 Standards and guidelines should recognize these for larger
implementation practices to hospitals
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10. Solutions to improve
environmental hygiene
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Antimicrobial materials
Breaking the
infection chain
Cleaning
Hand washing
U.S. Air Force Photo by Ken Wright
Touch surfaces

11. Solutions for environmental hygiene:
Antimicrobial material - copper
 Real-life facilities: hospital, kindergarten, retirement home, office building
 Less total bacteria in copper than reference surfaces regardless of varying
usage and cleaning profiles
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Inkinen et al. 2016, Letters in Applied Microbiology 64, 19-26
Statistical significance
***P < 0<001.

12. Solutions for environmental hygiene:
Antimicrobial material - copper
 Where to use antimicrobial
materials by real-life studies?
 Small surface area that are
frequently touched are cost-
effective locations for antimicrobial
touch surface materials
 Moist locations can support
microbial growth
 How about potentially pathogenic
bacteria?
 Less S. aureus in copper (2.6%) than
reference (14%) surfaces (N = 157)
 Less Gram-negatives in copper (21%)
than reference (34%) surfaces (N = 214)
 No differences in Enterococci between
copper and reference surfaces
(15%, N = 214)
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Link to doctoral thesis:
https://aaltodoc.aalto.fi/bitstream/handle/123456789/34090/isbn978
9526080925.pdf?sequence=1&isAllowed=y

13. Solutions for environmental hygiene:
Detect dirt - AutoDet
 Visual inspection of cleanliness is unreliable and all existing
touch surface contamination methods require:
 sampling & sample preparation
 use of expensive equipment and chemicals
 availability of qualified specialists,
 and takes a long time from 1 hours to several days
 Need for - Easy – Real-time – Rapid - instruments for surface
cleanliness control
 AutoDet project (Aalto University, Finland) develop and
commercialize hyperspectral scanning algorithm for touch
surface cleanliness monitor
 Pilot studies performed, real-life testing currently ongoing in
hospital environment including antimicrobial materials
 Real-time innovations to detect touch surface cleanliness
could aid in infection control and decrease of HAIs!
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Example, olive oil:

14. AutoDet: real-time touch surface dirt
measurement
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Example demo video: AutoDet

15. Main conclusions
 Standards and guidelines exist to control infectious diseases, to work in
practice - as found in STSM visit – money, resources, time,
communication and education is needed
 For the patient safety, the environmental hygiene is extremely important
 To support hygiene, methods to detect touch surface cleanliness (e.g.
AutoDet) and antimicrobial materials (e.g. copper) are available
 Implementing techniques that are not mentioned in standards or
guidelines to hospital however, is challenging due to limited human
resources
 The collected information was utilized in the doctoral study and
initiated interest to better cleaning practices and methods
 STSM visit was extremely beneficial for the personal learning
experience and future research focus
 STSM visit observations will be published in a scientific paper later
together with comparisons to Finnish practices
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16. Contact:
jenni.Inkinen@aalto.fi,
AaltoUniversity,Finland
Presentaffliation:
DepartmentofAppliedPhysics
ComplexSystemsandMaterials(CSM)
Previousaffliation:
DepartmentofCivilEngineering
IndoorEnvironmentTechnology
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Thank you!