Infection control at Christmas: Have a Hygienic Holiday

Christmas Hospital

“Deck the halls with rows of trolleys” is just one headline of many reports with the same conclusion: Emergency departments world-wide are busiest over long holidays.1,2,3 Anecdotally, the theories as to why include over-indulgences, crowded celebrations leading to germ-sharing or the merger of cold weather and the flu season. As another major holiday period approaches, both medical practitioners and patients should think about prevention: What is it they can do to avoid, or lessen the effects of, holiday-time illnesses? What are effective measures for infection control at Christmas? Here are our four ideas for the holiday season:

1. Ornaments and decorations:

Holiday decorations can bring cheer in home and clinical settings alike. Unfortunately, they can also carry germs. Many ornaments, and Christmas trees, cannot be washed or easily cleaned, so they can harbour dirt, dust and even norovirus. Consider, also, using an artificial tree to avoid the risks from pine needles. Experts from the NHS and nursing advise replacing decorations every five years – and throwing out decorations that are located at the sites of viral outbreaks.4,5

2. Teamwork for holidays:

With your colleagues on holiday or the practice closed for several days over the festive fortnight, patients’ demand for appointments can rise. Make sure to plan staff rotas way ahead and consider making contingency plans in case of staff illness.6 Your team needs to remain extra alert: If cleaning staff are on vacation, for example, everyone needs to take special care to wipe surfaces and do prompt clean-ups.6 Amidst the bustle of the holidays, proper surface disinfection* remains the gold standard.

3. Preventing holiday bugs:

As your offices fill up during limited holiday opening hours, or your hospital’s waiting room receives the overfill, patients and staff alike can lessen the risk of illness by receiving an annual flu shot.6,7 According to a report in the American Journal of Infection Control, Christmas wellness starts by everyone paying greater attention to hand hygiene.8 The authors also warn that, in the event of a flu pandemic, good hand hygiene will be the first line of defence during the early critical period before mass vaccination becomes available. This report follows a British Medical Journal study which indicates that physical barriers, such as regular handwashing and wearing masks, gloves and gowns may be more effective than drugs in preventing the spread of respiratory viruses such as influenza and SARS.9 If you want to make a meaningful Christmas gift to your patients, maintain a full and well-marked supply of alcohol-based hand rub* in waiting rooms, bathrooms, and building entrances and exits.

4. Better to stay hands-off:

With each greeting of “Happy Holidays” comes handshaking. But it’s known that handshaking is a vector for bacterial transmission. In addition to hand hygiene, researchers have investigated alternatives –including the “fist bump.” A study published in the Journal for Hospital Infection, for example, has shown that implementing the fist bump in healthcare settings may further reduce bacterial transmission between healthcare providers by reducing contact time and total surface area exposed when compared with the standard handshake. 10 Another research team has established a handshake-free zone (HFZ) at the UCLA (University of California, Los Angeles) Hospital. According to the researchers, patient families and most HCPs supported the implementation of an HFZ. They didn’t simply ban handshake but suggested other options: a fist bump, a smile, a bow, a wave or a non-contact Namaste gesture.11 And there was one other option: even a kiss (on the cheek) under the mistletoe… 12

further information

  1. Deck the halls with rows of trolleys . . . emergency departments are busiest over the Christmas holiday period, Wei Zheng et al., Medical Journal of Australia
  2. Emergency Department During Long Public Holidays, Seda Dagar et al., Turkish journal of emergency medicine
  3. More people go to the emergency room during the holidays — here’s why, according to ER doctors, Hilary Brueck, Businessinsider
  4. Do Christmas decorations pose an infection risk?, Julie Hughes, Nursing Times
  5. Miscellaneous Infection Control Guidance, NHS Borders
  6. The 12 Risks of Christmas, Dr Clare Redmond, Medical Protection
  7. Grippeschutzimpfung: Häufig gestellte Fragen und Antworten, Robert Koch Institut
  8. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers, Sally F. Bloomfield et al, American Journal of Infection Control
  9. Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review, Tom Jefferson et al., BMJ
  10. Reducing pathogen transmission in a hospital setting. Handshake versus fist bump: a pilot study., Ghareeb PA, Journal of Hospital Infection
  11. Handshake-free zone in a neonatal intensive care unit: Initial feasibility study., Parga JJ et al., American Journal of Infection Control
  12. Cheeky kiss is healthier than a handshake, Richard Gray, The Telegraph

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