Prevent sepsis by keeping your hands clean

Washing hands with water and soap is a simple, yet effective way to prevent spreading infection. — Filepic

Sepsis is a life-threatening situation where organs severely malfunction due to the body’s abnormal response to an 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.

Severe infection

A 2020 paper in The Lancet medical journal estimated that there were 48.9 million cases and 11 million sepsis-related deaths worldwide – accounting for almost 20% of all global deaths in 2017.

Sepsis is often the severe result of common and preventable infections within the community.

Sepsis also often results from infections acquired in healthcare settings.

Healthcare-associated infections (HAIs) are a major problem as it is the most frequent adverse event in healthcare globally, with an estimated hundreds of millions of patients affected worldwide annually.

Antibiotic resistance often occurs in HAIs and is a primary factor in unresponsiveness to treatment and rapid deterioration to sepsis, septic shock and increased risk of death.

Preventive measures against infection in the community and healthcare settings include good hygiene practices, water quality and sanitation, and safe practices in specific settings like intensive care units (ICUs), labour rooms, etc.

Early diagnosis and prompt and 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 risk of death, it can also be a cause of long-term illness that requires treatment and support.

Hand hygiene crucial

Sepsis often results from infections acquired in a healthcare setting, so it is important for healthcare staff to remember to clean their hands between seeing patients. — AFP

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’s (WHO) guidelines on hand hygiene in healthcare are used in hand hygiene promotion and improvement in healthcare settings globally.

These guidelines are complemented by the WHO Multimodal Hand Hygiene Improvement Strategy, which consists of a Guide to Implementation and an implementation toolkit.

This Strategy has been shown to be the most effective approach to improvement in hand hygiene practices.

Hand hygiene improvement programmes can prevent up to half of all avoidable HAIs.

The economic savings from this 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 healthcare facilities.

A study of hand hygiene promotion in the Penang and Sarawak state hospitals reported the effect of peer-identified change agents (PICA) and management change agents (MSCA) in 2020.

The average hand hygiene compliance in the PICA and MSCA groups improved from 48% and 50% respectively in the pre-intervention period, to 66% and 65% during the intervention period.

The Covid-19 pandemic has also impacted on hand hygiene practices.

An online survey during 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:

• 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 (the outcome) was related to: (i) lower total Covid-19 morbidity; (ii) lower total Covid-19 mortality; (iii) greater increases in recent cases of Covid-19 morbidity.

“As in the main regression models, higher handwashing adherence was associated with more frequent exposure to handwashing guidelines, being a healthcare professional, being older, being female, and being married...

“Additionally, 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’

The Covid-19 pandemic brought home to all members of the community the importance of practising good hand hygiene. — HARTINA BULATING

The safety culture in an institution refers to the environment and perceptions of patient safety at a healthcare 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 policymakers 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 healthcare.

This was an extension of the WHO’s First Global Patient Safety Challenge: Clean Care is Safer Care work.

The WHO has designated May 5 as World Hand Hygiene Day.

The campaign theme this year (2022) is “A healthcare quality and safety climate or culture that values hand hygiene and infection prevention and control”, and the slogan is “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 organisation.”

The campaign is focused on the recognition that a healthcare 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:

• Healthcare staff to lead by example and to encourage others to clean their hands
• Infection prevention staff to encourage healthcare 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
• Policymakers to prioritise resources, training and programmes on hand hygiene, and
• People who utilise healthcare facilities to get involved in local hand hygiene campaigns and activities.

Patients and their families can help by washing their hands, observing whether healthcare 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 Practitioners Associations and the Malaysian Medical Association. For more information, email [e-mail]. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.