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We all know the importance of good hygiene in preventing infections, but, until now, nobody has been able to quantify the impact individual hygiene measures have聽鈥� not just on infection acquisition rates, but on the broader healthcare system.

Professor Brett Mitchell of Avondale University said the major shortage of research in this area matters, because it leaves health services unclear on how to prioritise training, resource allocation and everyday practice.

鈥淔or example, we know that substandard urinary catheter hygiene is linked to urinary tract infections (UTIs), but to what extent? Also, how much do catheter-induced UTIs cost financially in terms of antibiotics, hospital stays and GP consultations; and more broadly in terms of patient wellbeing?鈥� Mitchell said.

鈥淚f the answer to these questions is 鈥榲ery little鈥�, then channelling significant resources into improving catheter practice may not be appropriate聽鈥� there could be other more impactful infections that warrant this investment. By contrast, if the answer is on the top end of the scale, you could consider more resource-heavy measures.

鈥淗ealth services have a finite budget, so 鈥榦ver-investment鈥� in one area may mean that significant gains or actions in other areas are missed.鈥�

Risk-benefit analyses

The lack of research surrounding hygiene protocols also makes it hard to perform risk-benefit assessments for infection prevention measures that carry risks of their own.

Having appropriate data around infection risks, such as UTI, can allow decision-makers to weigh up these risks more accurately and invest in areas of greatest need.

鈥淔or clinicians who have ever increasing workloads, understanding what practices are most important will help inform their priorities. Strong evidence to inform decision-making is therefore critical for both clinicians and decisions-makers,鈥� Mitchell said.

Incoming evidence base

To address issues like this, Mitchell is building a 鈥榣ong overdue鈥� evidence base for the prevention of hospital acquired infections (HAIs), after being awarded a grant from the Commonwealth Health Minister in 2022.

Currently, HAIs are a major sticking point in Australian healthcare delivery, with more than 165,000 acquired each year. While some are relatively harmless, others have high mortality rates, including pneumonia, which is among the most common.

Before lockdowns, pneumonia (and influenza) were the ninth leading cause of death in Australia, claiming 4124 lives in 2019. Immunocompromised people are especially vulnerable to it.

Mitchell points out that, despite its prevalence, little is understood about which protocols聽鈥� or lack thereof 鈥� play the greatest role in pneumonia transmission within medical settings.

鈥淕enerally speaking, practitioners know that good oral hygiene can prevent pneumonia, as it stops pathogens getting into the upper respiratory tract. However, we don鈥檛 know exactly what 鈥榞ood鈥� oral hygiene means. There isn鈥檛 sufficient high-quality research to inform guidelines for things like how frequently practitioners should be cleaning patients鈥� teeth, or what dental products work best, for example,鈥� he said.

鈥淲e need to build data around this, so that we can quantify the problem and provide an evidence base for the solution,鈥� he added.

Prevention not cure

It is not just people contracting HAIs that bear the health consequences of their existence. Often requiring antibiotics, the treatment of HAIs is contributing to our antimicrobial resistance (AMR) epidemic on a large scale.

AMR 鈥� where viruses, bacteria, fungi and parasites learn to outsmart the drugs designed to kill them聽鈥� is claiming an increasing numbers of lives each year.

Currently, 700,000 people die globally from infections that are not responding appropriately to treatment and this is expected to reach 10 million by 2050. The World Health Organisation has cited AMR as one of the top 10 public health threats currently facing humanity.

With greater pressure on healthcare professionals to minimise the use of antibiotics, Mitchell believes tackling HAIs at the root is important.

鈥淢y research looks at the prevention of HAIs as I believe this is where one focus should be. If infections are occurring and the treatment options are losing their efficacy, then it makes sense to channel more effort into prevention research,鈥� he said.

Long overdue data

While Mitchell鈥檚 research into HAI prevention is now well underway, he does not understand why the area has been neglected for so long by researchers.

鈥淚t鈥檚 concerning that one of the greatest health concerns of our time is so under-explored,鈥� he said.

鈥淲hile infection prevention may seem like a simple area, a commonsense or intuitive approach clearly isn鈥檛 working聽鈥� as reflected in the high numbers of HAIs acquired each year.

鈥淎lso, while we often have a good theoretical rationale for doing various hygiene measures, we don鈥檛 have high quality designed studies that demonstrate they make a difference.

鈥淚 hope my research will change this and help practitioners channel resources into measures that actually work and have the greatest impact.鈥�

Mitchell鈥檚 study will be completed in 2027.

Image credit: iStockphoto.com/sorbetto