Elizabeth Christenson

Antimicrobial resistance (AMR) is one of the top global public health threats, according to the World Health Organization (WHO). Scientists estimated that bacterial AMR was responsible for 1.27 million global deaths in 2019 and will cause 10 million deaths by 2050. The superbugs cleaning professionals combat in healthcare settings are a result of AMR, which occurs when germs, including bacteria, fungi, and viruses, develop the ability to defeat the antibiotics/drugs designed to kill them. All organisms, including people, have survival instincts and biological mechanisms to fight back, explained Joanna Mills, a registered nurse and system director of infection prevention at John Muir Health, Walnut Creek, California. She added that AMR is not a new occurrence. Alexander Fleming, who discovered penicillin in 1928, warned that “microbes are educated to resist penicillin.” Infection control progress Since the rise of superbugs, infection control practices have become more evidence-based, standardized, and proactive. “We’ve seen stronger emphasis on hand hygiene, environmental cleaning, and antimicrobial stewardship programs, along with enhanced surveillance and rapid diagnostic testing,” said Rodney E. Rohde, a Regents’ professor and associate director of the Translation Health Research Center at Texas State University System, San Marcos. “Education and cross-disciplinary collaboration—especially between infection prevention, laboratory science, and environmental services—have also improved. Together, these efforts create a more resilient infection prevention culture that helps contain resistant pathogens and protect patients and staff alike.” Improvements in disinfection and sterilization of high-risk environments, such as surgical suites and intensive care units, in addition to isolation standards, also continue to evolve. “I believe that pursuing the research needed to establish a validated and effective cleaning and disinfection methodology will open the door to discover and develop strategies to make significant improvements in prevention and patient outcomes,” Mills said. As the industry studies how to clean surfaces effectively, it has established best practices for cleaning and disinfection in healthcare and learned that personal protective equipment (PPE) can keep staff safe and prevent them from transmitting organisms to other patients, explained Sarah Wilkerson, system executive director of infection prevention at Providence St. Joseph Health, Everette, Washington. The industry also uses broader surveillance techniques to look for these organisms. “We’re trying to identify them early, so that we can put in place targeted interventions that can help prevent the spread that could potentially turn into an outbreak,” Wilkerson said. Healthcare setting improvements Healthcare professionals face significant challenges when dealing with superbugs, including limited treatment options, diagnostic delays, staff shortages, and the constant pressure to maintain strict infection control amid heavy workloads, Rohde said. Misinformation and inconsistent compliance can also undermine prevention efforts. Fortunately, new tools to address these challenges include rapid diagnostic technologies, antimicrobial stewardship programs, and multidisciplinary teams. “By integrating science, communication, and collaboration, we’re steadily improving our ability to detect, manage, and prevent resistant infections in healthcare environments,” Rohde said. “In the medical laboratory setting, we all need to work together to raise awareness surrounding current antimicrobial susceptibility testing breakpoints. These are challenges for clinical and medical laboratories to update their testing methods to keep up with new drug resistance patterns, and face hurdles like regulatory clearance and manufacturer delays.” Mills believes the biggest challenges in superbug prevention stem from three factors patients are exposed to before they arrive at acute care hospitals: the environment they came from, including skilled nursing facilities; the treatment they received, including antibiotics; and the healthcare practices of their care team, such as isolation and disinfection. Unfortunately, standards and requirements are not consistent. “The pandemic illustrated these issues and exacerbated the resistance patterns and emerging urgent and serious organism threats,” Mills said. Superbugs also can spread easily on surfaces, such as equipment. “While we know that it can be challenging to clean and disinfect some of the healthcare surfaces, we now know we need to be looking at the different types of surfaces and what is recommended to clean those effectively,” Wilkerson said. Collaboration between environmental services (EVS), nursing, engineering, supply chain, and infection prevention also is necessary to consider the environment, identify which surfaces need cleaning, and determine how teams can clean most effectively without using multiple products. Managers also must delineate each team’s role. “It can be really confusing to teams, because it can be a shared responsibility to clean the healthcare environment,” Wilkerson explained. As hospitals acquire pieces of equipment, furniture, buildings, etc., teams need to select surfaces that can be cleaned and disinfected easily. “We know that some of the older buildings have a real challenge with being able to keep those clean just because the surfaces degrade over time,” Wilkerson said. “It’s a great opportunity as we’re bringing in new products to be thinking about how to ease our way in the future.” Best practices adaptation Professional organizations have developed and published cleaning and disinfection standards specific to patient populations and specialty services. Still, the specific practices related to the general medical surgical areas are lacking, complicated by the recommendations of manufacturers of medical devices, hospital furniture, and construction materials, Mills explained. “Often, the instructions for use (IFU) related to cleaning and disinfection are insufficient and/or not defined, and the cleaning practices are deferred to hospital standards,” she said. The best cleaning practices for reducing superbugs start with consistency and adherence to evidence-based protocols. This includes routine, thorough cleaning of frequently touched and shared surfaces, proper use of Environmental Protection Agency (EPA) registered disinfectants effective against resistant organisms, and proper contact times. Staff training, hand hygiene, and clear communication between a multidisciplinary team is essential. Regular audits, monitoring, and feedback also ensure compliance. “Ultimately, a culture of shared responsibility—where everyone understands their role in infection prevention—is key to minimizing the spread of superbugs in healthcare settings,” Rohde said. Wilkerson also believes it is important to have rigorous environmental cleaning practices for patients with known AMR organisms. For example, place them on transmission-based precautions or in isolation, meaning that staff entering that room might need to wear a gown and gloves. Hand hygiene protocols also help ensure staff properly disinfect their

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Elizabeth Christenson

Editor for CMM and Cleanfax

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