With healthcare-associated infections rising, increasingly impacting patient outcomes and NHS finances, hospitals have the opportunity to implement new evidence-backed solutions that yield improved results, rather than those historically relied on, writes Professor Mark Wilcox.

Healthcare-associated infections (HCAIs) remain a significant global challenge, posing a persistent threat to patient safety. In the UK alone, HCAIs are pressurising the NHS in a variety of ways, ranging from increased occupied bed stays as well as absenteeism among frontline healthcare professionals. HCAIs can lead to prolonged hospital stays, severe health complications, and even fatalities.

HCAIs are particularly concerning for vulnerable populations, such as the elderly, immunocompromised individuals, and those undergoing surgical procedures. Despite ongoing efforts to enhance infection control measures, HCAIs continue to account for thousands of preventable illnesses and deaths each year. In the latest (2023) point prevalence survey on HCAIs in England, 121 NHS trusts and independent-sector organisations participated, representing data for more than 44,000 patients. Overall, ~1 in 13 patients (7.6 per cent) had at least one HCAI.

One of the biggest challenges in combating HCAIs is that they arise in environments where individuals are already unwell and highly susceptible to infection. The nature of hospitals —where patients with various conditions typically share spaces, where medical devices and implants are frequently implanted, used and removed, as well as where healthcare workers move rapidly between cases — unfortunately creates multiple risks for the spread of pathogens. The burden is immense, with infections caused by Clostridioides difficile (C. diff), Methicillin-Resistant Staphylococcus aureus (MRSA), and Gram-negative bloodstream infections posing serious risks – all of which are increasing in the UK since the pandemic.

The financial implications of HCAIs are stark. HCAIs cost the NHS billions annually, primarily due to extended hospital stays, with the need for additional treatments, and more complex medical interventions. They also contribute to staff shortages when healthcare workers become infected, further disrupting an already overburdened system.

One of the most effective ways to prevent infections is through optimal hand hygiene. However, compliance rates among healthcare workers remain worryingly low, ranging between 40 per cent and 60 per cent. Despite strict guidelines, busy hospital environments make it difficult for staff to consistently follow hand hygiene protocols, putting patients at risk.

The World Health Organization (WHO) introduced the “5 Moments of Hand Hygiene” to address this issue, outlining key moments when healthcare workers should clean their hands. However, studies suggest that the complexity of this system makes it difficult to follow in practice. In high-pressure hospital settings, staff often struggle to meet all the requirements, highlighting the need for a simpler, more effective approach.

Rethinking hand hygiene: Simplicity over complexity

Effective hand hygiene policies need to be practical and easy to follow. Studies show that when processes are intuitive and fit naturally into daily workflows, adherence rates improve significantly. However, the WHO’s current hand hygiene framework, while well-intentioned, is often carried out with low compliance in real-world hospital environments.

Healthcare workers operate in fast-paced, high-stress settings where they must prioritise patient care while managing multiple urgent tasks. In such conditions, overly complex protocols can inadvertently lead to lower hand hygiene compliance. Hospitals need to consider alternative strategies that streamline hygiene practices without compromising safety. A growing body of research supports the idea that simplifying hand hygiene procedures can lead to higher adherence rates, ultimately reducing the spread of infections.

The role of new technologies in infection prevention

To truly tackle HCAIs, hospitals should look beyond traditional hand hygiene methods and embrace innovative technologies designed to improve infection control. Several promising solutions are emerging:

  • Sustained, broad spectrum antimicrobial hand protection – Unlike alcohol-based hand sanitisers, which provide short-term protection, new antimicrobial coatings such as Primel’s Active Hand Shield offer prolonged defence against pathogens as well as reduces the transmission of pathogens. These coatings create an invisible barrier on the skin that continuously kills a wide range of pathogens for extended periods. Instead of requiring healthcare workers to repeatedly sanitise their hands throughout their shifts, this technology forms a long-lasting antimicrobial barrier that kills the broadest spectrum of pathogens upon contact and continues to offer protection for hours after application.
  • Antimicrobial surfaces and self-sanitising materials – Hospitals are increasingly exploring the use of antimicrobial materials on high-touch surfaces such as bed rails, door handles, and medical equipment. Antimicrobial surface technologies have shown promise in reducing bacterial contamination in hospital environments.
  • Advanced regimens – Updating the systems which accompany the innovative technology improvements provides additional benefits to the healthcare environment. These improvements of systems which are regularly relied upon help to enhance patient safety and elevate the efficacy of implementing new technologies.

A call for change in the UK healthcare system

As infection rates continue to pose a serious challenge, the UK healthcare sector should adapt to new opportunities to tackle these issues. Hospitals have the opportunity to implement new evidence-backed solutions that yield improved results rather than those historically relied on. Policymakers should take action by:

  1. Reevaluating current hand hygiene policies – the NHS and infection control teams should assess whether improvements in existing guidelines are available with the implementation of innovative technologies. Low compliance remains an issue after decades, indicating a need to shift towards more effective and efficient methods.
  2. Investing in research and development – infection is a critical challenge to all global healthcare systems and prioritising these issues within government institutions will help to elevate the priority of aspects such as hand hygiene compliance. More funding is likely to be allocated to testing and implementing new technologies that have the potential to improve infection prevention and control.
  3. Encouraging adoption of proven innovations – hospitals should be supported in adopting antimicrobial solutions, such as Primel’s active hand shield, and their supporting surface technologies that are able to drive meaningful change in routine infection prevention interventions.
  4. New methods for enhancing efficacy and efficiency – any novel innovation must be accompanied by comprehensive protocols to ensure staff can integrate these solutions into their daily routines effectively and efficiently to improve patient safety.

With experts across the UK healthcare sector calling for urgent action, there is a clear collective need to embrace innovation if we hope to reduce HCAIs and the burden they place on patients and staff alike. There is opportunity now: hospitals should implement practical, evidence-based infection prevention solutions to protect patients, professionals and visitors across all their care facilities.

The challenge is upon us and organisations such as Primel are in a position to confront these issues on a mass scale. The question remains – how will UK hospitals take this opportunity?