The transmission of micro-organisms from person to person – caregiver or patient – occurs through direct or indirect contact or, more rarely, is airborne. Recommendations for managing the most common infections have evolved in recent years1. What is the current situation? What guidelines should be followed?
Cross-transmission is driven by an epidemiological chain2: the infectious agent (bacteria, virus, fungi, parasites) is transmitted from a reservoir (patient, staff, visitor, environment) to a susceptible host. The fight against this transmission is notably based on controlling the spread of multi- or highly-resistant bacteria (MDRO or EMDRO) and is backed by a strategy to prevent the spread from carrier patients3.
Hospital teams therefore play an essential role in limiting cross-transmission by putting different systems in place, including those detailed below.
This requires additional guidelines beyond the standard precautions that are always observed daily by caregivers. Additional “contact” precautions help to prevent cross-transmission. More specifically, this refers to additional “droplet” and “airborne” precautions. For example, additional precautions involve wearing protective clothing. If direct contact with the patient is required, wearing a single-use apron is recommended. This is then disposed of as non-infectious medical waste (NIMW). In cases of Clostridium difficile infection, a long-sleeved over-gown is recommended. The over-gown is to be worn as soon as you enter the room and must be disposed of as infectious clinical waste (ICW) as soon as you leave. If care involves wetting and the over-gown is not waterproof, a single-use apron may be worn on top4.
The use of protective medical devices is also key to protecting against cross-transmission.
This is why healthcare professionals, particularly SF2H (French Society of Hospital Hygiene), observe good hygiene practices, particularly glove wearing; the use of gloves may be limited to the following situations, including Covid-19:
The inappropriate use of gloves increases the risks of self-contamination, cross-transmission and contamination of the environment, particularly as there is a risk of appropriate hand hygiene practices being forgotten.
It is therefore key both for the prevention of infectious risks and the optimised management of resources to use protective devices adequately.
Did you know6?
The skin has 102 to 105 bacteria per cm2. The mouth has 108 bacteria per ml of saliva
1 Ministère des Solidarités et de la Santé, Répertoire : des outils pour le bon usage des antibiotiques, novembre 2021, https://solidarites-sante.gouv.fr/prevention-en-sante/les-antibiotiques-des-medicaments-essentiels-a-preserver/professionnels-de-sante/article/repertoire-des-outils-pour-le-bon-usage-des-antibiotiques
2 Centre d’appui à la Prévention des Infections Associées aux Soins, La transmission croisée, Octobre 2019, http://www.cpias-auvergnerhonealpes.fr/animation/ehpad_fam_mas_ime/2019/03_10_19/3_ils_sont_parmi_nous.pdf
3 Haut Conseil de la Santé Publique, Prévention de la transmission croisée des « Bactéries Hautement Résistantes aux antibiotiques émergentes » (BHRe), https://www.hcsp.fr/Explore.cgi/AvisRapportsDomaine?clefr=372
4 INRIS, Précautions complémentaires ” Contact “. Prévention de la transmission des infections en milieu de soins, Novembre 2019, https://www.inrs.fr/media.html?refINRS=ED%206363
5 CPIAS, La lettre d’information du CPias ARA, Octobre 2020, http://www.cpias-auvergnerhonealpes.fr/Newsletter/2020/En_Bref_octobre2020.html
6 CPIAS, La transmission croisée, Octobre 2019, http://www.cpias-auvergnerhonealpes.fr/animation/ehpad_fam_mas_ime/2019/03_10_19/3_ils_sont_parmi_nous.pdf