The Important Fight Against Healthcare-Associated Infections in Thailand and Singapore

Healthcare-associated infections (HAIs), which are also known as nosocomial infections, are infections that patients get while receiving treatment for medical or surgical conditions. HAIs can occur in all settings of care—hospitals, surgical centers, ambulatory clinics, and long-term care facilities including nursing homes and rehabilitation facilities. They may account for up to billions of dollars annually in healthcare expenditures.

Routine cleaning and disinfecting are an important part of reducing the risk of exposure to HAI. These include COVID-19, which current evidence suggests may remain viable for hours to days on surfaces made from a variety of materials—which is why the proper cleaning procedures outlined below are so critical.

HAIs in Thailand and Singapore Hospitals

A 2014 study of HAIs conducted at fifty hospitals across Thailand concluded that, “HAIs are major public health problems in the studied hospitals and result in substantial mortality.” Among 15,475 patients, HAI incidence rates at different hospitals ranged from 1.6% to 5%. HAIs occurred with the highest frequency in intensive care units and primarily affected the elderly and infants. The most common HAIs were respiratory tract, urinary, and surgical site infections. Among the patients with HAIs, a sobering 24% died within three months of the survey.

The Journal of the Medical Association of Thailand emphasizes the criticalness of this issue by stating, “Healthcare-associated infections (HAIs) are one of the most important challenges in contemporary medicine. Surveillance of HAIs is essential for infection control programs and reduction of HAIs.

In 2015, Singapore broke ground on HAIs by conducting a country-wide HAI point prevalence survey (HAI-PPS), involving “virtually all public and private acute care hospitals in Singapore.” The nearly yearlong study found among 5,415 patients that 11.9% had HAIs. The researchers noted that the study “suggested a high prevalence of HAIs… in Singapore’s acute-care hospitals.”

Singapore and Thailand have top-ranked healthcare systems. Bloomberg ranked Singapore’s healthcare system the most efficient in the world in 2014. In the 2019 edition of its Health Care Index, CEOWorld magazine ranked Thailand sixth in the world for health care . Considering the prevalence of HAIs in even in two of the world’s best ranked healthcare systems, there is a stark need for vigilance and proper cleaning measures to prevent HAIs.

Reducing HAI Risks

Proper techniques can reduce the likelihood of spreading HAIs—improving patient outcomes and preventing unnecessary hospital readmissions. The first step to reducing the risk of HAIs in healthcare facilities is knowing the potential sources of infection. In healthcare, these are known as reservoirs of infection because they can hold various pathogens and microorganisms.

Maintenance personnel in healthcare facilities should know all potential reservoirs. Administrators should develop checklists for how to clean and maintain patient rooms and common areas. When maintaining patient rooms, cleaning staff may need one checklist for when a patient is occupying a room and another for after the patient is discharged. In cases where a patient is known to have a highly infectious disease, stricter sanitization procedures may be required.

High Touchpoints

According to the Singapore Ministry of Health, housekeeping surfaces “can be divided into two groups – those with minimal hand contact (e.g., floors, and ceilings) and those with frequent hand contact.” Fourteen high touch surfaces “require cleaning on a more frequent schedule.” These are:

Patient Area

  1. Tray table
  2. Bedside table
  3. Side rail
  4. Call box
  5. Telephone
  6. Chair
  7. Room doorknobs

Toilet Area

  1. Sink
  2. Toilet seat
  3. Toilet handle
  4. Toilet doorknobs
  5. Toilet hand hold
  6. Bathroom light switch
  7. Bedpan cleaner

Surfaces closer to patients pose a greater risk for transmission, while frequently touched surfaces are more likely to harbor and transmit microbial pathogens. It is therefore “more cost-effective to concentrate cleaning resources on high risk, high touch surfaces.