Cloutman-Green, EA; (2015) The role of the environment in transmission of healthcare associated infection. Doctoral thesis , UCL (University College London).

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Abstract

Infectious diseases are the current leading cause of human death and within this category nosocomial infections remain the most frequent complication of hospitalization. A range of infection prevention and control activities are employed to combat the selection and spread of these organisms. The principle components of which are: early identification of carriage/infection, patient isolation, improved hand hygiene, environmental control and good antimicrobial stewardship. In order to properly focus these interventions, it is essential to know how and when cross transmission has occurred. There is an ongoing debate about the role of the environment in the spread of healthcare associated infections and to what extent if any it acts as a potential vector for transmission. Within the healthcare setting patients spend a substantial amount of time surrounded by equipment and environmental surfaces that may be contaminated with microorganisms. In order to establish what role the environment could play, tracking the spread of organisms by molecular typing is key. The current methods used to do this are complex and often are only available at reference laboratories. This means that turnaround times are slow and only provide retrospective confirmation of cross-transmission events. Infection control interventions that can be used prior to receiving results play an important role. The selection and effectiveness of these interventions are often poorly supported by research studies, leading to problems with the introduction of evidence based practice and thus difficulty in selecting the most appropriate response to suspected cross transmission. This thesis aims to explore the role of the environment in cross transmission of infection by developing sampling methodologies to permit environmental surveillance, validating and developing typing techniques in order to establish epidemiological links between patients and environmental contamination and to evaluate infection control interventions to aid in prevention of cross transmission events.

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