Hand hygiene initiative aims to decrease healthcare-associated infection in developing countries

An open-access commentary in the December 2007 issue of Infection Control and Hospital Epidemiology examines a recently launched a global initiative by the World Health Organization (WHO) to combat healthcare-associated infection by improving hand hygiene in health care.

The commentary is part of the Global Theme Issue on Poverty and Human Development. An international collaboration organized by the Council of Science Editors of simultaneously published research from more than 200 medical and scientific journals , the Global Theme Issue aims to raise awareness of the relationship between poverty and human development.

Authors Benedetta Allegranzi, MD (World Alliance for Patient Safety, World Health Organization), and Didier Pittet, MD, MS (Infection Control Program, University of Geneva Hospitals, Geneva), note that healthcare-associated infection is a major patient safety problem found in every hospital, healthcare system, and country.

The risk of healthcare-associated infection is 2 to 20 times higher for patients in developing countries than for patients in industrialized countries. A complex array of factors contribute to that increased risk, including lack of resources, inappropriate use of antibiotics, use of counterfeit drugs, understaffing and lack of training of health care professionals, and governments that are overwhelmed with larger health issues and cannot commit to infection control procedures and standards.

The WHO recently launched the First Global Patient Safety Challenge, “Clean Care is Safer Care,” to reduce healthcare-associated infection worldwide. “The First Global Patient Safety Challenge represents an unprecedented initiative to improve infection control practices and procedures in any healthcare setting, regardless of the level of economic development,” explains Dr. Pittet. “Never before in the history of infection control has there been such an opportunity to improve the health of so many millions of individuals by promoting basic but essential practices through the powerful channels of the WHO, which allow the involvement of governments and influence their healthcare systems.” The ministries of health from 43 countries have already signed the pledge to reduce healthcare-associated infection and another 20 are expected to join by the end of 2007.

The WHO developed guidelines on hand hygiene in health care based on scientific evidence and international expertise. A multimodel implementation strategy will turn the guidelines into practice and will suggest feasible ways to induce changes that will result in increased hand hygiene compliance and reduced morbidity and mortality due to healthcare-associated infection. Part of the effort is to make the indications for hand hygiene universally understandable and not open to interpretation. It focuses on only five points when hand hygiene is required when providing health care.

A worldwide pilot test of the strategy and tools is under way to evaluate the feasibility, sustainability, cost-effectiveness and cultural adaptation of a multimodel strategy for hand hygiene improvement.

“Results obtained from the worldwide testing will be invaluable in helping to shape scale-up and sustainability worldwide and will go a long way to ensuring that infection control practices continuously improve and contribute to enhanced patient safety,” conclude the authors.