Hand Hygiene & Patient Safety

Health & safety is all in your hands!

By Earl D.C. Bracamonte

In the field of infection control where hand washing and the use of alcohol-based hand rubs have become common practice in hospitals globally, the World Health Organization (WHO) has reported that the failure to perform proper hand hygiene is still considered to be the leading cause of health-care associated infections (HAIs) in both developed and developing countries. It has also been a significant contributor to the spread of multi-drug resistant organisms (MDROs, MRSAs) and other outbreaks in the hospital setting.

“90 countries are at risk with malaria infection while tuberculosis has 8 million new infections. HIV caused 2.9 million deaths in 2009 and 40 million are affected worldwide. However, in the case of healthcare associated infections (HAIs), one in every ten is affected or about 1.4 million cases daily, globally,” reported DoH undersecretary Teodoro J. Herbosa, head of NCR & South Luzon operations cluster.

The WHO also reported that, in Europe, there are at least 5 million HAI cases contributing to 135,000 deaths annually.  In the United States, the Center for Disease Control (CDC) reported that HAIs are among the leading causes of death in the country; accounting for an estimated 1.7 million infections and 99,000 associated deaths annually. The WHO further stated that while HAI rates is between 5 per cent to 15 per cent of admissions in developed countries, the rates are several times higher in developing countries like the Philippines.

“The major patient safety problems are related to systems and processes of care. Compliance of health workers to the hand washing directive is really low. Time constraint is the major obstacle for hand hygiene in hospitals and healthcare facilities. But all that’s going to change for the better as 133 countries, including the Philippines, have pledged and are committed to address the HAI scare,” Dr. Herbosa continued.

To address this problem, the WHO launched its new global Guidelines on Hand Hygiene in Health Care in 2009. It was developed with the assistance of more than a hundred renowned international experts after trials in a wide range of testing sites from modern high-technology hospitals in advanced countries to remote dispensaries in poor resource villages.

“Using alcohol rinses for healthcare is more efficacious than soap & water. The WHO even re-read the Qur’an on passages relating to non-absorption of alcohol into the body, just to overcome religious barriers to safety measures. Rinses are much preferred than the gel form and should contain higher than 70 per cent isoprophyl alcohol or propanol and higher than 80 per cent for ethanol or ethyl alcohol. More importantly, patients should demand for hand hygiene before treatment or care from any health professional; especially in cases where patient-to-patient transfer is evident,” emphasized the undersecretary.  

To help hospitals in the Philippines address the HAI problem, as well as curb the alarming rise of MRSA and MDRO cases, the Dept. of Health (DoH), in partnership with Aesculap Academy, held recently the national symposium on infection control and patient safety; conducted by Prof. Didier Pittet, M.D., WHO’s director of infection control program and lead in its first global safety challenge. Prof. Pittet is also head of the University of Geneva Hospital’s collaborating center on patient safety; making him a luminary in the field as well as chief proponent of the global campaign.

“Every May 5^th, the five moments of hand care are celebrated. These are the moments before treating patients; after treating patients; after doing procedures; after touching body fluids; and after touching patients. Also, the 7-step to hand cleaning brings everyone closer to global health and safety.

“HAI accounts for five to fifteen per cent of admittance in hospitalized patients in Europe. In the Philippines and other developing countries, the rate is twice as much; at times, resulting to morbidity,” remarked Dr. Pittet during the intimate after-lunch media colloquy.

At the morning symposium, Prof. Pittet provided attendees with a comprehensive overview of the new WHO guidelines as well as its readily accessible tools and resources to help infection control practitioners in their implementations. He also presented global case studies on how compliance to the guidelines has dramatically reduced HAIs in hospitals. Moreover, he discussed the vital role of hospital management in the implementation of system change and in sustaining an institutional safety climate.

“Pinoys lack the culture of safety when it comes to risky behavior. Examples to this are the absence of helmets while driving motor vehicles and the non-use of contraceptives during coition of partners and unmarried couples. Cultural and systems change is what’s lacking and what’s wrong. Achieving this goal also needs individual compliance.

“The DoH now has the machinery to propel this initiative with its new 65 per cent increase in budget. New hospitals now have hepatitis filters. As bacteria thrives on the window filters and vents of air-conditioning systems, fumigation should be done prior to the re-opening of hospital rooms to prevent the presence of the so-called ‘sick buildings.’

“The Pinoy hygiene level is far from the international standard,” lamented USec Herbosa.

The Aesculap Academy is a training center with a network comprising 40 nations. It enjoys a worldwide reputation for medical training of physicians as well as senior nursing staff in operating rooms, anesthesia, ward, and hospital management. The accredited courses consist of hands-on workshops, management seminars, and international symposia. For that, the academy was given the Frost & Sullivan award as “Global Medical Professional Education Institution of the Year” three times in succession (for the consecutive years 2005, 2006 and 2007). The Aesculap Academy courses are of premium quality and accredited by the respective medical societies and international medical associations.

The Aesculap Academy will be giving out the Asia Pacific Hand Hygiene Excellence Award for 2014 and 2015. Deadline of submissions for the 2^nd Cycle is on June 30, 2014.

Project partner Braun Pharmaceuticals is operating in 60 countries worldwide. It has been in the Philippines 28 years hence. It devotes $42,000 in research & development to hand hygiene & patient care alone. Braun markets fluids, critical care products, sutures, blood replacements, surgical equipment, intravenous food, and a bevy of other stuff you can only find in sci-fi movies.

“The national policy on universal care (Kalusugang Pangkalahatan), wherein the PhilHealth reimbursement scheme is accessed, is now operating in public hospitals for this campaign to run its course, regardless of who sits in power or runs the agency,” USec Herbosa concluded.

Hospitals and health-care facilities throughout the world are invited to take part in this global initiative, to continue raise hand-hygiene awareness, to move action to the point of care, and to reduce health-care associated infections. You can sign up through http://www.who.int/gpsc/5may/register/en/index.html.