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Journal ArticleDOI

Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study

TL;DR: Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide.
Abstract: Summary Background Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO's strategy for improvement of hand hygiene in five countries. Methods We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3–6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygiene principles. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010. Findings We noted 21 884 hand-hygiene opportunities during 1423 sessions before the intervention and 23 746 opportunities during 1784 sessions after. Overall compliance increased from 51·0% before the intervention (95% CI 45·1–56·9) to 67·2% after (61·8–72·2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4·67, 95% CI 3·16–6·89; p Interpretation Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide. Funding WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists.
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Journal ArticleDOI
TL;DR: A systematic review of studies identified crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring to reduce health-care-associated infections and improve patients' safety.
Abstract: Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37,000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from 1996 to 2012 were assessed and ten key components identified: organisation of infection control at the hospital level; bed occupancy, staffing, workload, and employment of pool or agency nurses; availability of and ease of access to materials and equipment and optimum ergonomics; appropriate use of guidelines; education and training; auditing; surveillance and feedback; multimodal and multidisciplinary prevention programmes that include behavioural change; engagement of champions; and positive organisational culture. These components comprise manageable and widely applicable ways to reduce health-care-associated infections and improve patients' safety.

348 citations

Journal ArticleDOI
TL;DR: It is difficult to avoid the conclusion that had the recommendations from this revelatory patient safety research been assiduously followed over the past five decades, hundreds of thousands fewer patients would have been killed or seriously harmed by the medicines intended to make them well.

296 citations

Journal ArticleDOI
TL;DR: The need for a "One Health" approach requiring research, surveillance, and interventions across human, veterinary, agricultural and environmental sectors and new tools to provide highly specific diagnoses of pathogens can decrease diagnostic uncertainty and improve clinical management is underlined.
Abstract: The lack of new antibiotic classes calls for a cautious use of existing agents. Yet, every 10 min, almost two tons of antibiotics are used around the world, all too often without any prescription or control. The use, overuse and misuse of antibiotics select for resistance in numerous species of bacteria which then renders antimicrobial treatment ineffective. Almost all countries face increased antimicrobial resistance (AMR), not only in humans but also in livestock and along the food chain. The spread of AMR is fueled by growing human and animal populations, uncontrolled contamination of fresh water supplies, and increases in international travel, migration and trade. In this context of global concern, 68 international experts attending the fifth edition of the World HAI Resistance Forum in June 2015 shared their successes and failures in the global fight against AMR. They underlined the need for a “One Health” approach requiring research, surveillance, and interventions across human, veterinary, agricultural and environmental sectors. This strategy involves concerted actions on several fronts. Improved education and increased public awareness are a well-understood priority. Surveillance systems monitoring infections need to be expanded to include antimicrobial use, as well as the emergence and spread of AMR within clinical and environmental samples. Adherence to practices to prevent and control the spread of infections is mandatory to reduce the requirement of antimicrobials in general care and agriculture. Antibiotics need to be banned as growth promoters for farm animals in countries where it has not yet been done. Antimicrobial stewardship programmes in animal husbandry have proved to be efficient for minimising AMR, without compromising productivity. Regarding the use of antibiotics in humans, new tools to provide highly specific diagnoses of pathogens can decrease diagnostic uncertainty and improve clinical management. Finally, infection prevention and control measures – some of them as simple as hand hygiene – are essential and should be extended beyond healthcare settings. Aside from regulatory actions, all people can assist in AMR reduction by limiting antibiotic use for minor illnesses. Together, we can all work to reduce the burden of AMR.

165 citations


Cites background from "Global implementation of WHO's mult..."

  • ...The WHO’s global “Clean Care is Safer Care” campaign, launched in 2005, has been an opportunity for many countries to learn how to adapt a global campaign to national needs, in order to achieve local buy-in [68, 69]....

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Journal ArticleDOI
TL;DR: This work examines three policy domains-responsible use, surveillance, and infection prevention and control-and considers which will be the most effective at national and regional levels, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability.

149 citations

Journal ArticleDOI
TL;DR: In this paper, the authors focus on low-resource settings and develop new bedside diagnostic tools for bacterial infections and antimicrobial susceptibility, which may also be effective to stop the spread of resistance in resource-poor countries.
Abstract: Antibiotic resistance is a global crisis driven by appropriate and inappropriate antibiotic use to treat human illness and promote animal growth. The antimicrobial resistance epidemic continues to spread due to the triple threat of unfettered access, minimal product regulation and oversight of antibiotic prescription, and lack of clinical diagnostic tools to support antibiotic de-escalation in low-resource settings. In high-resource settings, evidence-based strategies have improved the appropriateness of antibiotic use, limiting the spread of drug-resistant organisms and reducing hospital-associated infections, strategies which may also be effective to stop the spread of resistance in resource-poor countries. Current research and surveillance efforts on antimicrobial resistance and hospital-associated infections in low-resource settings are extremely limited and largely focused on intensive care units. Many challenges exist to improving antibiotic use and infection control in resource-limited settings, and turning the tide requires intensifying research and surveillance, antimicrobial stewardship, and developing new bedside diagnostic tools for bacterial infections and antimicrobial susceptibility. Highlights Antibiotic resistance is a global crisis driven by appropriate and inappropriate antibiotic use. Resistance is driven by unfettered access and lack of product regulation and clinical diagnostic tools. Research and surveillance in low-resource settings is extremely limited and should be intensified. Antimicrobial stewardship and new bedside diagnostic tools are also needed to turn the tide.

148 citations

References
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Journal ArticleDOI
TL;DR: The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission, and the promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.

2,404 citations

Journal ArticleDOI
TL;DR: The epidemiology of endemic health-care-associated infection in developing countries is assessed and a need to improve surveillance and infection-control practices is indicated.

1,737 citations

Journal ArticleDOI
TL;DR: Although there are many potentially confounding differences between countries, the analysis suggests that the interaction of fiscal austerity with economic shocks and weak social protection is what ultimately seems to escalate health and social crises in Europe.

1,161 citations

Journal ArticleDOI
John P. Burke1
TL;DR: Nosocomial infections are today by far the most common complications affecting hospitalized patients, and a single type of nosocomial infection — surgical-wound infection — constituted the second-largest category of adverse events.
Abstract: Nosocomial, or hospital-acquired, infections (more appropriately called health care–associated infections) are today by far the most common complications affecting hospitalized patients. Indeed, the Harvard Medical Practice Study II found that a single type of nosocomial infection — surgical-wound infection — constituted the second-largest category of adverse events.1 Long considered the greatest risk that the hospital environment poses to patients,2 nosocomial infections abruptly became the province of public health officers at the time of a nationwide epidemic of hospital-based staphylococcal infections, in 1957 and 1958.3 Since then, the study and control of nosocomial infections have been profoundly shaped by the discipline . . .

1,096 citations

Journal ArticleDOI
TL;DR: Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring andoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.
Abstract: Objectives. To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care. Design. A systematic review of studies published before January 1, 2009, on observed or self‐reported compliance rates. Methods. Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed. Results. We included 96 empirical studies, the majority ( \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} ewcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} ormalfont \selectfont...

868 citations