WHO:Save lives: Clean your hands
4 May 2012 New Delhi: The World Health Organization today raised an alarm about the large number of healthcare-associated infections (HCAI) acquired during medical or surgical procedures. These infections can result in prolonged hospital stay, long-term disability, increased resistance to antibiotics and sometimes, death. They substantially increase the financial burden on the patient and health systems. HCAI can be prevented and the burden reduced by as much as 50% or more through good hand hygiene. On 5 May, WHO’s initiative, “Save lives: Clean Your Hands”, will focus on the importance of hand hygiene in hospitals and health care facilities to reduce healthcare-associated infections.
“There is clear evidence that hundreds of millions of patients are infected every year worldwide by healthcare-associated infections. Low and middle-income countries bear a huge burden of these infections” said Dr. Samlee Plianbangchang, WHO Regional Director for South-East Asia. “There is an urgent need to establish reliable systems for surveillance of such infections to assess the actual burden. This must be treated as a priority patient safety issue” he added.
The risk of HCAI is universal and pervades most healthcare facilities worldwide, but the true burden remains unknown particularly in developing countries. Risk factors for HCAI vary according to the type of healthcare facility and to the care area where the patient is admitted. The most common factors associated with HCAI are: patients aged over 65 years; admission as an emergency and to the intensive care unit (ICU); hospital stay longer than seven days; placement of a central venous catheter, indwelling urinary catheter, or an endotracheal tube and undergoing surgery. Low and middle-income countries bear an additional burden due to poverty, lack of basic hygiene, limited resources, malnutrition, patient age under 1 year and low birth weight. General barriers to infection control practices are lack of financial support, inadequate numbers of trained personnel working in infection control, understaffed hospital units, and insufficient equipment and supplies.
Surgical site infection (SSI) is the most surveyed and most frequent type of infection in low and middle-income countries with incidence rates ranging from 1.2 to 23.6 per 100 surgical procedures. By contrast, SSI rates vary between 1.2% and 5.2% in developed countries.
The risk of acquiring HCAI is significantly higher in intensive care units (ICUs). The incidence of ICU-acquired infection among adult patients in low and middle-income countries ranged from 4.4% up to 88.9% and averaged at 42.7 episodes per 1000 patient-days.
High frequency of infection is associated with the use of invasive devices, in particular central-lines (CL), urinary catheters, and ventilators. Newborns are also a high-risk population in developing countries and neonatal infection rates are three to 20 times higher than in industrialized countries.
Evaluation of the key determinants of HCAI is an important step to identify strategies and measures for improvement. Recommendations by national and international organizations need to be implemented and accompanied by performance monitoring in countries in South-East Asia.