Keep a hand on hygiene

Hand hygiene has received unprecedented attention during the Covid-19 pandemic, but good hand hygiene is also vital in preventing antimicrobial resistance (AMR) and many infections acquired in healthcare.

Infection acquired during health care delivery is a major problem worldwide, but patients in low- and middle-income countries are twice as likely to experience this as those in high-income countries, the World Health Organization (WHO) points out.

Out of every 100 hospitalised patients, it is estimated that seven patients in developed countries and 15 patients in developing countries will acquire at least one infection following treatment in a healthcare facility. The risk in intensive care units (ICU), especially among newborn babies, is between two and 20 times higher.

“Hand hygiene plays a key role in the prevention of all hospital infections,” says Jennifer Collins, an infection prevention and control (IPC) expert for the WHO southern Caucasus hub. “Hand hygiene programmes can reduce health-care associated infections (HAIs) by 50% if implemented properly.”

This is great as the knock-on effects of HAIs include prolonged hospital stays, long-term disability, increased antibiotic use leading to AMR, additional financial burdens, and excess deaths.

Unfortunately, in some low-income countries, only one in 10 health workers practise proper hand hygiene while caring for patients at high risk of HAIs in ICU – often because they simply do not have the facilities to do so.

Lack of financial resources and crumbling infrastructures are key challenges. A WHO publication, Global progress report on WASH in health care facilities: Fundamentals first, reveals that, globally, one in four health care facilities do not have basic water services and one in three lack hand hygiene supplies at the point of care.

Furthermore, according to a global survey that the WHO did across 88 countries, the level of progress of hand hygiene plus infection prevention and control programmes, especially regarding actual implementation, was significantly lower in low- than in middle- and high-income countries.

In 2018 only 45% of low-income countries had a functional national IPC programme compared to 53% and 71% of middle- and high-income countries. Dedicated budget to support it was available in only 5% of low-income countries as opposed to 18% and 50% of middle- and high-income countries.

While national guidelines on IPC practices existed in 50% of low-income countries and 69 to 77% of middle- and high-income countries, only 20%, 29% and 57% had implementation plans and strategies in low-, middle- and high-income countries respectively. Overall, only 22% of all countries monitored implementation roll-out and impact.

“This is unfortunate as an investment in effective IPC strategies can also yield significant financial returns,” the WHO points out. “Implementation of hand hygiene policies can generate economic savings averaging 16 times the cost of their implementation.

“Health care workers’ compliance with hand hygiene practices is one of the key performance indicators for IPC, patient safety and quality of health services worldwide.”

While few countries can monitor IPC effectively, the WHO offers a monitoring portal through a protected online platform. This allows countries to keep a hand on hygiene as they can collect data in a standardised and user-friendly manner and download their situation analysis (following data entry) along with advice on areas and approaches for improvement.