Doctors in personal protective equipment walking down a hospital hallway
Part 1

Eradicating HAIs: the challenge ahead

In an interview with HARTMANN professor Ojan Assadian reflects on the current state of fighting HAIs and the challenges ahead

Healthcare-associated infections (HAIs) were a problem long before COVID-19 and they will continue to be one when the pandemic is over. Every year millions of people still acquire an infection in healthcare institutions – and about half of that can be prevented with the correct hygienic measures. With COVID-19 sadly overshadowing these numbers, we met with Professor Ojan Assadian to discuss the current state of fighting HAIs and his perceptions on how it will evolve once the pandemic has passed.

Professor Assadian is Medical Director of the Hospital Wiener Neustadt, Austria and Emeritus Professor at the Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK. He is specialised in the prevention and control of healthcare acquired infections, chronic wounds and surgical site infections, and shares his thoughts on the challenge of tackling HAIs.
Professor Ojan Assadian

HARTMANN: Professor Assadian, could I begin by asking you whether you think HAIs are regarded as a serious problem in healthcare?

Prof. Assadian: It has long been known that HAIs pose a significant challenge. However, there has been a paradigm shift over the past 20 years. Pertaining to admitting the fact that we do see infections and complications which are inherently associated with diagnostic and therapeutic procedures in patients. We have moved away from a culture of shame and blame into one of objectivity, speaking freely about the challenge and devising solutions.

With the outbreak of the coronavirus pandemic, preventing transmission has been in the spotlight. Has the pandemic reduced HAIs or made it more difficult?

I know that many think that the pandemic has made it easier because so many people understand basics and principles of infectious diseases better now compared to 3 or 4 years ago. However, I do not agree totally. On the contrary, coronavirus has resulted in a collective focus on one single virus and has shifted our attention from particularly bacterial infections.

For instance, we conducted a small study of coronavirus patients to see how many also had infected chronic wounds. We found that the distribution of chronic wounds in patients with COVID-19 is very much what we have seen in patients before the pandemic, at about 15 percent. Now, however, the priority in the care of these patients is treating COVID-19, with a decreased attention on modern wound care. Other medical issues not receiving the same focus and attention.

So have you found it difficult to raise awareness of HAIs this past year?

There are negative and positive aspects. On the positive side, we note that with the daily media spotlight on SARS-CoV-2, we have an unprecedented opportunity to train the global population on reducing the transmission of infectious diseases. All these epidemiological terms such as prevalence, 7-days-incidence, base transmission rate R0 or protective personal equipment are far better understood commonly today. Two years ago, nobody knew the differences between a surgical mask, FFP2 mask or KN95 masks. Now, even laypeople are debating on an astonishing high medical level on their differences.

The conversation in the media has even extended into diagnostics and vaccine technologies, with people now knowing about antigens, PCR and molecular typing, and debating the pros and cons of mRNA and vector vaccines. I hope that in time we can build on this newly established foundation of knowledge in the population. However, the challenge is that many other infectious diseases are currently being overlooked. They must not be forgotten.

This is a crystal-ball question, but how do you estimate that the risk of HAI infections will develop over the next ten years?

Generally speaking, there are two aspects on reducing HAIs. First, training of medical staff; and second, the availability of more smartly designed medical devices. The latter is a very important aspect which is commonly overlooked.

For instance, if we look at urinary tract infections (UTIs), catheter system designs and materials have completely changed during the past 30 years, with a tremendous impact on reducing the incidence of UTI-related HAIs. Same for blood borne transmission. 20 years ago, we did not have the same safety products, which also have a tremendous impact today.

On the other hand, if we take a realistic look into the data pertaining to surgical site infection (SSI), we have to admit that the reduction has not been significant. We still have a tremendous way to go. My forecast is that device-associated infection will further decline, with the increasing availability of smart, better designed and constructed medical devices. But achieving a decline in surgical site infections will require significant changes in how we perform surgery. The continuing increase in endoscopic procedures is helping. However, I think surgical site infections will be very challenging to be reduced significantly further.

What you are saying is that we are moving towards less invasive surgical procedures and that this will lead to a decrease in the prevalence of infections, correct?

Absolutely, or a change in SSI. For instance, for cardiac patients requiring a pacemaker the current standard is an invasive procedure. It is a relatively small operation, but you still have to open the skin, prepare the muscle, insert a foreign body (the pacemaker), and bring in a wire. But we are now increasingly seeing the introduction of new technologies with the pacemaker positioned transcutaneously. You go through the skin to implant a micro pacemaker into the heart. Far less invasive, and therefore, a lower risk of infection.

Therefore, the impact on HAIs depends on the availability of this type of modern technology. Of course, it is evident that not all healthcare centres will be able to switch immediately to new technologies and strategies, but there will be a gradual change. Of course, we also have to remember not all patients are suitable for the use of these new technologies.

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