May 5 was World Hand Hygiene Day. This month, medical care centres across the world re-educate themselves about the importance of this one basic practice. The World Health Organization’s ‘Clean Hands Count’ campaign aims to improve healthcare providers’ adherence to hand hygiene recommendations. Naresh Trehan, chairman and managing director, Medanta, talks to The Hindu about the importance of hand hygiene
What is the importance of hand wash? How does it translate into better patient care?
Healthcare-associated infections are drawing more attention. This is not only because of the magnitude of the problem in terms of associated morbidity, mortality and cost of treatment but also due to the growing recognition that most of these are preventable.
The medical community is witnessing unprecedented advancements in understanding of pathophysiology of infectious diseases and the global spread of multi drug-resistant infections in healthcare set-ups. These factors have necessitated a relook into the role of basic practices of infection prevention in modern day health care.
There is now undisputed evidence that strict adherence to hand hygiene reduces the risk of cross-transmission of infections. With ‘Clean Care is Safer Care’ as the prime agenda of the global initiative by the WHO on patient safety programmes, it is time for developing countries to formulate much-needed policies for implementation of basic infection prevention practices.
A thorough disinfectant hand wash is necessary for everyone at all times and in all situations. Effective hand wash minimises the spread of potentially deadly germs. It also protects against secondary infections.
Every patient is at risk of infection while under treatment and healthcare providers are at a risk of infection while treating patients. Hand wash is, therefore, an instant self-administered vaccine. Preventing the spread of germs is especially important in hospitals and other facilities like dialysis centres, ICUs, OPDs and wards. Washing your hands properly is one of the most important things you can do to help prevent and control the spread of illnesses.
What is the normal rate of infection in India when basic hygiene is compromised?
Analysis of the rate of device-associated infections across hospitals shows markedly higher rates of infection stemming from compromised basic hygiene. Rates of hospital-acquired infections and anti-microbial resistance are markedly higher in India than the rates reported by the Centre for Disease Control and Prevention, the leading national public health institute in the United States.
Their study found an incidence rate of 7.92 central line-associated bloodstream infections per 1,000 central line-days, 10.6 catheter-associated urinary tract infections [UTIs] per 1,000 urinary catheter-days and a ventilator-associated pneumonia rate of 10.4 per 1,000 mechanical ventilator-days in adult ICUs. These high rates could reflect ‘the typical ICU situation in hospitals in India’. Incidence of nosocomial infections in Medical Intensive Care Unit [MICU] patients was 17.7% [23/130]. Of these, 34.8% [8/130] were UTIs and the most frequent. This was followed by pneumonias at 21.7% [5/130]; 17.4% [4/130] surgical site infections; 13% [3/130] gastroenteritis; and 13% [3/130] bloodstream infections and meningitis. In the larger public sphere, UNICEF estimates that 594 million people [130 million households] in India currently do not have access to toilets, accounting for approximately 50% of the country’s population. This number is more than double the rate of the next 18 countries in the world combined. In rural communities, this number increases to 72%. According to the World Health Organization, lack of public hygiene is the main cause of preventable illnesses such as malnutrition, cholera, and diarrhoea [diarrhoea alone kills three lakh people per year].
What is being done to improve the situation?
The best and most effective way to address the situation is awareness, education and action. The government has undertaken several initiatives towards this. With healthcare and public health partners, Medanta is raising awareness about hand hygiene in hospitals and in the community. Hand hygiene is practised by healthcare providers and encouraged among attendants and patients to prevent infection. We have a robust initiative which motivates people to wash their hands. As part of this initiative, they are advised to clean hands before eating, and before and after direct contact with a patient’s intact skin [taking a pulse or blood pressure, performing physical examinations, lifting the patient in bed, etc.]; after contact with blood, body fluids or excretions, mucous membranes, or wound dressings, after contact with inanimate objects [including medical equipment] in the immediate vicinity of the patient; and after using the restroom. Constant and consistent communication, and enforcement of this is practised at Medanta.
Is there any specific movement your hospital has adopted?
The WHO says as many as 1.4 million people globally suffer from a nosocomial or hospital-acquired infections, which account for about 80,000 deaths annually. Medanta has initiated a public health initiative where our teams demonstrate six steps of hand hygiene to school and university students.
The team has trained more than one lakh students in Gurugram, Lisana, Jhajjar, Manesar, Faridabad, Karnal, Sohna and Delhi. In addition, special hand hygiene training workshops are organised for RWAs, NGOs, slums and at mass events. The team has organised cyclothons, marathons and nukkad nataks in the community to raise awareness. It is in routine practice inside the hospital, where all doctors, nurses and paramedical staff regularly and religiously practice hand hygiene to prevent transmission of infection.
