Infection control: Let’s get back to basics

Infection control: Let’s get back to basics

Hand hygiene is a fundamental pillar of effective infection prevention and control (IPC) programmes, playing a pivotal role in reducing the transmission of pathogenic microorganisms within healthcare settings and thereby decreasing the incidence of healthcare-associated infections (HCAIs).1

According to the World Health Organization (WHO), initiatives aimed at improving hand hygiene can prevent up to 50% of avoidable infections acquired during healthcare delivery and yield economic savings about 16 times the cost of implementation.2

High-risk patients, especially those treated in intensive care units (ICUs), are at high risk of HCAIs. In these settings, infection prevalence rates range from 9.7% to 31.8% in Europe and 9% to 37% in the United States, with mortality rates ranging from 12% to 80%. In Africa, the prevalence of HCAIs is 12.76%, with varying rates across different wards, including ICUs, neonatal ICUs/ wards, and paediatric medical wards.2,3

Surgical site infections (SSIs) constitute the most common type of HCAIs (41.6%), followed by bloodstream infections and respiratory tract infections/ pneumonia.3

Despite the proven effectiveness of hand hygiene in preventing HCAIs, global implementation remains substandard. The WHO’s Multimodal Hand Hygiene Improvement Strategy, launched in 2009, aimed to address this issue. However, a 10-year study assessing global implementation levels revealed that >25% of healthcare facilities, primarily in low-income nations, reported basic or inadequate levels of hand hygiene implementation.1

Resource availability significantly influences hand hygiene implementation levels, with lower scores observed in lowincome and public healthcare facilities compared to high-income and private ones. Investment in IPC measures, including hand hygiene, is crucial to enhancing patient safety and mitigating the financial burdens associated with HCAIs.1

Pathogens everywhere!

Healthcare-associated pathogens are not confined to infected wounds but also inhabit intact patient skin and environmental surfaces, contributing to cross-contamination.2

Healthcare workers’ hands become contaminated during patient care activities, with gloves offering limited protection. Hand hygiene is essential in mitigating the spread of pathogens. 2

Hand hygiene options and their efficacy

Various hand hygiene options are available including plain soap, alcohol-based hand rubs, chlorhexidine, chloroxylenol, iodine, quaternary ammonium compounds, and triclosan.2 Alcohol-based hand rubs are recommended by the WHO due to their evidence-based effectiveness, suitability for resource-limited areas, promotion of adherence, economic benefits, and safety.2

Preparing for surgery

Effective surgical hand preparation is crucial in reducing the risk of SSIs. Modern protocols involve shorter preparation durations and the use of antiseptic agents like chlorhexidine and povidone-iodine. Alcohol-based hand rubs are recommended for surgical hand preparation due to their broad-spectrum antimicrobial activity and convenience.2

Conclusion

Hand hygiene significantly reduces the transmission of pathogenic microorganisms within healthcare settings and ultimately saving millions of lives annually. Effective implementation of hand hygiene programmes is essential to improve patient safety and mitigate the financial burdens associated with HCAIs.

References are available on request. SF