Overview of hospital associated infections and the role of POCT in disease managementOverview of hospital associated infections and the role of POCT in disease management

The World Health Organization (WHO) affirms that healthcare-associated infections (HAI) pose a significant global public health concern. A larger number of microorganisms are lurking in healthcare settings and causing a variety of infections whenever aseptic techniques are lacking. These infections include but are not limited to, central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia.

The HAI worldwide prevalence, impact, and burden triggered many countries to develop and implement several strategies to reduce their incidence. These strategies were required and encouraged because many of these HAIs are deemed preventable. The core of the strategies tackling HAI is vested in well-established and effective infection control programmes. These programmes help reduce the HAI attributable morbidity and mortality rates, reduce prolonged hospital stays, and reduce unnecessary economic costs.

Related: Addressing antimicrobial resistance and its impact on human vulnerability

Even though a precise quantification of HAIs is not easy to establish, the WHO estimates suggest that millions of patients are affected by HAIs each year, and prevalence varies across regions and healthcare settings, with higher rates often observed in low and middle-income countries. The additional medical interventions, unnecessary prolonged hospitalisation, and the use of resources such as antibiotics and laboratory tests lead to a significant financial and economic burden to patients, healthcare, and insurance providers equally. Furthermore, their economic burden extends beyond the healthcare sector to include costs related to lost productivity and the negative impact on patients’ quality of life. HAIs are considered a major driver in antibiotic resistance because antimicrobials are often needed to treat these patients.

The launch of POCT testing for infectious disease diagnosis in the past decade gained substantial attention in scientific papers. Mentioning a few examples, we appreciate its simplicity, short turnaround time, wide accessibility, and prompt diagnosis of infectious diseases especially where resources are scarce. POCT to detect respiratory viruses such as influenza allows quick identification and implementation of appropriate isolation and treatment measures. POCT for blood cultures and sensitivity can help select the most effective antibiotics, and therefore reduce the risk of antimicrobial resistance.

When used in active surveillance testing for MRSA (Methicillin-resistant Staphylococcus aureus) or Clostridioides difficile, POCT enables early detection and isolation of patients, eliminating potential outbreaks. Another use is in testing for C-reactive protein (CRP) or procalcitonin, which are the two central inflammatory markers in detecting sepsis and predicting potential deaths. The role of POCT is not limited to the inpatient healthcare settings.

Related: Strategies to optimise clinical sterilisation

During the COVID-19 pandemic, POCT gained merit for swift and efficient contact tracing. It became convenient because it allowed mass screening and surveillance. Its clinical value was indeed underscored, and, it enabled testing populations in remote or underserved areas where access to centralised laboratories is limited.

In summary, POCT provides rapid results for quick decision-making, allowing prompt isolation and management of patients when required, and in return, it reduces the risk of cross-transmission within healthcare facilities and communities.

References available on request.

Elias Tannous is an Infection Control Specialist at Cleveland Clinic Abu Dhabi.

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