WHO: Ten threats to global health in 2019

The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis.

 

The world is facing multiple health challenges. These range from outbreaks of vaccine-preventable diseases like measles and diphtheria, increasing reports of drug-resistant pathogens, growing rates of obesity and physical inactivity to the health impacts of environmental pollution and climate change and multiple humanitarian crises.

To address these and other threats, 2019 sees the start of the World Health Organization’s new 5-year strategic plan – the 13th General Programme of Work. This plan focuses on a triple billion target: ensuring 1 billion more people benefit from access to universal health coverage, 1 billion more people are protected from health emergencies and 1 billion more people enjoy better health and well-being. Reaching this goal will require addressing the threats to health from a variety of angles.

Here are 10 of the many issues that will demand attention from WHO and health partners in 2019.

READ THE FULL ARTICLE AT WHO’s site here:
https://www.who.int/emergencies/ten-threats-to-global-health-in-2019


A Breeding Ground for a Fatal Scourge: Nursing Homes

From The New York Times:

Drug-resistant germs, including Candida auris, prey on severely ill patients in skilled nursing facilities, a problem sometimes amplified by poor care and low staffing.

https://www.nytimes.com/2019/09/11/health/nursing-homes-fungus.html

“They are caldrons that are constantly seeding and reseeding hospitals with increasingly dangerous bacteria,” said Betsy McCaughey, a former lieutenant governor of New York who leads the nonprofit Committee to Reduce Infection Deaths. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”

Resistant germs can then move from bed to bed, or from patient to family or staff, and then to hospitals and the public because of lax hygiene and poor staffing.

A recent inquiry by the New York State Department of Health found that some long-term hospitals grappling with C. auris were failing to take basic measures, such as using disposable gowns and latex gloves, or to post warning signs outside the rooms of infected patients. At one unnamed facility, it said, “hand sanitizers were completely absent.”

https://www.ncbi.nlm.nih.gov/pubmed/30753383


Antibiotic Resistance and the Importance of Hand Hygiene | Infection Control Today

The increasing risk of antibiotic-resistant infections is a threat in todayʼs world but can be reduced through key interventions such as hand hygiene. Better hand hygiene cannot eliminate all infections, but because of the central role contaminated hands play in a large number of infections, better hand hygiene practices used broadly in society would help to reduce the risk of infections in general and for those that are antibiotic resistant as well.

Read more about it here: https://www.infectioncontroltoday.com/hand-hygiene/antibiotic-resistance-and-importance-hand-hygiene


Historical perspective on hand hygiene in health care

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009.

Handwashing with soap and water has been considered a measure of personal hygiene for centuries48,49 and has been generally embedded in religious and cultural habits (see Part I, Section 17). Nevertheless, the link between handwashing and the spread of disease was established only two centuries ago, although this can be considered as relatively early with respect to the discoveries of Pasteur and Lister that occurred decades later.

In the mid-1800s, studies by Ignaz Semmelweis in Vienna, Austria, and Oliver Wendell Holmes in Boston, USA, established that hospital-acquired diseases were transmitted via the hands of HCWs. In 1847, Semmelweiss was appointed as a house officer in one of the two obstetric clinics at the University of Vienna Allgemeine Krankenhaus (General Hospital). He observed that maternal mortality rates, mostly attributable to puerperal fever, were substantially higher in one clinic compared with the other (16% versus 7%).50 He also noted that doctors and medical students often went directly to the delivery suite after performing autopsies and had a disagreeable odour on their hands despite handwashing with soap and water before entering the clinic. He hypothesized therefore that “cadaverous particles” were transmitted via the hands of doctors and students from the autopsy room to the delivery theatre and caused the puerperal fever. As a consequence, Semmelweis recommended that hands be scrubbed in a chlorinated lime solution before every patient contact and particularly after leaving the autopsy room. Following the implementation of this measure, the mortality rate fell dramatically to 3% in the clinic most affected and remained low thereafter.

Apart from providing the first evidence that cleansing heavily contaminated hands with an antiseptic agent can reduce nosocomial transmission of germs more effectively than handwashing with plain soap and water, this approach includes all the essential elements for a successful infection control intervention: “recognize-explain-act”.51 Unfortunately, both Holmes and Semmelweis failed to observe a sustained change in their colleagues’ behaviour. In particular, Semmelweis experienced great difficulties in convincing his colleagues and administrators of the benefits of this procedure. In the light of the principles of social marketing today, his major error was that he imposed a system change (the use of the chlorinated lime solution) without consulting the opinion of his collaborators. Despite these drawbacks, many lessons have been learnt from the Semmelweis intervention; the “recognize-explain-act” approach has driven many investigators and practitioners since then and has also been replicated in different fields and settings. Semmelweis is considered not only the father of hand hygiene, but his intervention is also a model of epidemiologically driven strategies to prevent A prospective controlled trial conducted in a hospital nursery and many other investigations conducted over the past 40 years have confirmed the important role that contaminated HCWs’ hands play in the transmission of health care-associated pathogens (see Part I, Sections 7–9).

The 1980s represented a landmark in the evolution of concepts of hand hygiene in health care.infection. The first national hand hygiene guidelines were published in the 1980s,53–55 followed by several others in more recent years in different countries. In 1995 and 1996, the CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) in the USA recommended that either antimicrobial soap or a waterless antiseptic agent be used56,57 the rooms of patients with multidrug-resistant pathogens. More recently, the HICPAC guidelines issued in 200258 defined alcohol-based handrubbing, where available, as the standard of care for situations only. The present guidelines are based on this previous document and represent the most extensive review of the evidence related to hand hygiene in the literature. They aim to expand the scope of recommendations to a global perspective, foster discussion and expert consultation on controversial issues related to hand hygiene in health care, and to propose a practical approach for successful implementation (see also Part VI).

As far as the implementation of recommendations on hand hygiene improvement is concerned, very significant progress has been achieved since the introduction and validation of the concept that promotional strategies must be multimodal to achieve any degree of success. In 2000, Pittet et al. reported the experience of the Geneva’s University Hospitals with the implementation of a strategy based on several essential components and not only the introduction of an alcohol-based handrub. The study showed remarkable results in terms of an improvement in hand hygiene compliance improvement and HCAI reduction.60 Taking inspiration from this innovative approach, the results of which were also demonstrated to be long-lasting,61 many other studies including further original aspects have enriched the scientific literature (see Table I.22.1). Given its very solid evidence base, this model has been adopted by the First Global Patient Safety Challenge to develop the WHO Hand Hygiene Improvement Strategy aimed at translating into practice the recommendations included in the present guidelines. In this final version of the guidelines, evidence generated from the pilot testing of the strategy during 2007–2008 is included (see also Part I, Section 21.5).62

Copyright © 2009, World Health Organization.
All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who.int).
Bookshelf ID: NBK144018
hand hygiene practices in health-care settings, whereas handwashing is reserved for particular


Is our obsession with hand sanitisers doing us more harm than good?

Itʼs no secret that Donald Trump is a fan of Fox News, the American news channel whose hosts the President regularly sits down to do interviews with. However, one such host, Pete Hegseth, probably wonʼt be getting a handshake from the president any time soon.

“I donʼt really wash my hands ever,” Hegseth announced on air this week. “Germs are not a real thing. I canʼt see them, therefore theyʼre not real.”

Twitter erupted, while the president probably made a mental note to avoid shaking hands with Hegseth, one of his most vocal supporters, ever again. A self-confessed “germaphobe”, Trump has already admitted avoiding handshakes and is regularly caught on camera being handed small bottles of hand sanitiser by White House staff.
Robbie Williams was caught on camera doing the same (and looking quite squeamish) after performing Auld Lang Syne with audience members during a New Yearʼs Eve gig at Westminsterʼs Central Hall.

But Trump and Williams are far from alone. Sales of hand sanitisers have skyrocketed in the last ten years, along with antibacterial hand soaps and wipes, and recent data from Mintel found a third of us buy a bottle of hand sanitiser every month.

No longer the preserve of hospitals (the first hand sanitiser was invented by an American nurse in 1966 after discovering alcohol, when delivered through a gel, removed germs without soap and water), theyʼre now found in handbags, homes and on desks across the UK.

So, when did we become a nation of germ-fighters? And is it doing us any good?

“Of course you should wash your hands regularly,” says Tim Spector, a professor of genetic epidemiology at Kingʼs College London and author of The Diet Myth. “However, we seem to have developed an obsession with hygiene that, along with antibiotics, is decreasing our gut diversity and having an impact on our microbes and gut health.

“Children who grow up on farms have about a third less allergy risk. People who have pets, and those who come from large, poor families also have fewer allergies. The theory goes, if youʼre exposed to microbes from an early age, and have a healthy exposure to them in general, your immune system is exercised and trained to deal with harmful germs. Having friendly microbes on your skin and in your gut improves how your immune system responds to real threats.”

Speaking of threats, Professor Spector says headlines about SARS, Swine Flu and ebola have driven fears weʼre under siege from infection, when we should be more worried about the connection between overzealous clearning and poor gut health, which is linked to obesity and allergies.

“Of course, thereʼs a middle ground. If youʼre a chef, or work in a hospital, or youʼre on a cruise where thereʼs an outbreak of vomiting and diarrhoea, then it pays to be cautious. But the average person just needs to wash their hands with soap and hot water when required.”

“I find it scarcely believable that Pete Hegseth doesnʼt wash his hands,” says Professor John Oxford, a virologist at the Queen Mary School of Medicine. “Iʼve spent my life looking down microscopes and I can assure you that germs are very real.

“The first doctor who championed hand washing was a Hungarian called Ignaz Semmelweis, who in 1846 questioned why so many mothers on the maternity ward where he worked were dying. He realised doctors were performing autopsies and then delivering babies straight after. He ordered staff to wash their hands and death rates dropped. So hand washing is an important tool in public health.”

Though soap and hot water will do, thereʼs now a commercial edge to cleanliness too: “One hundred years ago, there werenʼt hundreds of cleaning products, bleaches, anti-bac sprays and hand sanitisers in our homes and lining supermarket shelves,” says Professor Spector. “Our kitchens didnʼt look like gleaming intensive care units. Our natural, friendly, healthy microbes are being washed, scrubbed and sanitised away so our immune systems have nothing to fight against.”

Indeed, so-called ‘clean-fluencersʼ (clean influencers) such as Mrs Hinch (1.8m followers and counting) are all over Instagram telling us how to keep our homes spotlessly clean, which, combined with the Marie Kondo effect means weʼre vulnerable to the idea we need to be as clean as possible – and never more so than when it comes to protecting our childrenʼs health. The child hand sanitiser market (unheard of 20 years ago) is rising, you can now buy antibacterial nappy sacks, and most mumsʼ nappy bags contain mini pots of hand sanitisers.

“Thereʼs been a huge rise in all types of allergies among children in the last 40 years,” says Professor Spector. “Somethingʼs going on. So while hand washing after nappy changing and going to the toilet should be encouraged, children should be allowed to play in the dirt, stroke pets and climb trees without worrying too much.
Otherwise, the danger is that we’re just ” replacing one problem – the risk of infection – for an altogether different one.”

By Maria Lally
February 12th 2019

https://www.telegraph.co.uk/health-fitness/body/obsession-hand-sanitisers-us-harm-good/


Resistente bakterier blir med hjem fra ferien

Når vi reiser på ferie, bidrar vi til at resistente mikrober reiser verden rundt. Sykehusbesøk og antibiotikakur gir størst risiko.

Du kan bære dem med deg på huden eller i tarmen, og du kan ha dem med deg helt uten at du vet det. Og de kan bli lenger enn du aner.

En studie av 2000 nederlendere som reiste på utenlandstur, viste at hele 35 prosent av dem brakte med seg resistente tarmbakterier hjem.

Av dem som hadde vært i India eller landene rundt, bar hele 75 prosent av dem med seg resistente bakterier hjem. Dette var bakterier som er helt normalt å ha i tarmen, og ga ingen symptomer. Hadde disse nederlenderne ikke vært med i denne studien, ville de ikke visst at de hadde med seg slike bakterier fra turen.

Aller størst risiko
Men disse bakteriene som normalt finnes i tarmen, kan gi resistens-gener videre til sykdomsfremkallende bakterier i neste omgang. Og da er du ille ute. Da virker ikke de vanlige antibiotikaene lenger. Og 12 prosent av de reisende ga også de resistente bakteriene videre til andre personer i husholdningen.

Det som klart ga aller størst risiko for å bli bærer av resistente tarmbakterier (ESBL), var å ta en antibiotikakur under reisen. Men det var ikke likegyldig hva slags antibiotika de tok. Antibiotika som Ciprofloxacin ga klart høyest risiko, mens penicilliner ga mindre risiko. Diaré og kronisk tarmsykdom ga også økt risiko for å bli bærer av resistente bakterier.

Fakta: Dette gir økt risiko
Dette gir økt risiko for at man bærer med seg resistente bakterier hjem fra ferie i utlandet:

• Å bli innlagt på sykehus i utlandet.
• Å ta antibiotika på turen.
• Å få diaré under reisen. Risikoen øker hivs du tar antibiotika mot diareen, og risikoen blir enda større hvis du tar stoppende midler som for eksempel loperamid eller imodium.
• Reise utenfor Nord-Europa, Nord-Amerika og Australia. Særlig til det indiske subkontinent, men også i Sør- og Øst-Europa er forekomsten av resistens høy.

Men det som er det positive i denne studien, er at de fleste kvittet seg med de resistente bakteriene ganske raskt. Etter en måned hadde over halvparten kvittet seg med de resistente bakteriene. Men 11 prosent var fortsatt bærere et år etter. Antibiotikakurer gjennom året, kronisk stamsykdom og nye reiser var igjen risikofaktorer som gjorde at bærerskapet kunne vare ved.

Sykehus er verst
Det som helt klart gir høyest risiko for å bli bærer av multiresistente bakterier, er å bli innlagt på sykehus i utlandet.

Men du trenger ikke å reise til eksotiske land for at denne risikoen skal bli høy. Folkehelseinstituttet meldte nylig om et utbrudd av hyperresistente (KPB – karbapenemaseproduserende) bakterier med over 350 smittede pasienter ved syv sykehus i Italia.

Det Europeiske smitteverninstituttet melder om raskt økende forekomst av disse svært resistente bakteriene i Sør- og Øst-Europa, og de melder stadig nye utbrudd på sykehus.

I USA har én person nylig dødd og syv andre blitt syke av bakterier med denne typen hyperresistens etter å ha reist til Mexico for slankeoperasjon. Nå advarer delstaten Utah på sine nettsider folk mot disse helsereisene og mot den konkrete kirurgen som utførte disse inngrepene.

Fakta: Dette er resistente bakterier
Resistens gjør ikke bakteriene nødvendigvis mer sykdomsfremkallende, men mostanddyktige mot antibiotika. Ved multiresistents er bakteriene motstandsdyktige mot flere antibiotika.

Typer resistens:
MRSA – Methicillinresistente Staphylococus aureus: En type resistens som finnes hos gule stafylokokker. Stafylokokker er normalt en del av floraen på huden vår, men kan også gi sårinfeksjoner, og kommer de inn i blodet gir de alvorlige og livstruende infeksjoner. Når de bærer resistensgenet MRSA, vil slike infeksjoner bli vanskelig å behandle, fordi de antibiotika man da må behandle med, virker dårligere og har mer bivirkninger.

ESBL – Extended spectrum betalactamase: En type resistens som finnes hos en rekke tarmbakterier og noen bakterier som lett etablerer seg på utstyr og overflater i sykehus. Blant disse bakteriene finnes både sykdomsfremkallende bakterier og normalfloraen i tarmen. Denne type resistens kan også påvises i urin ved urinveisinfeksjon.

Når bakterier innen denne gruppen blir ekstra resistente kalles det ESBL-CARBA/KPB – Karbapenemase produserende bakterier. Disse er resistente mot nesten alle typer antibiotika, også de mest bredspektrede midlene vi har. Her må legene ofte ty til gamle og mindre effektive antibiotika med en rekke til dels alvorlige bivirkninger. Og når disse heller ikke virker: Da kan vi risiker å stå igjen uten behandlingsmuligheter.

VRE/LRE – vancomycin- eller linezolid resistente enterokokker: Enterokokker er også en bakterie som finnes normalt i tarmen, men kan gi sykdom i bl.a. i urinveier og i blodbanen. Det er i utgangspunktet få antibiotika som virker på denne bakterien, så når den i tillegg blir resistent mot disse få, blir den svært vanskelig å behandle. Denne bakterien har tidligere forårsaket utbrudd på norske sykehus.

Advarer mot helsereiser
Folkehelseinstituttet advarte mot å reise til utlandet for helsetjenester i en oppdatering tidligere i sommer. De ber deg unngå helsebehandling, inkludert tannbehandling, i utlandet dersom du kan få utført den samme behandlingen her til lands.

De anbefaler god håndhygiene og god kjøkkenhygiene for å unngå å plukke opp resistente bakterier, men fraråder ikke å reise. De understreker også at hvis du blir syk under reisen, må du ikke nøle med å oppsøke helsetjenester når du trenger det.

Hvem testes?
Pasientene som har størst risiko for å være bærer av resistente bakterier, isoleres og testes med både nese, hals, hud og avføringsprøve ved innleggelse på norske sykehus. Dette gjelder blant annet alle som har vært i kontakt med helsetjenesten i land utenfor Norden siste 12 månedene, for å unngå at resistens spres på sykehuset til andre og mer sårbare pasienter.

Bakteriene florerer
Men verst er selvfølgelig denne utviklingen for dem som bor i landene med høy forekomst av resistens, og som ikke har tilgang på andre helsetester enn sykehus hvor sykehusinfeksjoner med resistente bakterier florerer.

En organisasjon som har merket dette i sitt arbeid, er Leger Uten Grenser. De beskriver på sine nettsider en situasjon hvor nyere «siste utvei»-antibiotika er dyrere, og i mange mellom- og lavinntektsland kan disse være vanskelig å få tak i. Offentlige sykehus får ikke tak i riktig type antibiotika til pasienter som ikke kan betale selv, og de får ikke gitt pasientene sine fullgod behandling.
Leger Uten Grenser oppgir at årsakene til denne utviklingen er uregulert salg av antibiotika over disk uten krav om resept fra lege, dårlig smittevernkontroll i helsetjenesten, antibiotika av dårlig kvalitet på apotekene, dårlig forskrivningspraksis hos leger og mangel på diagnostisk utstyr, i tillegg til dårlig opplæring av pasientene.

Varsko om antibiotika
Tenkt deg om før du tar antibiotika mot en lett diaré på turen. Å ta toppende midler gir også økt risiko, ifølge en finsk studie. Å ta begge deler på én gang er enda verre.

Det beste er kanskje å la den gå over av seg selv for ikke å risikere å bære med deg resistente bakterier hjem. Skulle du da få en alvorlig infeksjon på toppen, kan den bli vanskelig å behandle.

Personer med alvorlig kronisk sykdom som har høy risiko for å måtte søke helsehjelp under turen, bør også være klar over risikoen for å bli smittet med multiresistente bakterier ved et sykehusopphold i utlandet. Har de også nedsatt immunforsvar, risikerer å få en infeksjon det kan bli vanskelig å bli kvitt.

Øyunn Holen Overlege, spesialist i infeksjonsmedisin Folkehelseinstituttet

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Import and spread of extended- spectrum β-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study

BACKGROUND:

International travel contributes to the dissemination of antimicrobial resistance. We investigated the acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) during international travel, with a focus on predictive factors for acquisition, duration of colonisation, and probability of onward transmission.

METHODS:

Within the prospective, multicentre COMBAT study, 2001 Dutch travellers and 215 non-travelling household members were enrolled. Faecal samples and questionnaires on demographics, illnesses, and behaviour were collected before travel and immediately and 1, 3, 6, and 12 months after return. Samples were screened for the presence of ESBL-E. In post-travel samples, ESBL genes were sequenced and PCR with specific primers for plasmid-encoded β-lactamase enzymes TEM, SHV, and CTX-M group 1, 2, 8, 9, and 25 was used to confirm the presence of ESBL genes in follow-up samples. Multivariable regression analyses and mathematical modelling were used to identify predictors for acquisition and sustained carriage, and to determine household transmission rates. This study is registered with ClinicalTrials.gov, number NCT01676974.

FINDINGS:

633 (34·3%) of 1847 travellers who were ESBL negative before travel and had available samples after return had acquired ESBL-E during international travel (95% CI 32·1-36·5), with the highest number of acquisitions being among those who travelled to southern Asia in 136 of 181 (75·1%, 95% CI 68·4-80·9). Important predictors for acquisition of ESBL-E were antibiotic use during travel (adjusted odds ratio 2·69, 95%CI 1·79-4·05), traveller’s diarrhoea that persisted after return (2·31, 1·42-3·76), and pre-existing chronic bowel disease (2·10, 1·13-3·90). The median duration of colonisation after travel was 30 days (95% CI 29-33). 65 (11·3%) of 577 remained colonised at 12 months. CTX-M enzyme group 9 ESBLs were associated with a significantly increased risk of sustained carriage (median duration 75 days, 95% CI 48-102, p=0·0001). Onward transmission was found in 13 (7·7%) of 168 household members. The probability of transmitting ESBL-E to another household member was 12% (95% CI 5-18).

INTERPRETATION:

Acquisition and spread of ESBL-E during and after international travel was substantial and worrisome. Travellers to areas with a high risk of ESBL-E acquisition should be viewed as potential carriers of ESBL-E for up to 12 months after return.

FUNDING:

Netherlands Organisation for Health Research and Development
(ZonMw).

Copyright © 2017 Elsevier Ltd. All rights reserved.


Millions of health-care facilities lack WASH services

Proper water, sanitation, and hygiene are vital for infection prevention and curbing antimicrobial resistance, yet millions of centres lack even basic facilities. Talha Burki reports.

896 million people worldwide rely on health-care facilities with no water service, according to a joint report by WHO and UNICEF. The authors also noted that 1·5 billion people use facilities with no sanitation, and that every year 17 million women in the world’s poorest countries give birth in health-care centres with inadequate water, sanitation, and hygiene (WASH).

The report, which is the first of its kind, offers baseline estimates for national, regional, and global provision of WASH in health care. It also examined waste management services and environmental cleaning, although for cleaning in particular there are very few data. Services were categorised as basic, limited, or non-existent. For water, a basic service implies that there is an improved source such as a piped supply on the premises. For sanitation, it implies that the facilities are designed to ensure that people do not come into contact with excreta and that there are male and female toilets and a dedicated staff toilet. A basic hygiene service means that there are working hand hygiene facilities, either soap and water or alcohol-based hand rub, at points of care and near toilets.

Most countries do not collect data on the basis of the definitions outlined in the report. For global coverage of basic services, there was enough information to provide estimates for only water (75% of health-care facilities worldwide have basic water services). Nonetheless, the available data, which are for 2016, are sufficient to raise concern. One in eight health-care centres has no water service at all, one in five has no sanitation, and one in six has no hygiene services. There is wide variation within countries, regions, and continents. Hospitals tend to be better served than other health-care facilities, and urban institutions do better than rural ones. Only 30% of health-care centres in Ethiopia have basic water services; in Zimbabwe, the proportion stands at 81%. 64% of centres in China lack adequate hand hygiene facilities.

Moreover, while limited or non-existent WASH services in health care present an obvious danger, basic services do not necessarily equate to safe services. A flush toilet connected to a sewer qualifies as a basic service, for example, but the toilet still needs to be regularly cleaned, and users need somewhere to wash their hands. Even if a facility has piped water, it can still be unfit for consumption. The report cites a 2016 survey in Lebanon, which found that a quarter of health-care centres with basic water services had faecally contaminated water. “If you have water, but you do not have sanitation, then the human waste will get into the water”, said Maria Neira (WHO, Geneva, Switzerland). Water supplies can also be interrupted, forcing people to resort to storage tanks, which have an increased risk of contamination.

Neira believes that prioritising access to clean water and sanitation when countries are planning infrastructure for primary care would make a big difference. “WASH has to be something that is properly financed from the beginning”, she said. Solutions for waste management need not be costly. “Using simple principles, you can do a lot with very little”, explains Didier Pittet (University of Geneva Hospitals and Faculty of Medicine, Switzerland). “It is mostly about education; you train people on the basics, where to discard what, and you spend a bit of money on colour-coded bins.”

Pittet stresses the importance of alcohol-based hand rubs. “If health-care facilities really want to make a significant change in the risk of infection transmission, they must switch to alcohol-based hand rub”, he said. “Hand-washing facilities do not improve compliance to hand hygiene, because health-care workers do not always have the time to wash their hands with soap and water.” He points out that if water supplies are contaminated, then hand-washing can even be counterproductive, especially if users rinse off the soap and leave their hands wet. Alcohol-based hand rubs can provide an effective transitional solution for institutions that cannot afford to install basic water services throughout, although they cannot act as a substitute for soap and water after using the toilet. “It is a direct way to change the process, it has been proven in developed and developing countries, and you can introduce it to places where there is difficulty in putting in hand-washing facilities”, concluded Pittet.

Neira notes that without improving WASH services, it is hard to envisage progress in key areas of health care. “You might have fantastic plans for preventing maternal and neonatal mortality, or on antimicrobial resistance, but you will still have major difficulties unless water safety and sanitation are a strong part of your programmes.”

Article by Talha Burki

Article shared from: https://www.thelancet.com/infection Vol 19 June 2019

For the WASH report see https://apps.who.int/iris/bitstream/handle/10665/311620/9789241515504-eng.Pdf


Hand hygiene helps reduce HCAIs (healthcare-associated infection)

Chris Wakefield, Vice President at GOJO Industries-Europe Ltd, highlights how hand hygiene systems reduce the spread of healthcare-associated infection (HCAI)

It is estimated that 300,000 patients a year in England acquire a healthcare associated infection (HCAI) as a result of care within the NHS. Such infections draw large attention from patients, regulatory bodies and the media. Not only because of the magnitude of the problem – after all, they are associated with morbidity, mortality and the financial cost of treatment – but, also, because most are preventable.

Despite being avoidable, HCAIs continue to present a major threat to our public health. They are particularly difficult to eliminate due to the speed and ease that they can be transmitted – and because of their long-life span. Did you know, for example, that MRSA can live up to nine weeks, whilst C.Diff spores can live up to five months? Or that they can be spread through both direct and indirect contact?

Studies have shown that contaminated hands can sequentially transfer some viruses to up to seven surfaces, and that fourteen people can be contaminated by touching the same object one after the other. Perhaps itʼs not surprising then, that research indicates that you have a 50/50 chance of picking up a dangerous pathogen anytime you touch anything or anyone in a hospital.

Such outbreaks can have serious repercussions; including the increased risk to the lives of vulnerable patients, disruption of services and reduced clinical activity, such as the enforced closure of hospital wards, cancelled admissions and delayed discharges. There is also the cost of treatment to factor.
Indeed, a report by the National Audit Office estimated that a reduction in the rates of MRSA bloodstream infections saved the NHS in England between £45 million-£59 million in treatment costs between 2003/4 and 2008/9. It also identified that by reducing the rate of C. difficile infections, between £97 million-£204 million was saved in treatment costs between 2006/7 and 2007/8.

Going back to basics

A great deal of scientific research has shown that, if properly implemented, hand hygiene is the single most important, easiest and cost-effective means of reducing the prevalence of HCAIs and the spread of antimicrobial resistance. In fact, research shows it can cut the number of HCAI cases by up to 50%. Several other studies have also demonstrated that handwashing virtually eradicates the carriage of MRSA which invariably occurs on the hands of healthcare professionals working in intensive care units. An increase in handwashing adherence has also been found to be accompanied by a fall in MRSA rates.
In order to reduce the spread of illness, everyone has to engage with hand hygiene practices – not only healthcare workers, who already make this a part of their daily lives, but visitors and patients too. As a founder member of the World Health Organization (WHO) Private Organizations for Patient Safety group, GOJO is a strong advocate of the ‘total solutionʼ approach to making hand hygiene second nature to everyone in a healthcare setting. We believe that, to successfully change behaviour, a triple-pronged approach is required.

Firstly, handwashing facilities must be accessible and dispensers easy to use. The WHO recommends that an adequate number of appropriately positioned hand hygiene facilities should be readily available at the point of care.

Secondly, the high frequency with which healthcare workers clean their hands means that the formulations must be gentle yet effective against germs, complying with key hospital norms EN 1500, EN 14476 and EN 12791. Studies have also shown that using an alcohol-based handsanitising rub can improve hand hygiene practice, since it is quicker, is microbiologically more effective and is less irritating to skin than traditional hand washing with soap and water.
Finally, eye-catching signage is very effective as a prompt, especially at key germ hot-spots such as washrooms and waiting areas. Hand hygiene facilities must remain well-stocked and maintained at all times too.

Getting smart

Although evidence supports a ‘back to basicsʼ approach, digital innovation also has a role to play. GOJO has spent many years developing advanced formulations and high-tech dispensers, and has recently harnessed revolutionary smart technology to create its SMARTLINK™ Electronic Monitoring Solutions. These two mobile apps are a smarter way to help reduce the maintenance time spent on dispensers, and measure hand hygiene performance – ultimately helping to prevent the spread of germs.
Combining the latest technology with the simple act of hand hygiene, and working together to put effective systems in place, we can reduce the spread of HCAIs. GOJO, the leading global producer of skin health and hygiene solutions for away-from-home settings, is your specialist partner in healthcare hygiene.

For a tailored, effective, total solution for your setting, or for more information, please call +44 (0)1908 588444,
email infouk@GOJO.com or visit www.GOJO.com

 

By Kerrie Doughty
Trade Marketing & Communications Manager GOJO Industries-Europe
Tel: +44 (0)1908588457
infouk@gojo.com
www.GOJO.com
www.twitter.com/GOJO_Hcare
www.twitter.com/GOJO_Europe

 

 

References
1. https://www.nice.org.uk/guidance/qs61/chapter/introduction
2. Hata B et al. Clin Infect Dis 2004; 39k1182 | Kramer A et al. BMC Infect Dis 2006; 6k130 | Havill NL. et al. Infect Control Hosp Epidemiol 2014; 35k445 | Weber DJ et al. Infect Control Hosp Epidermiol 2015.
3. Barker J, Vipond IB, Bloomfield SF. J Hosp Infect 2004,58k42-494 Stiefel U et al. Infect Control Hosp Edipdemiol 2011; 32k185.
4. 2008 SDA Clean Hands Report Card® sponsored by the Soap and Detergent Association.
5. 24 &25 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1
6. 26 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1
7. 2,3 & 35
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1


The European Commission has awarded its Seal of Excellence to Resani’s Horizon 2020 Phase 2 proposal - describing Resani’s disruptive hand sanitizing and compliance technology.

The Seal of Excellence is a quality label awarded to a few project proposals submitted to Horizon 2020, the EU’s research and innovation funding programme.

Following evaluation by an international panel of independent experts, Resani’s proposal was scored as A HIGH-QUALITY PROJECT PROPOSAL IN A HIGHLY COMPETITIVE EVALUATION PROCESS *)

* ) This means passing all stringent Horizon 2020 assessment thresholds for the 3 award criteria (excellence, impact, quality and efficiency of implementation) required to receive funding from the EU budget Horizon 2020.