The Role of Robots and Smart Environments in Infection Prevention and Control (IPC) Systems: A Systematic Review

Infection prevention and control (IPC) are paramount in health care settings to mitigate the risk of health care-associated infections. With the advent of advanced technologies, including robotics and smart environments, this systematic review aims to investigate their current utilization and impact on infection prevention and control (IPC) within health care facilities.

Conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines, this review spans research published from January 2016 to October 2022. A search strategy yielded 1,520 citations, of which 17 papers met the eligibility criteria for inclusion.

“The purpose of this paper was to conduct a systematic literature review on the use of robots and automation for IPC purposes in health care settings, focusing on nosocomial infections,” Lead author Davide Piaggio, PhD, School of Engineering, University of Warwick, Coventry, United Kingdom., and his colleagues wrote. “We intended to investigate the performance measures, the health care workers (HCWs) [adherence], as well as cost and resources needed (including personnel, time, infrastructure, existing servers/computer systems, etc) of IPC technologies compared with the gold standard of practice, if existent. This is of vital importance for informing the preparedness plans to tackle the next global health emergency.”

Three main areas of interest emerged from the review:

1. Hand Hygiene and Personal Protective Equipment (PPE) Adherence: Eleven of the 17 studies assessed hand hygiene adherence. The review looked at the effectiveness of automation and robotic technologies in improving hand hygiene practices and PPE adherence among health care workers. These technologies aim to reduce the transmission of infectious agents within hospital settings. While some promising results were reported, widespread adoption remains limited.

2. Automatic Infection Cluster Detection: Two of the 17 studies assessed automatic infection cluster detection systems. Automation played a role in the early detection of infection clusters. By analyzing vast amounts of patient data, machine learning algorithms and smart systems offered a means to identify potential outbreaks swiftly. However, the implementation of such systems faced challenges in terms of data accuracy and integration with existing health care infrastructure.

3. Environments Cleaning and Air Quality Control: Robots and automated systems were explored in 1 article for their effectiveness in cleaning and maintaining optimal air quality within hospitals. Sterilization and air quality control were of particular interest. While these technologies showed promise, they encountered hurdles related to cost, resource allocation, and integration into hospital workflows.

The authors noted that the review underscored a crucial finding: IPC practices in health care facilities predominantly do not rely on automation and robotic technologies. Despite the potential benefits, according to the authors, few advancements have been made in this domain.

To enhance IPC in the Health 4.0 era, there is a pressing need to raise awareness among health care professionals regarding the utility of these technologies. Training programs and active involvement of health care workers in the design and implementation processes are essential steps to drive the transformation toward Health 4.0.

Moreover, according to the investigators, research priorities should extend to finding contextualized alternatives for low-income countries, ensuring that advancements in IPC are accessible and adaptable worldwide.

The COVID-19 pandemic served as a stark reminder of the vulnerabilities within health care systems and the need for innovative solutions. The lessons learned during this crisis have highlighted the urgency of bolstering IPC strategies, with technology playing a pivotal role in this endeavor. “It is clear that automation, digital tools, and robots could have played a key role in the IPC in health care settings,” the authors wrote.

Technological innovation, encompassing robotics, artificial intelligence, and the Internet of Things, is shaping the future of health care. These advancements have the potential to revolutionize IPC, making health care facilities more prepared and resilient in the face of future pandemics and emerging threats.

However, according to the authors, “Furthermore, from the included papers, it is clear that all the emerging technological solutions are not easy to implement, because they are extremely advanced, expensive and their envisioned use environment is up to relevant international standards and minimum requirements. This means that none of them is suitable, as it is, for low-resource settings.”

This systematic review emphasizes the need for greater integration of robots and smart environments into IPC systems. The path forward involves collaborative efforts among health care professionals, investigators, and technology developers to harness the full potential of these innovations in safeguarding public health.