Breaking the chain of infection

As I write this month’s message, we are in the midst of a coronavirus outbreak. The coronavirus in question is COVID-19. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. A person can also be infected by touching contaminated surfaces if they do not wash their hands. This is a new strain of coronavirus, and research is being undertaken to discover a vaccine.

In the meantime, we need to take effective preventative measures. Evidence-based practices, associated with similar respiratory viruses such as influenza, can be applied to prevent spread. Such evidence suggests covering your mouth and nose with a tissue, or your sleeve (not your hands) when you cough or sneeze, put used tissues in the bin and immediately wash your hands with soap and water. If soap and water are not available, use hand sanitiser gel and try to avoid close contact with people who are unwell.

Much of this is common sense, but with the threat of a pandemic on the horizon, many people are applying ritualistic practices to protect themselves. I have seen images of uninfected people wearing facemasks as they go about everyday life. However, no studies have established a conclusive relationship between mask use and protection against influenza type infections.

There is evidence to support the wearing of masks during illness to protect others from contamination by containing the spread of infected droplets. Crucially, the effectiveness of masks is likely linked to early, consistent and correct usage. Poor practices when wearing and utilising masks can exacerbate the spread of infection. However, I wonder how many members of the general public have been educated in the correct usage of face masks?

This brings me to the use of face masks in the operating theatre. We are probably all familiar with the evidence that suggests face masks are ineffective after 2min of use, due to them becoming moist and thereby facilitating ‘strike through’. Yet, we still advocate their use during surgery involving implants.

Personally, I will wear a mask when in close contact with the sterile field, as I know that people spray saliva when speaking. Masks are effective at capturing that spray and preventing the spread of contamination from droplets. What they do not prevent is contamination of the wearer. Droplets captured on the surface will moisten the mask and as mentioned earlier, facilitate strike through of any viruses that may be present. If that mask is then touched, there will also be potential transmission of contaminants. The links in the chain of infection transmission are being developed.

I have observed many poor practices, from supposedly educated professionals, regarding the use of face masks. The wearing of face masks around the neck is at the top of the list. Staff regularly sit in the coffee room, eating their lunch while wearing the used contaminated mask around their neck like a fashion accessory. On return to theatre, the offending article is then repositioned back over the nose and mouth. Hands are all over the ‘article’, and I have yet to see any of these offenders wash their hands after touching the contaminated masks. It is such practices that promote the spread of infection, as the perpetrators then touch patients, door handles, coffee cups and many other surfaces, thereby completing the chain of infection.

Poor practice is not isolated to mask wearing. Removal of the mask after use is frequently performed incorrectly and the lack of hand washing after removing gloves is also often observed. Similarly, hand washing after touching patients is not practised consistently. Sadly, poor hand hygiene is not limited to clinical practice. I frequently witness members of the public leaving toilet facilities without washing their hands. I see people coughing and sneezing without using tissues or making any attempt to capture the resultant spray.

Without doubt, good hand hygiene is one of the most effective ways of preventing the transmission of contaminants and breaking the chain. We should all practice good hygiene habits, teach others and disseminate evidence-based practice, but moreover, let us all challenge those who are putting us at risk with their poor practices. Break that chain, wash those hands and keep yourselves and each other heathy and well.

Tracey Williams

President AfPP

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