Healthcare is not without risks, some of which are preventable while others are not.
According to the World Health Organisation (WHO), 1 in 10 patients acquire an infection while receiving healthcare; more than 5 in 10 surgical site infections can be antibiotic-resistant; and effective infection prevention and control reduces at least 3 in 10 healthcare-associated infections (HAI).
HAI is acquired by a patient during healthcare delivery at a hospital or other healthcare facilities, and that the infection was not present or incubating during their admission. It is the most frequent adverse event in healthcare. It affects patients in any care setting during and after discharge.
HAI leads to prolonged hospital stays, antimicrobial resistance, disability, high costs for individuals, their families and health systems, and unnecessary deaths. It can also lead to infections in doctors, nurses, other healthcare professionals (HCPs) and caregivers attending to patients.
The true burden of HAI is unknown because of various reasons. According to WHO, the prevalence of HAIs in Malaysia was 13.9% in 2010. No healthcare facility or country has yet to claim that they have solved the problem.
The transmission of healthcare-associated microorganisms from one patient to another through caregivers’ hands involves the following sequence:
- Organisms are present on the patient’s skin or have been shed onto inanimate objects in the patient’s immediate vicinity;
- The organisms are transferred onto the hands of caregivers;
- The organisms are capable of survival for several minutes on the caregivers’ hands;
- Hand washing or antisepsis by the caregivers is inadequate, omitted, or the agent used for hand hygiene is inappropriate;
- The contaminated hand or hands of the caregivers comes into direct contact with another patient or with an inanimate object that will come into direct contact with the patient.
There is substantial evidence that hand antisepsis reduces the transmission of healthcare-associated microorganisms and the incidence of HAI.
WHO has had an annual campaign on hand hygiene, “Save Lives: Clean Your Hands”, on May 5 since 2009. The rationale is that hand hygiene is the core of infection prevention and control (IPC).
The 2018 campaign has been linked to a broader IPC issue, “Prevent Sepsis In Healthcare”. The campaign is directed at HCPs, IPC leaders, healthcare facility leaders, health ministries and patient advocacy groups.
HCPs are urged to comply with the “5 Moments For Hand Hygiene” concept, i.e. before touching a patient; before clean/aseptic procedures; after body fluid exposure/risk; after touching a patient; and after touching patients’ surroundings.
The 5 Moments For Hand Hygiene is stated explicitly in the UK National Health Service guidelines: “Hands must be decontaminated immediately before each episode of direct patient contact or care, including clean/aseptic procedures; immediately after each episode of direct patient contact or care; immediately after contact with body fluids, mucous membranes and non-intact skin; immediately after other activities or contact with objects and equipment in the immediate patient environment that may result in the hands becoming contaminated; and immediately after the removal of gloves.” (Source: Loveday et al. Journal of Hospital Infection 86S1  S1–S70)
WHO estimates that the harm to patients and healthcare professionals can be prevented by less than US$10 (RM39.50) and that alcohol-based hand rub, which costs about US$3 (RM11.85) per bottle, can prevent HAI and millions of deaths annually.
An alcohol-based hand rub is used for decontamination before and after direct patient contact and clinical care, except in the following situations when soap and water must be used:
- When hands are visibly soiled or potentially contaminated with body fluids,
- When caring for patients with vomiting or diarrhoeal illness, regardless of whether or not gloves have been worn.
The entrenchment of specific moments for hand hygiene in caregivers’ workflow will ensure doing the right thing every time. Compliance with guidelines are essential if they are to be effective in preventing HAIs. As such, reports of non-compliance by some HCPs are of concern.
As everyone is a potential patient, it is incumbent on all HCPs to ask themselves what their reaction would be if they themselves acquire a HAI because of other HCPs who are also non-compliant.
Patients, their families and visitors to healthcare facilities are advised to observe if HCPs have cleaned their hands prior to and after touching a patient, and if not, to request them to do so.
The improvement of hand hygiene practices may reduce transmission of micro-organisms by 50%. The 2018 WHO slogan states: “It’s In Your Hands – Prevent Sepsis In Healthcare”. Reida El Oakley, a former Libyan Health Minister, put it succinctly: “Hand hygiene is as effective as vaccines, even more than some vaccines.”