News and Opinions  –  2022

“Need to address the paradox of hospitals spreading disease” says new WHO report

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2022-06-28

The concept of infection prevention and control – that involves implementing a variety of protocols to prevent avoidable infections in hospital settings - has become an essential part of all modern healthcare. In the context of antimicrobial resistance also, infection prevention and control plays a central role by helping lower burden of health care-associated infections, thereby reducing the need to use antibiotics.

People at Government Hospital, Hyderabad India. Photo: Shutterstock.

According to the first-ever global situation analysis of how infection prevention and control programmes are being implemented in countries around the world there is compelling evidence to show that up to 70% of health care-associated infections can be prevented by scaling up an array of effective infection prevention and control interventions. Investing in infection prevention and control is one of the most effective and cost-saving interventions available says the report, brought out by the WHO.

Hand hygiene and environmental hygiene can halve risk of infections at hospitals

Hand hygiene is an important part of infection prevention at hospitals. Photo: Shutterstock.

In particular, hand hygiene and environmental hygiene in healthcare facilities were found to be able to more than halve the risk of dying as a result of infections with antimicrobial resistance pathogens, as well as to decrease the associated long- term complications and health burden by at least 40%.

However, the report also points out that the problem lies in turning this awareness into action and its prescriptions into practice. Despite years of awareness raising and even training, the impact of health care-associated infections on people’s lives continues to be incalculable.

Almost 24% of sepsis cases treated in hospital are health care-associated

The report quotes a meta-analysis study which shows that almost a quarter (23.6%) of all sepsis cases treated in the hospital are health care-associated, while approximately half (48.7%) of sepsis cases with organ dysfunction treated in hospital intensive-care units are hospital-acquired. Furthermore, mortality of all patients with health care-associated sepsis was 24.4% increasing to 52.3% for those treated in intensive-care units.

Infections resistant to antimicrobials increase deaths two to threefold

Girl sleeping with sickness. Photo: Shutterstock.

Deaths are increased two to threefold also when infections are resistant to antimicrobials. Today, out of every 100 patients in acute-care hospitals, seven patients in high-income countries and 15 patients in low- and middle-income countries will acquire at least one health care-associated infection during their hospital stay. On average, one in every 10 affected patients will die from their health care-associated infections.

People in intensive care and newborns are particularly at risk. As per the WHO report approximately one in four hospital-treated sepsis cases and almost half of all cases of sepsis with organ dysfunction treated in adult intensive-care units are health care-associated.

What is preventing infection prevention and control from being implemented rigorously in healthcare facilities?

Public hospital in the city of Borama in North-West Somalia. Located near the border with Ethiopia. The hospital has a poor funding. Photo: Shutterstock.

In the case of low resource settings, one reason for the poor record of infection prevention and control, is the lack of basic infrastructure in healthcare facilities.

In many low- and middle-income countries, things that are taken for granted in higher income settings – for example, access to clean running water, continuous supply of energy, sanitizing equipment – are usually missing.

There may also be a lack of trained personnel or no dedicated infection prevention and control programs set up in healthcare facilities.

Improved implementation of infection prevention and control national programs needed

Indeed, the WHO report found little improvement in the implementation of infection prevention and control national programs in low-income countries in surveys carried out between 2018 and 2021. This was despite increased attention being paid to infection prevention and control due to the COVID-19 pandemic.

Only 15% of health care facilities meet all the infection prevention and control minimum requirements

Though the report found high-income countries are eight times more likely to have a more advanced infection prevention control implementation status than low-income countries, very few of them had all the minimum requirements for infection prevention and control in place at the national level.

A WHO survey in 2019 showed inadequate implementation of infection prevention and control practices at the point of care worldwide, with only 15.2% of healthcare facilities meeting all of the infection prevention and control minimum requirements.

This notwithstanding, many countries are now recording encouraging progress in some areas such as having dedicated infection prevention and control budgets, use of multimodal strategies for infection prevention and control interventions and establishing hand hygiene compliance as a key national indicator. There however still remains urgent need for expedited and sustained scale-up and investment in infection prevention and control minimum requirements and core components of infection prevention and control programs.

No country or health system free from health care-associated infections

The WHO report points out that:

“no country or health system, however sophisticated, can claim to be free from health care-associated infections”.

The report cites studies which found that even in the European Union and European Economic Area countries the three most impactful antibiotic-resistant microorganisms, which account for 70% of the burden of antimicrobial resistance in terms of disability and premature mortality, are typically acquired in healthcare settings.

Address infection prevention and control in the national and international health agendas

Given this global picture, the report calls for addressing infection prevention and control in the national and international health agendas. It points out the need for political commitment at the highest levels, the allocation of resources and the establishment of the appropriate regulations and legal frameworks for infection prevention and control.

Focus on health worker and patient safety

Very importantly, infection prevention and control should focus on health worker and patient safety at the point of care, with optimal practices becoming an integral part of the patient pathway and clinical care. According to the WHO report this can only happen if adequate standard operating procedures, training, infrastructure, supplies and human resources are available and monitored. This will in turn mitigate the spread of antibiotic-resistant microorganisms and associated long hospital stays, disabilities, increased healthcare expenditure and premature mortalities.

“It is time to turn the page on the paradox of hospitals spreading disease, rather than being the curative centers they were designed to be. Investments in infection prevention and control improvements are urgently needed”

concludes the report.