It’s the second time I’ve had the pleasure to speak at Healthcare Infection Transmission Systems (HITS) conference. The conference launched in 2017 and since then, provides an excellent platform for industry and academia to exchange knowledge, ideas and expertise. As always, there was a lot of excellent presentations and thought- provoking debates. The main areas of focus were hands, surfaces, air and water.

Dr Knighton raised a very important problem that is often overlooked. A lot of emphasis is being put on hospital staff hand hygiene, but not much attention has been paid to patients’ hand hygiene; they are not being trained enough. Also, patients prefer alcohol foam over wipes because in most of the cases it’s difficult for them to open single use packages. We’ve been shown a video of a patient that tried to open the package supplied with his lunch- in the end it took him 5 minutes! When patients are unwell, they don’t have enough energy to do that, so often give up hand hygiene before meals. Also, many wipes have a strong odour that repels patients from using them. It is a problem that needs to be addressed.

There was a very good presentation on soft surfaces delivered by Dr Gerba. Soft surfaces might pose a greater risk to patients than hard surfaces- bacteria remain in them and are far more difficult to be disinfected than hard surfaces. Mattresses are one of the examples of soft surfaces that do not receive enough attention and are not cleaned properly. There is a gap in treating those fabrics in healthcare- not many effective solutions are out there. Treatment with soaking is better than spraying but still not effective enough and sometimes impossible to perform.

The problem of hospital showers and anti-slip mats has been raised. They are needed to prevent patients from slipping (especially if patients are weak and cannot balance properly), but at the same time might be a source of pathogens. Rougher tiles were suggested as an alternative option, but if they are too rough they might damage the feet of patients and could also promote biofilm formation.

Using disposable wipes in hospital cleaning is extremely essential. Microfibre re-usable cloths can remove more bacteria but also carry more bacteria, so can contribute to the transfer of microorganisms if reused. Moreover, as showed by John LaRochelle, when microfibre cloths are being washed, the plastic melts and significantly decreases their effectiveness in picking bugs (from 70% down to around 10-15%).

Dr Jane Stout gave a summary on how to combat Legionella and highlighted the importance of biofilm within plumbing systems – we loved the idea of Legionella chill pills! She later went on to discuss how policy changes can dictate the products used within healthcare settings and overall the levels of HAI’s.

The problem of other water borne pathogens was described further by Dr Clock. Infection incidence of multi-drug resistant organisms (MDROs), non-tuberculosis mycobacterium (NTM), Burkholderia and Sphingomonas koreensis was showed. Biofilm formation in drains was mentioned, and that it needs to be prevented. One of the ways would be incorporating regular flushing of sinks at healthcare facilities. But it’s still unclear how often and for how long flushing should be done. Moreover, flushing is not enough to get rid of the biofilm formed and grown in drain.

Dr Molly Scanlon later gave a talk about construction and how this can lead to higher HAI’s. This research was done by a systematic review of literature and analysed 31 papers on where construction was happening, duration, type and infection/morbidity. The results of this showed higher infections of organisms such as Aspergillus (a fungal pathogen) during demolition, although somewhat surprisingly, higher infection of typically water-borne pathogens could spread from other buildings. The cause is hypothesised to be the aerosolization of these pathogens during construction but also the introduction of water sources from unknown areas for construction purposes. The policy again was mentioned and once this correlation was highlighted, the problems have reduced.

The topics discussed at this year’s conference were extremely thought provoking. The speakers delivered excellent presentations and gave interesting point of view accounts due to the diverse backgrounds they were from. This highlighted the need for communication between the academics, industry and clinicians. A motif that was noted between many of the talk was the importance of policy within hospitals. Due to the high-pressure environment and volume of patients, hospitals will do the basic requirements whether to save time or money. However, policy change can dictate the cleaning routines, how products are used, and which products are used within hospitals. When these stricter policies are implemented, it will likely cause a decrease in HAI’s.