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The now and the future of infection prediction

Marco-Felipe King, an infection control postdoctoral researcher at the Institute for Public Health and Environmental Engineering at the University of Leeds, explains why the future of infection prevention is in smart buildings and real-time contamination prediction.

Current practice centres on antimicrobial stewardship and hand hygiene as being the most effective interventions for controlling infection. They have become a central focus for global infection control, with much media attention devoted to their promotion. A disproportionate amount of effort has been put into strategies enticing us to clean our hands, but despite time and money being spent on this, hospital-acquired infections (HCAIs) are still a major problem. The central tenets of Florence Nightingale’s ‘Notes on Nursing’ are still very much present in current infection prevention practices today: most of them are common sense, but what happens when common sense isn’t enough? From an engineering perspective, the future of infection prevention is in smart buildings and real-time contamination prediction. 

‘The Big Five’ is what I call the most prominent routes of infection transmission: direct and indirect contact, common vehicle, droplet and airborne transmission are terms that very rarely exist independently but which are still poorly understood. Some multidrug resistant organisms, such as MRSA and Clostridium difficile, are known to spread through direct contact but many others hitch a ride on airstreams, depositing out onto surfaces metres away from the infectious source. As a result, four or all five of these routes can be involved in pathogen transmission.

The idea that the hospital building, the air and staff behaviour can contribute to propagating infection is not a new one, but often too much effort is invested cheaply into only one aspect at a time. Advancement lies in understanding how these three interact. Hospital airflow patterns are too often slaves to external weather conditions, cold patients and poorly functioning ventilation systems. It’s crucial to remember that the building around us itself is not a static entity, especially in terms of microbial biome, and that the way humans interact with their workspace is surprisingly predictable. Computer simulations at the University of Leeds can now predict the movement of pathogens through the air, how long it will take them to deposit on surfaces and what rate of ventilation would help balance the cost of airborne infection transmission with energy usage. 

Moving forward with connectivity 

We’re at the beginning of an age where every gadget in our homes contains a computer, and this idea of connectivity is now being applied to hospital wards. If you ever wanted to be able to see the movement of microorganisms floating through the air, the technology to make this possible is already here. Infection prevention within five years will see smart systems such as indoor ‘weather’ forecasting, at a fraction of the cost of traditional building management systems. Tiny wireless sensors in clinical areas will relay live air quality data to a central computer which will alert staff when conditions such as low humidity, high temperature or increased bioaerosol counts might increase infection risk. It will combine smart algorithms that can predict staff surface contacts with cleaning rotas to give an up-to-the-minute forecast of which areas might pose a higher risk to patients, particularly those with weakened immune systems or susceptible to airborne pathogens. 

It is time to address the current obsession with the culture of blame and unrealistic hand hygiene targets by balancing out the use of other weapons we have in our infection prevention arsenal. Appropriate antimicrobial stewardship, catheter-care, targeted cleaning, patient screening and good ventilation should go hand-in-hand with future smart technologies. Florence Nightingale is often quoted as saying “hospitals should do the sick no harm”, and this is as current today as it will be in the future.

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