Special spotlight interview about HAI with Michael Dimond
During International Infection prevention week, we met Michael Diamond, the Co-founder & Executive Director of TIPS. Michael has a vast background in infection prevention innovation and practices. The conversation we had had a simple yet important value – to learn what changed over the last two decades in healthcare facilities in terms of infection prevention.
Q: Based on your experience, why are Hospital Associated infections still a “thing” in today’s healthcare facilities?
A: I believe we have reached an acceptance and compliance frame of mind that is fueled by budgetary concerns and fear of adopting new processes and technologies. Also, organisms are smart and will always find a way into environments. Facilities will always be addressing this issue.
Q: Is it an education, a technology, or a human behavior challenge?
A: The challenge is all three plus a budgetary issue. Education is critical but must be supported by technology to steer human behavior in the right direction. However, no matter how great an innovation is or how clearly it needs to be implemented, if the price is cost prohibitive, the road to adoption will be a short, complicated path.
Q: Did you notice any shift or change during or after(if we can say that) the pandemic?
A: The pandemic brought to light the inadequacies in nonhealthcare facilities such as schools, restaurants, and hotels. One of the most significant arguments throughout the pandemic was the division between healthcare environments and nonhealthcare environments. In healthcare, environmental precautions are common. These environments are built and managed with an infection-prevention mindset. Personal protective equipment, hand hygiene, air ventilation, and filtration are all commonplace. The pandemic highlighted the disconnect between these principles outside of healthcare.
Q: What processes do you see as more efficient in preventing the spread of infections in healthcare facilities?
A: Without a doubt, regular and proper hand hygiene is very important in preventing the spread of infections in healthcare. Air handling is another crucial means of infection prevention and control. Hand hygiene and air handling are also generic in nature in that they apply to all settings and a vast variety of pathogens. It should also be noted here that cleaner indoor air also equates to less microbial contamination of environmental surfaces. The use of personal protective equipment (PPE) is, of course, necessary to protect healthcare personnel who should also receive available vaccinations. High-touch environmental surfaces must be routinely cleaned and decontaminated to reduce the risk of hand contamination.
It must also be emphasized here that confining the spread of a given pathogen as much as possible to its source can curtail the need for much environmental contamination.
Q: If you need to choose one thing you want every healthcare provider to improve on in hand hygiene, what will that be?
A: Time and attention.
Q: Can you give us a fun fact about infectious agents?
A: Viruses and bacteria lack a sense of humor and are far too serious. They ignore politicians and do not respond to protests.
Q: Who is “stronger” viruses or microbes, and who spreads faster?
A: “Viruses” are one of five categories of microbes or microorganisms. “Microbes” are living creatures that are too small to be seen with the naked eye. We need a microscope to be able to see them. Within microbes, viruses are the smallest and simplest life forms. They consist mainly of nucleic acid and protein. Whereas bacteria, another category of “microbes,” can be grown in the laboratory using simple items such as meat broths, viruses require whole living animals (e.g., mice) or cells derived from animals or humans to grow in the laboratory.
In general, ‘microbes’ are the most common and prevalent of life forms. In fact, it is believed that there are more microbes on the face of this earth than stars in all galaxies!
In addition, microbes come in a wide variety of shapes and forms while being able to perform many functions, such as recycling elements. Our own bodies harbor billions of microbes that are vital for our survival. Only less than 1% of all known microbes (pathogens) can cause diseases in humans.
The term ‘stronger’ is difficult to apply when talking about microbes. Does it refer to how well they can survive or mean how difficult they are to kill? If one means the latter, there is no simple answer can be given. For example, bacteria of certain types can produce ‘spores’, which are the most resistant life forms and can withstand heat and chemicals. ‘Spores’ are roughly equal to the seeds of a plant. However, viruses cannot produce spores and, in that sense, are not as resistant as spore-producing bacteria.
Viruses come in main forms – ‘enveloped’ (e.g., influenza virus) and ‘non-enveloped’ (e.g., norovirus). As a rule, enveloped viruses are more fragile and easier to kill with disinfectants (chemicals used in hygiene).
Another point to note here is that, in the environment, disease-causing microbes, in particular, are constantly surrounded by one type of body fluid or another (e.g., blood or saliva). This gives them better protection overall.
So, in summary, there can be as many answers to that question as there are ‘microbes’ and the context in which they may be found.
The speed with which ‘microbes’ can spread depends less on their type but more on how they are spreading. Air in a crowded room is perhaps the fastest means of spread of respiratory disease-causing microbes (e.g., the SARS virus). Well, water in a community can rapidly spread enteric diseases such as cholera. However, microbes can vary in their degree of ‘communicability’ or the ease with which they can spread.
How old is the problem?
As old as life itself! Humans are an invasive species also. As long as there is life on the planet, there will be competing organisms seeking survival. Viruses and bacteria are simply trying to exist in the same space.
Why do you think we care more about coffee flavor than about personal hygiene?
We understand coffee and appreciate the “immediate” gratification. Washing our hands and taking preventive measures to prevent infection does not provide “immediate” gratification and is often a bothersome step on the way to having a coffee.