Lowbury Lecture 2005: infection control from a global perspective

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Summary

All healthcare settings around the world face the problem of healthcare-associated infections (HCAIs). Rates of infection vary between countries and within the same country depending on resources, interest of caregivers and healthcare staff, and patients' socio-economic situation. According to recent publications, 10–70% of HCAIs are preventable. Failure to comply with guidelines on hand hygiene, glove and gown use, and barrier nursing is a problem and unnecessary infection control measures are costly. National legislations and regional, national and international standards and guidelines associated with infection control also have an impact for countries that are not directly involved. They should be based on the assessment of infection risk, and should not increase costs unnecessarily. The International Federation of Infection Control and national infection control societies play an important role in continuing the education of infection control specialists.

Introduction

Healthcare-associated infections (HCAIs) are a threat to patient safety and contribute to unnecessary patient suffering, morbidity and death. In affluent countries, the emergence of multi-resistant micro-organisms and recognition of the additional costs of HCAIs to healthcare systems have raised political and public awareness of the problem and infection control. In many countries, where human immunodeficiency virus, malaria, tuberculosis, hepatitis and other infectious diseases are a major threat to public health, HCAIs are not recognized as an additional problem. Resources are not allocated to prevention of HCAIs, and when cross-infection appears, it is often misdiagnosed.

The four cornerstones for efficient infection control in healthcare settings are resources, knowledge, education and compliance.

Section snippets

Resources

Income is unequally distributed across the world, as are resources for health care. The richest 20% of the world's population have 74% of the income, and the poorest 20% of the world's population have 2% of the income. Child survival up to five years of age is regarded as a good indicator of the socio-economic situation in a region, and correlates approximately with the average gross domestic product (GDP) per capita. In 2003, the GDP per capita in sub-Saharan Africa, East Asia and the Pacific,

HCAI rates

Information on HCAI rates around the world is fragmentary. There are a few national surveillance systems, such as the National Nosocomial Infection Surveillance Study (NNIS) in the USA and the Krankenhaus Infektion Surveillance System in Germany. In Russia, there has been a long history of registration of HCAI. The old-fashioned system of punishment of the doctor or hospital when an infection is reported has not yet been totally abandoned. As a consequence, the official rates of hospital

Important infection control measures in patient care

Systematically collected information on causative factors responsible for high HCAI rates is rare.6 Multiple simultaneous interventions are usually introduced at the same time, which is understandable in a critical situation. It does, however, make it difficult to evaluate the relative importance of a single intervention. The most important infection control measures usually mentioned are shown in Table I.

Misuse of infection control measures in patient care

No country can afford to use infection control measures that are proven to be useless. Earlier, before compliance with hand hygiene precautions was the hottest topic at international infection control conferences, topics under headlines such as ‘money down the drain’ were common. This debate seems to have faded away. However, the list of unnecessary hospital infection control practices from Thailand is still valid in many countries.26 Responses to a questionnaire were obtained from 84 hospitals

International organizations, official bodies, legislation and standards

International organizations, e.g. WHO, World Alliance for Patient Safety, and international, regional and national legislation, standards and guidelines have an impact on infection control. National legislations and national, regional and international standards and guidelines also play a role for countries that are not directly involved, as they affect what is being produced by large multi-national manufacturers. In some cases, legal requirements and standards seem to be based on the

The future

The Study on the Efficacy of Nosocomial Infection Control in the 1970s showed that effective infection control programmes could reduce infection rates by as much as 32% and be cost effective.33 In an overview of published reports on the effect of infection control programmes from 1990 to 2002, Harbarth et al. found that between 10% and 70% of HCAIs were preventable.34 The existence of an infection control programme with a firm structure is essential. Infection control teams are important in

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    Copyright © 2006 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.