Infection Control

Sterilization and Infection Control

The basic steps to ensure patient safety

Sterilization and infection control are the cornerstone of patient and medical staff safety within the hospital environment, which is what hospitals and medical facilities have been working on in the past years to ensure that they are infection-free. In addition, international certificates of accreditation place sterilization and infection control at the very top of their priority list before granting accreditation to any institution.

For that purpose, infection control departments have been established in hospitals that work to implement specialized programs aimed at preventing or stopping the spread of infection among patients and hospital staff, through the application of a set of policies, guidelines and preventive measures.

For instance, standard procedures based on risk assessment and personal protection methods are used to protect healthcare providers from infection and prevent cross-contamination, while seeking to apply various methods that provide a clean infection-free environment.

Hospitals are keen to follow the guidelines set by international authorities such as the World Health Organization, the Joint Commission International and other global and international authorities concerned with infection control and patient safety in hospitals. In this dedicated department, employees are trained and educated on how to apply the best healthcare practices and improve the correct medical practices. The Infection Control Department also aims at keeping the hospital clean and germ-free, while having sterile devices and tools, by selecting materials that have been globally tested to sterilize medical equipment and tools. The goal is to ensure staff safety and to provide a clean infection-free workplace through regular examinations, preparing periodic reports and conducting monthly laboratory swabs, in addition to striving to provide state-of-the-art technologies, supplies and special means that help prevent the spread of infection.

Regular handwashing is one of the most effective ways to prevent the spread of germs. Clean hands can stop germs from spreading from one person to another and throughout an entire community—from your home and workplace to childcare facilities and hospitals.

The use of gloves is also fundamental and should not be considered an alternative to performing hand hygiene. Hand hygiene is required before putting on gloves and immediately after removal. Gloves should be changed between tasks and procedures on the same patient and should be removed immediately after a procedure and hand hygiene performed so as to avoid contaminating the environment.

These are among the most important procedures stipulated in global health policies and implemented by hospitals to ensure the continuity of obtaining the global healthcare accreditation certificate. Hence, infection control in hospital departments is a top priority and of utmost importance and is applied in accordance with several procedures and policies within the best practices and international standards in order to ensure security and safety of patients and hospital staff, and enhance the patient’s trust in the healthcare system.

Since any hospital worker may be exposed to infection, there is an infection control work methodology that relies on several pillars, namely risk assessment and control, setting policies and procedures to prevent its spread and providing infrastructure that ensures safety for high-risk procedures, in addition to focusing on mainstreaming policies and procedures with the aim of upgrading the staff experience to reduce risks within performance indicators that conform to the highest international levels through infection monitoring systems and identification of the most severe health conditions.

Smart Sterilization Robots for Patient Rooms

Smart robots are increasingly advocated as a simple solution for the immediate disinfection of rooms and spaces of all surfaces in one process and as such they seem attractive to hospital management. However, disinfection robots do not replace manual cleaning but complement it.

Robots have been successful in cleaning and sterilizing hospitals, which was fundamental during the coronavirus pandemic, as hospitals THE SMART STERILIZATION ROBOT IS THE LATEST ADVANCED TECHNOLOGY SOLUTION FOR SAFE STERILIZATION THAT ENSURES A SAFE EXPERIENCE FOR PATIENTS AND MEDICAL STAFF IN ALL DEPARTMENTS AND FACILITIES.

are increasingly adopting robots that are able to kill germs, viruses and bacteria as well as sterilize rooms in a few minutes.

The robot is the latest advanced technology solution for safe sterilization in a way that ensures a safe experience for patients and medical staff in all departments and facilities. The robot can navigate around a room and thoroughly sterilize the entire operating room in record time (no more than seven minutes) without the need for human intervention.

The UV robot has the ability to move automatically and ensures greater and better coverage of high-contact areas. The robots use ultraviolet-powered sterilization whilst scanning all rooms and corridors in its facilities. Each robot can complete exhaustive sterilization of a room in no time. Moreover, the robots provide 360-degree coverage and can repeat the same process with high accuracy several times.

The smart sterilization robot is like a revolutionary innovation in the world of safe sterilization. UV-disinfection robots offer a no-touch technology, delivering disinfection by irradiation of effective intensity to kill microorganisms in operating rooms, ICUs, outpatient clinics, hospital corridors, etc.

Cross-infection prevention

Handwashing is the most important preventive measure against cross-infection. Medical professionals follow special procedures to help prevent infections. Aseptic technique is a common process used to sterilize equipment so harmful microorganisms can’t spread from patient to patient.

Wearing gloves helps protect both patients and healthcare workers from infection. Gloves help keep your hands clean and lessen your chance of getting germs that can make you sick. Healthcare workers should wear gloves every time they touch blood, bodily fluids, bodily tissues, mucous membranes, or broken skin. They should wear gloves for this sort of contact, even if a patient seems healthy and has no signs of any germs. WEARING GLOVES HELPS PROTECT BOTH PATIENTS AND HEALTHCARE WORKERS FROM INFECTION. GLOVES HELP KEEP YOUR HANDS CLEAN AND LESSEN YOUR CHANCE OF GETTING GERMS THAT CAN MAKE YOU SICK. HEALTHCARE WORKERS SHOULD WEAR GLOVES EVERY TIME THEY TOUCH BLOOD, BODILY FLUIDS, BODILY TISSUES, MUCOUS MEMBRANES, OR BROKEN SKIN.

Hand hygiene is described by many healthcare workers as the single most important tool in preventing the spread of healthcare-associated infections between patients. The five moments of hand hygiene outlined by WHO are: Before patient contact; before aseptic task; after bodily fluid exposure; after patient contact; and after contact with patient surroundings.

Workers in operating rooms, including surgeons, assistants and others, should wash their hands and forearms with an antiseptic soap for 3-5 minutes before touching the patient.

Healthcare Apparel

Healthcare apparel is also part of sterilization; employees can usually wear their normal clothes under their white scrub. But in special departments such as ICUs and operating rooms, uniform pants and a short-sleeved gown are required for men and women, and these clothes are made of an easy-to-wash material. The uniform should also be changed after exposure to blood or if it became wet through excessive sweating or exposure to other fluids.

Other basic hygiene procedures include ensuring all staff have access to single-use disposable gloves, making sure all staff can easily access hand washing facilities or hand sanitizer and safe disposal of clinical waste, blood and other body fluids. The healthcare worker should assess the level of risk of splashes or sprays of blood or body fluids, and secretions or excretions involved in the procedure being undertaken and wear appropriate apparel, ie. plastic apron, gown, mask, goggles, face shield.

All healthcare workers must take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices. The adoption of safe work practices and correct disposal is incumbent on all who use sharps. The maintenance of a safe environment for patients incorporates the basic requirement that the area a patient is nursed in, and equipment used on the patient is hygienically clean. HEALTHCARE APPAREL IS ALSO PART OF STERILIZATION; EMPLOYEES CAN USUALLY WEAR THEIR NORMAL CLOTHES UNDER THEIR WHITE SCRUB. BUT IN SPECIAL DEPARTMENTS SUCH AS ICUS AND OPERATING ROOMS, UNIFORM PANTS AND A SHORTSLEEVED GOWN ARE REQUIRED FOR MEN AND WOMEN, AND THESE CLOTHES ARE MADE OF AN EASYTO-WASH MATERIAL.

Diabetes: Managing care by leveraging AI

By Dr. Maryam Sayed Jaffar AlSharaf, Director, Data and Statistics - Emirates Health Services & Dr. Bashar Balish, General Manager & Senior Director – Middle East & Africa, Cerner

Over the past few decades, the burden of chronic diseases has significantly increased all over the world, contributing a substantial cost to the healthcare systems. These diseases are responsible for a major proportion of the top ten causes of death globally, especially in middle-to-high income countries.

Chronic disease management requires a very comprehensive approach with sustained efforts to cover all segments across the spectrum of these complex diseases. While efforts are required to manage the chronic conditions, many resources are also required to prevent disease complications. To create relevant and effective disease management strategies, the role of data is more paramount than ever before . Data is increasingly being utilized to curate healthcare programs and it continues to be a source of program evaluation and enhancements in the healthcare industry. Of the many ways employed to utilize data for insights creation, visualizations have proven to be a very effective tool for creating system insights for leaders and decision-makers. Diabetes is one of the leading chronic diseases in today’s world. With an expectation of the global burden of disease to increase manifold in the years to come, healthcare leaders are looking into insightful, evidence-based approaches to address this issue.

Approach towards designing the data-driven Diabetes Management

With a mission of providing innovative and high-quality care to its patients, Emirates Health Services (EHS) has a patient-centric focus. There is a high emphasis on improving healthcare quality that is aligned with the international sustainable development goals. With the increasing burden of chronic diseases and categorical increase in diabetes cases in the past few decades, EHS leadership required insights into WITH THE INCREASING BURDEN OF CHRONIC DISEASES AND CATEGORICAL INCREASE IN DIABETES CASES IN THE PAST FEW DECADES, EHS LEADERSHIP REQUIRED INSIGHTS INTO THEIR POPULATION STATISTICS FOR THE CONDITION. THESE INSIGHTS WOULD BE UTILIZED AS THE EVIDENCE BASE FOR PLANNING AND MANAGEMENT OF DIABETES CARE PROGRAMS FOR THE POPULATION.. their population statistics for the condition. These insights would be utilized as the evidence base for planning and management of diabetes care programs for the population.

To meet these expectations, we designed a data-driven solution utilizing Cerner EHR (called Wareed) data. This is a dashboard that gives EHS leaders a view of the distribution and well-being of their diabetic population across their entire network.

The program was launched on World Diabetes Day, November 14 2021, and consists of a series of visualizations that are based on several customized reports catering to different requirements of diabetes care and management. The data analyzed spans from patient demographic details to clinical outcomes. The team worked on creating multiple reports that could accommodate massive amounts of data over a span of six years, representing the diabetic cohort enrolled with EHS.

There are actionable insights into the service utilization frequencies and trends through visits analysis, which gives leaders an understanding of their resource consumption and requirements.

Besides showcasing trends of service utilization, advanced analytics techniques were used to predict future visits that would support leaders in foreseeing the expected service utilization in the future. This can serve as an effective tool for future program planning and management by program leaders.

There are visualizations that project the burden of disease and trends over a period of time. These trends can be mapped against geographical location, age category and gender of patients. Moreover, the program includes clinically-rich analytics displayed over layers that cover patient comorbidity conditions and their risk factors for disease complications. The diabetes care coordinators utilize this program to view continuity of care for their patients’ cohort, which also reflects upon compliance to recommended care practices by EHS clinicians.

Bringing Artificial Intelligence into action

The platform includes a unique patient traceability feature that can be utilized by care coordinators to identify their vulnerable populations. This function is supported by the analytics feasibility to identify the coexistence of different clinical conditions at a patient level. This information can be tied back to the patient management process and used to reach out to highrisk patients through the information displayed. Clinically, it is significant for the care team to identify their patients who require a tailored approach to disease control. This rich data set can be utilized to create advanced analytics models utilizing artificial intelligence. These models can help identify high-risk characteristics from the EHS population that predispose them to a risk of poor disease control. To further elaborate on the significance of such capabilities, it can also be utilized to identify the financial impact of such preventive interventions by avoiding high resource consumption visits and events.

Supported by the huge volume of data available and utilizing the machine learning capabilities, a new AI model was built that utilizes historical data to identify features of patients at risk of poor disease control. The model predicts individuals who are at risk of deterioration in the future and patient traceability features helps to bring them back into the health system. This clinical decision support gives information to clinicians about the diabetics that need close monitoring and enhanced care NOW to reduce disease burden. By meaningful use of machine learning and advanced analytics techniques, this program provides insights that can be utilized to plan resources, identify clinical practice compliance, find out the burden and distribution of diabetes, highlighting the high-risk patients and provides the facilitation to reach out to such patients for prompt action and improved patient management. It displays a wealth of information that would support decision-makers in identifying high achievements as well as areas of refined focus for future action by using epidemiological as well as clinical evidence. THE PLATFORM INCLUDES A UNIQUE PATIENT TRACEABILITY FEATURE THAT CAN BE UTILIZED BY CARE COORDINATORS TO IDENTIFY THEIR VULNERABLE POPULATIONS. THIS FUNCTION IS SUPPORTED BY THE ANALYTICS FEASIBILITY TO IDENTIFY THE COEXISTENCE OF DIFFERENT CLINICAL CONDITIONS AT A PATIENT LEVEL. THIS INFORMATION CAN BE TIED BACK TO THE PATIENT MANAGEMENT PROCESS AND USED TO REACH OUT TO HIGH-RISK PATIENTS THROUGH THE INFORMATION DISPLAYED.

Kidney Disease and Diabetes go hand in hand

Diabetes is the leading cause of chronic kidney disease

Numerous diabetic patients suffer from diabetic nephropathy, which is a complication that is expected to occur over the years due to uncontrolled diabetes. Diabetic nephropathy affects the kidneys' ability to do their usual work of removing waste products and extra fluid from your body. Over time, the two diseases form a group of complications that affect all parts of the body. Over time, the high blood sugar levels damage the millions of tiny filtering units within each kidney. This eventually leads to kidney failure.

Diabetic nephropathy takes many years before it develops and symptoms appear. It rarely occurs in the first ten years of diabetes onset. Symptoms begin about 15 to 20 years after the diagnosis of type 1 diabetes.

Why does sugar affect the kidneys?

Your kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Severe damage to these blood vessels can lead to diabetic nephropathy, decreased kidney function and kidney failure. Damage to the kidneys puts stress on these vital organs and prevents them from working properly. When this happens, the body starts to lose protein through the urine, the kidneys cannot remove waste products from the blood and the kidneys cannot maintain healthy fluid levels in the body. Patients with diabetes and microalbuminuria who progress to macroalbuminuria are more likely to progress to end-stage renal disease.

However, it is difficult to determine if a diabetic patient will develop diabetic nephropathy, but there are some risk factors that increase the risk of its occurrence, namely:

• Type 1 diabetes diagnosed before the age of 20 • Uncontrolled diabetes, meaning that the patient suffers from high or low

blood sugar levels • Uncontrolled hypertension. • Family history of diabetes and chronic kidney disease.

Diabetes harms the kidneys in several ways, including:

• Damage to the blood vessels inside the kidneys. Over time, high blood sugar levels can cause these blood vessels to get narrow and clogged. As your kidneys get less blood, less waste and fluid is taken out of your body. When your kidneys are not working as well as they should, protein can leak through your kidney's filters and into your urine. • High blood sugar damages the nerves, and these nerves may stop sending messages to different parts of your body including the bladder. If the nerves of the bladder are damaged, the patient does not feel that it is full. This pressure on the bladder causes damage to the kidneys. • If urine remains in the bladder for a long time, the patient can develop a urinary tract infection due to bacteria, especially as they grow rapidly in the urine with the high level of sugar. These infections often affect the bladder, but they may sometimes spread to the kidneys.

Early signs and symptoms

The diabetic patient should do regular check-ups, especially in the case of type 1 diabetes. Having even a small amount of albumin in your urine (microalbuminuria) is a sign that early kidney damage is present. Research suggests that people with albumin in their urine are more at risk of eventually developing kidney or cardiovascular problems. Early detection limits the development of the condition, but the delay in diagnosis and the lack of appropriate treatment leads to an increased excretion of DIABETIC NEPHROPATHY TAKES MANY YEARS BEFORE IT DEVELOPS AND SYMPTOMS APPEAR. IT RARELY OCCURS IN THE FIRST TEN YEARS OF DIABETES ONSET.

urinary albumin. Macroalbuminuria of clinical nephropathy is when albumin excretion in a 24hour urinary collection is greater than 300 mg continuously; this is called nephrotic syndrome.

When should we perform a urine microalbumin test?

Screening for microalbuminuria should be initiated five years after diagnosis of type 1 diabetes and at diagnosis of type 2 diabetes. The test should be repeated annually. During the microalbumin test, you simply need to provide a fresh urine sample. Your doctor may ask you to collect all of your urine in a special container over a 24hour period and submit it for analysis. Your doctor may ask you to provide a urine sample first thing in the morning or after a four-hour period of not urinating. A random urine test can be taken at any time. But to improve accuracy of the results, it's often combined with a urine test for creatinine — a waste product usually filtered by the kidneys.

Managing diabetes means managing blood glucose, blood pressure, and cholesterol. The patient should follow a healthy diet, exercise regularly while taking the right medications to help control his blood sugar levels. Patients should also control their glucose levels and take measures to lower blood pressure such as losing weight, reducing salt intake, quitting smoking, and increasing activity levels.

Treatment

The most important steps of treatment and complication prevention include good control of blood sugar levels, undergoing regular checkups, especially urine microalbumin test because it indicates the presence of changes in the blood vessels that filter blood and eliminate waste.

Angiotensin-converting enzyme (AEC) inhibitors are a type of medications that lower the blood pressure. ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder. Angiotensin II also releases hormones that raise blood pressure. Reducing salt intake is an important step in the nutritional program developed by a nutritionist and adopted by the patient due to the damage it causes to the kidneys, in addition to limiting the consumption of animal protein such as meat and others. SCREENING FOR MICROALBUMINURIA SHOULD BE INITIATED FIVE YEARS AFTER DIAGNOSIS OF TYPE 1 DIABETES AND AT DIAGNOSIS OF TYPE 2 DIABETES. THE TEST SHOULD BE REPEATED ANNUALLY.

What is the diet of a patient with diabetic nephropathy?

An appropriate diet and drug treatment have an effective role in maintaining kidney health and controlling blood sugar level. Therapeutic nutrition for these patients aims to maintain glucose levels and improve lipid levels, as well as reduce blood pressure and complications of diabetes, including heart, eye, nerve, and kidney diseases.

A low-protein diet should be followed as it puts less strain on the kidneys. As a result, this type of diet can benefit people with kidney-related disorders such as kidney disease. A low-protein diet can reduce the loss of protein through the urine and increase protein levels in the blood. The patient should also reduce or stop his salt intake and the doctor may ask him to stay away from citrus fruits, sweets, and various baked goods. Both sugary and starchy carbohydrates can raise blood sugar levels. In addition, a diet with more fruits and vegetables and less or no animal protein may lower acid in the body to promote kidney health. Prevention is the most effective way to protect the kidneys from diabetic disorders, and the most important step is to maintain normal blood sugar levels by following a healthy diet, exercising regularly and taking the medications as prescribed by the treating physician.

Foods to avoid if you have diabetic nephropathy

• Processed meats that are made by drying, salting, curing, or smoking meats which eliminate all nutrients. • Sodas, especially dark-colored varieties, as they contain 90–180 mg of phosphorus per 355-mL serving. Healthy kidneys can easily remove excess phosphorus from the blood, but this isn’t the case when you have kidney disease. • Fruit juices and other sugar-sweetened beverages because they contain many preservatives and added sugar that can cause rapid spikes in blood sugar. • High potassium fruits such as bananas, avocados, apricots, kiwis and oranges.

Fortunately, there are plenty of healthy

low potassium fruits you can add to your diet in moderation as long as you monitor your carb intake. Grapes, berries, pineapple, mango, and apples are a few examples. • Processed foods as they are high in sodium which actually alone makes up 60-70% of the daily sodium allowance. • Dried fruits aren’t ideal for people with kidney disease and diabetes because they’re high in sugar and minerals like potassium. • For people with kidney disease and diabetes, beans and lentils are not ideal due to their relatively high phosphorus content. Canned versions are typically also high in sodium. • Various leafy green vegetables, such as spinach, chard and beet greens, because they contain high amounts of nutrients like potassium. A LOW-PROTEIN DIET SHOULD BE FOLLOWED AS IT PUTS LESS STRAIN ON THE KIDNEYS. AS A RESULT, THIS TYPE OF DIET CAN BENEFIT PEOPLE WITH KIDNEYRELATED DISORDERS SUCH AS KIDNEY DISEASE.