Ermira Tartari

Clean your hands on May 5, 2017: Fight antibiotic resistance—it's in your hands

Preventing healthcare-associated infections and reducing their avoidable impact on health systems is critical today to make facilities safer for patients worldwide. In addition, the increasing public health burden of antimicrobial resistance (AMR) urges action. Stronger political commitment in reducing AMR was highlighted at the last United Nations General Assembly in September 2016 in New York. Hand hygiene is at the center of effective infection prevention and control (IPC) to combat AMR spread. The World Health Organization (WHO) recently issued guidelines on the Core Components of effective IPC program. Their implementation will help create strong, resilient health systems in all settings. The guidelines include the application of a multimodal strategy: achieving system change (infrastructure and resources), raising awareness, increasing education and training, monitoring and timely feedback, and creating a patient safety culture that includes visibly committed leadership. This approach improves hand hygiene, reduces infections, and saves lives. Therefore, on the May 5, 2017, Global Annual Hand Hygiene Day, WHO urges policy makers, top-level managers, IPC specialists, and other health professionals to focus on the fight against AMR spread by building everstronger hand hygiene and IPC programs (Table 1). We encourage health facilities worldwide to endorse the May 5, 2017, WHO campaign and to further improve hand hygiene, fight antibiotic resistance, and commit to progressing toward adherence to all core components of the IPC program. Let’s fight antibiotic resistance together; it’s in our hands.

The Prevalence of Healthcare-Associated Infections in Mainland China: A Systematic Review and Meta-analysis

OBJECTIVETo assess the prevalence of healthcare-associated infections (HAIs) in mainland China.DESIGNSystematic review and meta-analysis.SETTINGAdults and children from secondary and tertiary acute-care hospitals in mainland China.METHODSWe searched PubMed, the China National Knowledge Infrastructure, and Wan Fang for multicenter point-prevalence surveys of acute-care hospitals in mainland China from January 2006 to August 2016. All reports related to HAI, using a point-prevalence methodology and published either in English or Chinese were eligible.RESULTSIn total, 3,021 publications were identified; 115 were eligible for quality assessment and data abstraction. The weighted HAI prevalence (95% confidence interval [CI]) overall, in general hospitals, childrens hospitals, maternal and child health hospitals, and oncology hospitals were 3.12% (95% CI, 2.94%-3.29%), 3.02% (95% CI, 2.79%-3.26%), 4.43% (95% CI, 3.39%-5.47%), 1.88% (95% CI, 1.47%-2.29%), and 3.96% (95% CI, 3.12%-4.79%), respectively. In general hospitals, prevalence was highest in adult intensive care units (26.07%; 95% CI, 23.03%-29.12%), followed by surgery (3.26%; 95% CI, 2.96%-3.57%), and internal medicine (3.06%; 95% CI, 2.67%-3.46%). Overall, lower respiratory tract infection was the most frequent HAI (24,185, 47.28%), followed by urinary tract infection (5,773, 11.29%) and upper respiratory tract infection (5,194, 10.15%). Gram-negative bacilli were the most frequently isolated pathogens, and Pseudomonas aeruginosa (3,395, 14.91%), and Escherichia coli (2,918, 12.82%) were the most common single microorganisms.CONCLUSIONSThis study is the largest systematic review on the prevalence of HAI in mainland China. These results provide a benchmark for future PPSs and a reference for infection prevention and control strategies in mainland China.Infect Control Hosp Epidemiol 2018;39:701-709.

Why language matters: a tour through hand hygiene literature

BackgroundHand hygiene has evolved over the last decades and many terminologies emerged. We aimed to analyse the evolution in the frequency of utilization of key hand hygiene terms in the literature along the years.MethodsWe identified keywords and Medical Subject Headings (MeSH) used in MEDLINE® indexation related to hand hygiene by searching international guidelines and the MeSH database. We performed a MEDLINE® search combining the selected keywords and MeSH and analysed the number of publications retrieved yearly.ResultsThe literature search yielded 9019 publications when all hand hygiene related search terms were combined, between 1921 and November 2016. The total number of publications per year increased from a median of 4 (IQR 3, 6) in the 1950’s to 554 (IQR 478, 583) between 2011 and 2015. The most frequently used keywords are hand disinfection, hand hygiene, hand washing, handrub, hand sanitizer and alcohol-based hand rub (ABHR). Until the 1990s, hand disinfection and hand washing were the most frequently used terms. Whilst the last decade has seen a remarkable increase in publications mentioning hand disinfection and hand hygiene and for the first time handrub, hand sanitizers and ABHR were introduced in the literature. Hand disinfection, hand hygiene and hand sanitizers are the main MeSH used by MEDLINE®. Since 2013 hand hygiene is the most frequently used MeSH and keyword.ConclusionsThe change seen in literature in the last two decades, from hand washing and hand disinfection to hand hygiene, most probably reflect the paradigm shift favouring use of ABHR over soap and water promoted by international guidelines in the early 2000s.

Global hand hygiene improvement progress: two surveys using the WHO Hand Hygiene Self-Assessment Framework

The World Health Organization (WHO) conducted two global surveys in 2011 and 2015 using the Hand Hygiene Self-Assessment Framework. In 2011, 2119 health facilities from 69 countries participated, and in 2015, 807 health facilities from 91 countries participated. In total, 86 facilities submitted results for both surveys; their overall score increased significantly (P<0.001) from 335.1 [standard deviation (SD) 7.5] to 374.4 (SD 90.5). In terms of WHO regions, the scores for the Eastern Mediterranean, Europe and Western Pacific regions all improved significantly (P<0.01). This represents a snapshot of the current position of global hand hygiene improvement efforts, outlining facility progress and highlighting the value of such an assessment tool.

The Effect of Participating in a Surgical Site Infection (SSI) Surveillance Network on the Time Trend of SSI Rates: A Systematic Review

This systematic literature review reveals that participating in a surgical site infection (SSI) surveillance network is associated with short-term reductions in SSI rates: relative risk [RR] for year 2, 0.80 (95% confidence interval [CI], 0.79-0.82); year 3 RR, 0.92 (95% CI, 0.90-0.94); year 4 RR, 0.98 (95% CI, 0.96-1.00). Infect Control Hosp Epidemiol 2017;38:1364-1366.

Clean Your Hands 5th May 2017: 'Fight antibiotic resistance - it's in your hands'

Preventing healthcare-associated infections and reducing their avoidable impact on health systems is critical today to make facilities safer for patients worldwide [1]. In addition, the increasing public health burden of antimicrobial resistance (AMR) urges to action [2]. Stronger political commitment in reducing AMR was highlighted at the last United Nations General Assembly in September 2016 in New York. Hand hygiene is at the center of effective infection prevention and control (IPC) to combat AMR spread [3]. The World Health Organization (WHO) recently issued guidelines on the Core Components of effective IPC programmes [1]. Their implementation will allow for strong, resilient health systems in all settings. The guidelines include the application of a multimodal strategy that consists in achieving system change (infrastructure and resources), raising awareness, education and training, monitoring and timely feedback and a patient safety culture that includes visibly committed leadership. This approach improves hand hygiene, reduces infections and saves lives [4]. Therefore, on the occasion of the upcoming 5 May 2017 Global Annual Hand Hygiene Day, WHO urges policy makers, top-level managers, IPC specialists and other health professionals to focus on the fight against AMR spread, by building ever stronger hand hygiene and IPC programmes (Table 1). We encourage health facilities worldwide to endorse the WHOs 5 May 2017 campaign [5] and further improve hand hygiene, fight antibiotic resistance and commit to progressing towards adherence with all core components of IPC programmes. Let’s fight antibiotic resistance together; its in our hands.