The role of environmental and healthcare-associated infections in Asia: Lessons learned from the coronavirus disease 2019 (COVID-19) pandemic

Environmental cleaning and disinfection practices have been shown to reduce microorganism bioburden in the healthcare environment. Due to the coadministration of high-dose steroids and the prolonged duration of mechanical ventilation, coinfection with multi-drug-resistant organisms (MDROs) among coronavirus disease 2019 (COVID-19) patients is common in critical care patients, with a prolonged length of stay in critical care units. Furthermore, the rush of creating of negative-pressure units during the COVID-19 pandemic may have resulted in some outbreaks associated with molds such as Aspergillus and Zygomyces. In countries where they are prevalent, emerging fungal outbreaks, such as Candida auris outbreaks, have been reported. The control of MDROs among COVID-19 patients is also difficult, given the requirement for airborne plus contact isolation among these patients and the difficulty in wearing and changing personal protective equipment (PPE) in a critical care unit. The control of invasive fungal infections (IFIs) also requires practice of proper infection prevention and control (IPC) during construction and renovation. In this commentary, we provide evidence of how environment contribute to HAIs in Asia. We discuss how to properly disinfect and decontaminate healthcare environment, and we provide suggestions on how to improve air quality and water quality during COVID-19 pandemics.