Infection prevention
Global update on infection prevention and control
Kate Woodhead RGN DMS provides an overview of the latest global reports on the state of infection prevention and control (IPC). These reports reveal the considerable variability in the implementation of core components of IPC and highlight the need for significant improvement.
A new report from the World Health Organization (WHO) on the state of infection prevention and control shows that there has been slow progress in addressing critical gaps to prevent healthcare associated infections (HCAIs). As might be expected, there is a wide gap between high income countries (HICs) and low- and middle-income countries (LMICs) with patients in the latter having an up to twenty times higher risk of acquiring infections during healthcare delivery than in high income countries. A large proportion of HCAIs can be prevented with improved IPC practices and basic water, sanitation and hygiene (WASH) services, which are also highly cost-effective to reduce antimicrobial resistance. WASH applies across all different levels of facilities which deliver healthcare from primary, secondary to tertiary, as well as public and private in both urban and rural areas. The report found that healthcare facilities face significant resource and financial issues including a lack of IPC professionals and budgets. Nearly one quarter of countries reported shortages of personal protective equipment.
Recent estimates indicate that 136 million
antibiotic-resistant HCAIs are occurring each year. WHO emphasises that this will not reduce unless IPC improves. HCAIs already prolong hospital stays and have enormous complication rates, such as sepsis, and in some cases disability or death. Without urgent action, the number of deaths could rise significantly. The modelling suggests that IPC interventions at the point of care, co-ordinated by Ministries of Health or established networks, could avert up to 821,000 deaths per year, by 2050, and save at least US$ 112 billion.1
No country or health system, regardless
of the level of development, can claim to be free of HCAIs. On average, out of every 100 patients in acute hospitals, seven patients in high income countries and fifteen patients in low- and middle- income countries will acquire at least one HCAI during their hospital stay. The point prevalence report, undertaken in Europe during 2022- 20232
, found an HCAI rate
of 7.1 %, with a range of 3.1%- 13.8%. The most frequently reported HCAIs were respiratory tract infections, urinary tract infections, surgical
site infections, bloodstream infections and gastro-intestinal infections. Twenty-six per cent of HCAIs were present on admission. The most frequent type of HCAI on admission was surgical site infection (25.7%).
Global targets The World Health Organization called for action on IPC following the lessons learned during the pandemic and many steps forward have been made since in elevating the importance of IPC in the global and national health agendas.3 A global strategy was produced and approved by Member States serving as the core of the 2024-2030 Global Action Plan and monitoring framework. Eight strategic directions are signalled in the global strategy as being critical to the development of improvement in IPC. (See Table 1). The Global report identifies that significant investments are required by all countries to achieve these targets and resource mobilisation is also needed. However, there is compelling data to suggest that a high return can derive from investments in IPC, both in terms of lives saved and economic gains.
Starting from a low base A research project reported from Rwanda in 20194 identified surgical site infections in the most common of procedures in Africa; a Caesarean Section has a rate of 7%-48% and is associated with younger age, obesity, hypothermia on admission, difficult delivery, premature rupture of the membranes, neonatal death, prolonged labour and long duration of C-section. The study estimated the prevalence of surgical site infection on postoperative day ten and identified risk factors for these infections in a rural district hospital in Rwanda. Additionally, they stated that hospital factors, which are relevant to surgical site infection, are poor operating room infrastructure, poor adherence to operating room guidelines including handwashing techniques, inadequate hygiene and sanitation at the hospital and at home,
February 2025 I
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