We spoke with Prof Benedetta Allegranzi at the World Health Organization (WHO) to find out about the importance of implementing infection prevention and control (IPC) programmes to reduce healthcare-associated infection (HCAI) and sepsis worldwide
The World Health Organization (WHO) calls on everyone to be inspired by the global movement to achieve universal health coverage (UHC), that is, achieving better health and well-being for all people at all ages, including financial risk protection, access to quality essential healthcare services and to safe, effective, quality and affordable essential medicines and vaccines for all. Infection prevention and control (IPC), including effective hand hygiene, is a critical part of achieving UHC because it is a practical and evidence-based approach that has a demonstrated impact on the quality of care and patient safety across the health system.
In this interview, Prof Benedetta Allegranzi shares her thoughts on why WHO is calling health facilities and governments worldwide to establish and implement infection prevention and control (IPC) programmes to reduce especially healthcare-associated infections (HAIs) and sepsis. This is because there is strong evidence that specific measures, such as effective hand hygiene can reduce the transmission of pathogens, spread of antimicrobial resistance (AMR) and the occurrence of HAIs which all pose a major health problem worldwide.
The conversation includes a focus on the extent to which HCAIs and sepsis affects patients every year on a global scale. Benedetta explains that according to WHO estimates hundreds of millions of patients are affected annually by HCAIs. In Europe, every year almost 9 million patients acquire an infection while receiving care in hospitals and long-term care facilities. On average, HCAIs affect 7% and 15% of patients in high-income and low- and middle-income countries, respectively. Hospital-born babies in low- and middle income countries are at a higher risk of being affected by neonatal sepsis, with infection rates three to 20 times higher than in high-income countries. Overall, sepsis affects more than 30 million people worldwide every year, potentially leading to 6 million deaths. Benedetta then develops this key point to us in further detail.
“It is estimated that the burden is much higher in low and middle-income countries and it affects specific populations, for example, it is estimated that there are 3 million newborns and 1.2 million children suffering from sepsis globally every year.
“Among pregnant women, this is also a major issue, for instance, sepsis is estimated to cause 1 in 10 maternal deaths on average. Most of this occurs in low- and middle-income countries, so these are the most affected populations.”
Last year, the focus of the WHO SAVE LIVES: Clean Your Hands 5 May campaign was the prevention of sepsis in healthcare, something that Benedetta is keen to elaborate on.
“The focus was the prevention of sepsis and this can happen in two ways. Firstly, preventing pathogen transmission and infection reduces the number of infections. This is the first step towards preventing sepsis, which is the clinical evolution of an infectious status to a life-threatening illness that injures tissues and organs; therefore, if you prevent infection this contributes to reducing sepsis. Prevention of infection is mainly based on using effective hygiene practices such as hand hygiene, both in health facilities and the community, and establishing functioning infection prevention and control programmes in health care facilities.
“Secondly, to reduce sepsis itself, it is important to recognise sepsis signs and symptoms timely and treat it appropriately with antibiotic treatment of infection and supportive therapy.”
Continuing the themes of SAVE LIVES: Clean Your Hands 5 May 2018, Benedetta then underscores the key messages to convey in this respect, such as why ministries of health should implement the 2017 WHA sepsis resolution and make hand hygiene a national marker of healthcare quality. By way of background, WHO Member States adopted a resolution on improving the prevention, diagnosis and treatment of sepsis at the Seventieth World Health Assembly in May 2017.
“First of all, it is really important to remember that all WHO Member States endorsed this resolution on sepsis which is about improving the prevention, diagnosis and clinical management of sepsis. Therefore, there are specific actions that the WHO Member States or countries should establish, including education and training as Benedetta goes on to explain in more detail.
“Firstly, they should raise more awareness about this problem with different audiences, of course, such as health care professionals, patients, patient associations and the community for the early recognition of the signs and symptoms of potential situations which can evolve to sepsis. Of course, in this approach, there is also a need for raising awareness of the importance of this problem using the data mentioned earlier on the extent to which sepsis affect patients, so people can understand that this can potentially be a big problem. An effective way to raise awareness is to launch local or national campaigns on sepsis.
“At the national level, it is important to develop policies and guidelines on sepsis prevention, diagnosis and clinical management according to the 2017 WHA sepsis resolution. Also, health systems should educate and support general practitioners (GPs) who are frontline professionals who may recognise sepsis in a timely manner when a patient has an infection which has evolved into a severe condition.
“Emergency staff and these type of healthcare professionals are also crucial but so are patients and communities who need to understand the severity of this condition and recognise the early signs and symptoms. Guidance and toolkits enable processes which detect sepsis timely and immediately establish the right treatment this goes with education and training, which should be different depending on the target audience, such as highly specialised training for emergency professionals to handle sepsis in an appropriate way.
“On diagnosis, there are specific diagnostic tests that can be done to recognise the condition of sepsis and not all of these are currently available in all countries. As such, the provision of diagnostic tools and equipment can be quite important when we talk about a healthcare system and infrastructure at the national level for countries and governments.”
To bring the discussion to a close, Benedetta highlights that sepsis and septic shock are really life-threatening conditions which can emerge in terms of the evolution of infection. This often happens when inappropriate or ineffective treatment is given for an infection. When treatment is ineffective, it means that AMR plays an important role in the sense that it can be a factor which jeopardises the effectiveness of antibiotic treatment that is given for infection.
“As you may know, AMR is a threat and a big problem in most countries and, therefore, strategies for sepsis prevention should include strong national action plans and activities to reduce AMR and, in particular, to preserve the use of specific antibiotics which are still effective but if misused they will certainly become ineffective in the future.”
Prof Benedetta Allegranzi, MD, DTM&H
Coordinator, Infection Prevention and Control Global Unit
Service Delivery and Safety
World Health Organization
Tel: +41 22 791 2689