Clean hands save patient lives

Mar 5 2007

Experts on patient safety are urging countries in Latin America and the Caribbean to join a global effort to improve hand hygiene and related practices in hospitals and health care facilities to help reduce the growing number of deaths and illnesses due to health care-associated infections.

"There are effective strategies to improve hand hygiene and other basic practices that, if implemented by PAHO/WHO member countries, will save lives and reduce the largely preventable burden of health care-associated infections," said Sir Liam Donaldson, chairman of the World Alliance for Patient Safety, a program of the World Health Organization (WHO), in comments addressed to a workshop titled "Clean Care is Safer Care," being held this week in San Jose, Costa Rica, with the support of the Pan American Health Organization (PAHO) and WHO.

The workshop was convened to develop a regional strategy for reducing health care-associated infections - also called nosocomial infections - in Latin America and the Caribbean through better hand hygiene and other improvements in infection-control practices, clinical procedures, and surveillance. Participants include experts on infection prevention and control from 21 countries of Latin America and the Caribbean.

Health care-associated infections are a growing problem throughout the world, affecting an estimated 1.4 million people at any given time. At least 1 in every 4 patients in intensive care facilities acquires a nosocomial infection during their stay. The problem also contributes to antimicrobial resistance.

Most research on nosocomial infections has been carried out in developed countries, and less is known about the problem in the developing world. But data from Mexico indicate some 450,000 cases of health care-associated infection annually, causing 32 deaths per 100,000 inhabitants. In one Guatemalan hospital, the cost of 116 reported cases of a single health care-associated pneumonial infection in one year was estimated at more than US$200,000, or 160 times the cost of care for the same number of uninfected patients.

The incidence of health care-associated infections has increased in recent decades in part due to medical advances that allow people to live longer and to survive more serious diseases. Many new therapies are available to treat cancers, for example, but they leave patients with weakened immune systems. Growing possibilities for organ transplants also make patients vulnerable to infection.

But a large part of the problem has to do with inadequate hygiene in health care settings, says Professor Didier Pittet, leader of the World Alliance for Patient Safety's Global Patient Safety Challenge and director of the Infection Control Program of Geneva's University Hospitals.

"Basic good practices of infection control still remain the most important thing for reducing health care-associated infections, and the first thing among those basics is hand hygiene," he said. "Most bacteria are carried by patients, and the most common way they are transmitted is by hands. Medical schools may not teach enough about it, but it is also a problem of health care systems. Overloaded doctors and nurses have to deal with too many patients at once and don't have time to wash their hands. The solution can be as simple as always having alcohol hand rub at the point of care."

Some countries have successfully improved hand hygiene practices through targeted campaigns. During a four-month hand hygiene campaign in Switzerland, for example, compliance increased 25 percent among doctors and nurses in two hospitals. These results suggest that 17,000 cases of nosocomial infection could be prevented if hospitals achieved comparable improvements nationwide.

Costa Rica is one of 22 countries that have signed on to the First Global Patient Safety Challenge since it was launched by WHO in 2005. With the theme 'Clean Care is Safer Care,' the Global Challenge promotes improvements in blood safety, injection practices, water and sanitation, safety of clinical procedures, and hand hygiene.

Participants in this week's workshop will examine and provide feedback on a set of WHO recommendations on hand hygiene issued as part of the Global Challenge, and will discuss adapting the guidelines to the needs of health care facilities in Latin America and the Caribbean. San Jose's Children's Hospital will be the site of a pilot study of a new strategy to increase compliance with hand hygiene recommendations.

The Pan American Health Organization (PAHO) was established in 1902 and is the world's oldest public health organization. It serves as the regional office of the World Health Organization, and works with all the countries of the Americas to improve the health and quality of life of their peoples.

For more information, visit www.who.int/patientsafety/challenge/clean.care/en/.

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