Why promoting good hand hygiene will increase the safety and quality of health care for all
Good hand hygiene is the cornerstone of safe and effective health care. Just 20-30 seconds of washing with an alcohol-based product, or 30-40 seconds with soap and water, will help anyone in a health care setting stop the spread of infection, control the risk of bacterial mutations (and therefore antimicrobial resistance) and advance the safety and quality of health care for all. Importantly, they will also help make health care more effective, saving billions of dollars in associated costs.
The benefits of good hand hygiene in health care settings – from the primary level up – have long been known. In the mid-19th century hand-washing was identified as a key factor in driving down maternal mortality and reducing the risk of childbirth. More recent studies have confirmed the critical role good hand hygiene plays in preventing the spread of a range of health care-associated pathogens. In particular, good hand hygiene is vital to preventing sepsis, a potentially life-threatening condition that can result from the body’s response to infection, and which kills over 30 million patients across the world annually. The bulk of these deaths are in low- and middle-income countries, including those of the WHO South-East Asia Region.
By promoting good hand hygiene in both practice and policy, patients, health workers, administrators and policymakers can dramatically enhance the safety, quality and effectiveness of health care at all levels. In doing so, they can also accelerate progress towards the Sustainable Development Goal target of universal health coverage, at the same time as combating the threat of antimicrobial resistance – one of the Region’s Flagship Priorities.
To achieve these outcomes, a series of key initiatives – outlined in WHO’s Guidelines on Hand Hygiene in Health Care – should be embraced, implemented and enforced with immediate effect.
Core among them is ensuring health workers are aware of and habitually practice the ‘five moments for hand hygiene’ – a five-step formula that requires health workers to wash their hands as per WHO standards before touching a patient, before clean/aseptic procedures, after bodily fluid exposure, after touching a patient, and after touching patient surroundings.
Facility-based infection prevention and control leaders should meanwhile seize all opportunities to champion hand hygiene. That can – and should – include communicating the critical importance of implementing WHO guidelines on hand hygiene to policymakers, hospital chief executive officers, administrators and health workers. It should also include advocating for the health facility they are responsible for to sign up to WHO’s global SAVE LIVES: Clean Your Hands campaign, which all facilities can be a part of.
Health facility leaders and senior management should similarly make hand hygiene a key quality monitoring indicator. Compliance with hand hygiene standards should be a core part of every health facility’s infection control regimen, with areas of risk identified and solutions found as a matter of priority. Where compliance is found wanting, clear means of enforcement must be created and implemented.
Importantly, promoting good hand hygiene goes beyond health facilities themselves, requiring buy-in at the highest levels of government. Ministries of health from across the Region, for example, should fully implement the 2017 World Health Assembly resolution on sepsis, which makes improving the prevention, diagnosis and management of sepsis a critical imperative. As the resolution outlines, one of the best ways to tackle the problem is via good hand hygiene and the development of clear, country-wide guidelines on the issue.
Individual citizens, too, have a role to play. Patient advocacy groups, for example, should continue to insist on good hand hygiene as a way to limit the occurrence of health care-associated infection and sepsis, and advocate for the development and implementation of effective hand hygiene-related policies at national and local levels, in addition to the provision of appropriate equipment and consumables and the highest standards of practice within health care facilities,
The impact each one of these interventions will have is substantial. Though health and wellbeing is often discussed and written about in the same breath and on the same pages that detail cutting-edge technologies and research, some perspective is in order. Clean hands remain one of the most powerful ways to prevent health care-associated infections, save lives and transform the quality of health care at all levels. Across the WHO South-East Asia Region, good hand hygiene is a tool that can – and must – be harnessed to decisive effect.
Dr Poonam K Singh
Regional Director, WHO South-East Asia