Pittet_EU_Infectious.qxp 24/1/08 9:07 am Page 12
Infection Control
general and hand hygiene in particular, the combined efforts expected results from the pilot and complementary testing sites are very
under the First Global Patient Safety Challenge have the potential to promising in terms of feasibility and effectiveness of the WHO hand
save millions of lives, prevent morbidities and long-term disability for hygiene improvement strategy. To scale up and to sustain the project
hundreds of millions of patients and lead to major cost savings. Early are the next goals to be achieved. ■
1. Pittet D, Allegranzi B, Sax H, et al., Evidence-based model for nosocomial infection, Pediatrics, 2004;114:565–71. units, J Gen Intern Med, 2006;21(Suppl. 2):S35–42.
hand transmission during patient care and the role of improved 11. Rosenthal VD, et al., Effect of education and performance 19. Hugonnet S, Perneger TV, Pittet D, Alcohol-based handrub
practices, Lancet Infect Dis, 2006;6:641–52. feedback on handwashing: the benefit of administrative support improves compliance with hand hygiene in intensive care units,
2. World Health Organization. WHO Guidelines for Hand Hygiene in Argentinean hospitals, Am J Infect Control, 2003;31:85–92. Arch Int Med, 2002;162:1037–43.
in Health Care (Advanced Draft). Geneva: World Health 12. Bischoff WE, et al., Handwashing compliance by healthcare 20. Maury E, Alzieu M, Baudel JL, et al., Availability of an alcohol
Organization, 2006,
www.who.int/patientsafety/ workers: The impact of introducing an accessible, alcohol-based solution can improve hand disinfection compliance in an
information_centre/ghhad_download/en/index.html hand antiseptic, Arch Int Med, 2000;160:1017–21. intensive care unit, Am J Resp Crit Care Med, 2000;162:324–7.
3. Pittet D, The Lowbury lecture: behaviour in infection control, 13. Berg DE, Hershow RC, Ramirez CA, Control of nosocomial 21. Girard R, Amazian K, Fabry J, Better compliance and better
J Hosp Infect, 2004; 58:1–13. infections in an intensive care unit in Guatemala city, Clin Infect tolerance in relation to a well-conducted introduction to rub-in
4. Pittet D, Promotion of hand hygiene: magic, hype or scientific Dis, 1995;21:588–93. hand disinfection, J Hosp Infect, 2001;47:131–7.
challenge?, Infect Control Hosp Epidemiol, 2002;23:118–19. 14. Avila-Aguero ML, et al., Handwashing practices in a tertiary- 22. Brown SM, Lubimova AV, Khrustalyeva NM, et al. Use of an
5. Pittet D, Improving adherence to hand hygiene practice: a care, pediatric hospital and the effect on an educational alcohol-based hand rub and quality improvement interventions
multidisciplinary approach, Emerg Infect Dis, 2001;7:234–40. programme, Clin Perform Qual Health Care, 1998;6:70–72. to improve hand hygiene in a Russian neonatal intensive care
6. Naikoba S, Hayward A, The effectiveness of interventions aimed 15. Maury E, Alzieu M, , et al., Availability of an alcohol solution unit, Infect Control Hosp Epidemiol, 2003;24:172–9.
at increasing handwashing in healthcare workers – a systematic can improve hand disinfection compliance in an intensive care 23. World Health Organization. The Global Patient Safety Challenge
review, J Hosp Infect, 2001;47:173–80. unit, Am J Respir Crit Care Med, 2000;162:324–7. 2005-2006 ‘Clean Care is Safer Care’, 2005;
7. Larson EL, Bryan JL, Adler LM, Blane C, A multifaceted 16. Girou E, Oppein F, Handwashing compliance in a French
http://www.who.int/patientsafety/events/05/GPSC_Launch_ENG
approach to changing handwashing behaviour, Am J Infect university hospital: new perspective with the introduction of LISH_FINAL
Control, 1997;25:3–10. hand-rubbing with a waterless alcohol-based solution, J Hosp 24. Pittet D, Donaldson L, Clean Care is Safer Care: a worldwide
8. Pittet D, Hugonnet S, Harbarth S, et al., Effectiveness of a Infect, 2001;48 (Suppl. A):S55–7. priority, Lancet, 2005;366:1246–7.
hospital-wide programme to improve compliance with hand 17. Johnson PD, Martin R, et al., Efficacy of an alcohol/chlorhexidine 25. World Health Organization. Simple Guide to the WHO
hygiene, Lancet, 2000;356:1307–12. hand hygiene programme in a hospital with high rates of Approach to Hand Hygiene Improvement, 2007,
9. Harbarth S, Pittet D, Grady L, et al., Interventional study to nosocomial methicillin-resistant Staphylococcus aureus (MRSA)
http://www.who.int/gpsc/resources/summary_of_who_
evaluate the impact of an alcohol-based hand gel in improving infection, Med J Aust, 2005;183:509–14. approach_HH_march07.pdf
hand hygiene compliance, Pediatr Inf Dis J, 2002;21:489–95. 18. Eldridge NE, Woods SS, Bonello RS, et al., Using the six sigma 26. Sax H, Allegranzi B, Uckay I, et al., “My five moments for hand
10. Lam BC, Lee J, Lau YL, Hand hygiene practices in a neonatal process to implement the Centers for Disease Control and hygiene: a user-centred design approach to understand, train,
intensive care unit: a multimodal intervention and impact on Prevention Guideline for Hand Hygiene in four intensive care monitor and report hand hygiene”, J Hosp Infect, 2007;67:9–21.
Spotlight – Healthcare-associated Infection
• 384 children die every day of healthcare-associated infections in
Staphylococcus aureus – Proportion of Invasive Isolates
developing countries.
Resistant to Oxacillin (MRSA) in 2006
• In Mexico, the costs of healthcare-associated infections represent
70% of the entire budget of the ministry of health.
<1%
• At least 10% of legionella cases are nosocomial and concern
healthcare facilities worldwide.
1–5%
• In developed countries, about 5–10% of patients admitted to
5–10%
acute care hospitals acquire an infection that was not present or
10–25%
incubating on admission. 25–50%
• Methicillin-resistant Staphylococcus aureus (MRSA) is the most
>50
commonly identified antibiotic-resistant pathogen in hospitals in
No data
Europe. MRSA-linked infection in intensive care units is highest in
Croatia, Greece, Ireland and Malta, but MRSA incidence is stabilising
or reducing in France, Slovenia, Cyprus and Turkey.
• A study at the Edinburgh Royal Infirmary estimated that 100%
hand hygiene compliance by all healthcare workers would require
about 230 minutes per patient per day to enact.
Types of Hospital-acquired Infection in Acute Trusts in England
6.2%
Urinary tract
23.2%
27.4%
Surgical wound
Lower respiratory tract
10.7%
9.6% Other
22.9%
Blood (bacteraemia)
Skin
Sources: World Health Organization, BMJ, European Antimicrobial Surveillance System (EARSS), UK National Audit Office.
12 EUROPEAN INFECTIOUS DISEASE 2007
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130