Sepsis is a life-threatening abnormal organ function caused by an abnormal host response to infection.
Without early recognition and prompt management, it leads to septic shock, multiple organ failure and death. It is a serious and frequent complication of infection, particularly in low- and middle-income countries.
Problem And Solution
A 2020 article in The Lancet estimated that there are 48.9 million cases and 11 million sepsis-related deaths worldwide, which accounted for almost 20 per cent of all global deaths in 2017. (Rudd KE et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England). 2020;395(10219):200-11)
Sepsis often leads to deterioration of common and preventable infections in the community. Sepsis also often results from infections acquired in health care settings.
Health care associated infections (HAIs) are a major problem as it is the most frequent adverse event in health care globally with an estimated hundreds of millions of patients affected worldwide annually.
Antibiotic resistance often occurs in HAIs and is a primary factor in the unresponsiveness to treatment and rapid deterioration to sepsis, septic shock, and increased risk of mortality.
Preventive measures against infection in the community and the health care settings include good hygiene practices, water quality and sanitation, and safe practices in specific settings e.g. intensive care units, labour rooms, etc.
Early diagnosis and prompt appropriate clinical management of sepsis are critical in increasing the likelihood of survival. Even when the onset of sepsis is acute and poses a short-term mortality risk, it can also be a cause of long-term morbidity that requires treatment and support.
Most HAIs are preventable through the best hand hygiene practices i.e. cleaning hands at the right time and in the right way. The World Health Organization (WHO)’s guidelines on hand hygiene in health care are used in hand hygiene promotion and improvement in health care settings globally.
These guidelines are complemented by the WHO Multimodal hand hygiene improvement strategy, the guide to implementation, and an implementation toolkit with the strategy having been shown as the most effective approach to improvement in practices. Hand hygiene improvement programmes can prevent up to 50 per cent of avoidable HAIs and the economic savings average about 16 times the cost of implementation.
While there is some published data on hand hygiene practices in Malaysia, there is no published national data, although there are hand hygiene practices in all public and private health care facilities.
A study of hand hygiene promotion in Penang and Sarawak General hospitals reported in 2020 on the effect of peer-identified change agents (PICA) and management change agents (“MSCA”). The mean hand hygiene compliance in the PICA and MSCA arms improved from 48 per cent and 50 per cent in the preintervention period to 66 per cent and 65 per cent in the intervention period, respectively.
The Covid-19 pandemic has impacted hand hygiene practices. An online survey from March to July 2020 involving 6,064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland investigated adherence across eight situations, such as before preparing food or eating; before eating food; before and after caring for someone at home who is sick with vomiting or diarrhoea; after using the toilet; after blowing nose, coughing, sneezing; after touching garbage, after visiting public spaces; and when the hands are visibly dirty.
The study reported that higher handwashing adherence was related “to lower total Covid-19 morbidity; lower total Covid-19 mortality; and greater increases in recent cases of Covid-19 morbidity…Higher handwashing adherence was associated with more frequent exposure to handwashing guidelines, being a health care professional, being older, being female, and being married…. Higher handwashing adherence was related to an absence of flu-like symptoms, an absence of acquaintances with flu-like symptoms, and lower education level.”
Unite For Safety: Clean Your Hands
The safety culture in an institution refers to the environment and perceptions of patient safety at a health care facility in which hand hygiene improvement is a high priority. It is vital to maintain motivation and momentum to achieve increased compliance to hand hygiene standards given that they are nowhere near the targets set out by policy makers and managers.
The WHO launched the “Save Lives: Clean Your Hands” annual global campaign, in 2009, as part of a major global effort to improve hand hygiene in health care. This was an extension of the WHO First Global Patient Safety Challenge: Clean Care Is Safer Care Work.
The WHO has designated May 5, 2022 as World Hand Hygiene Day. The campaign theme this year was “A health care quality and safety climate or culture that values hand hygiene and infection prevention and control”, and the slogan was “Unite for safety: clean your hands”.
The objectives of the campaign are “To recognise that people of all levels should work together to influence the culture/climate through clean hands knowledge and behaviour, to meet the common goal of safety and quality in the health care organization”.
The campaign is focused on the recognition that a health care facility’s safety culture can be improved through cleaning of the hands and that a strong safety and quality culture will be an encouragement for everyone to clean their hands at the right times and with the right products.
There are numerous resources available at the WHO’s website to assist in the creation of an institutional safety culture.
The WHO states that action is needed by health care staff to lead by example and to encourage others to clean their hands; infection prevention staff to encourage health care staff to be part of new hand hygiene initiatives; quality and safety staff to work with infection prevention staff to support hand hygiene improvement; facility managers to promote a quality and safety culture; policy makers to prioritize resources, training and programmes on hand hygiene; and people who utilise health care facilities to get involved in local hand hygiene campaigns and activities.
Patients and their families can help by washing their hands; observing whether health care staff wash their hands prior to and after touching a patient; and reminding them if they did not do so.
In summary, the reduction of HAIs through hand hygiene requires action by everyone.
Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.