Infection prevention
and inadequate quality and quantity of staffing. A further study from Rwanda5
reviewing surgical site
infections, identified additional causative factors, which were inadequate sterilisation of surgical instruments, poor hand hygiene practices among healthcare workers, limited access to antibiotics and antiseptics, overcrowded hospitals, insufficient surgical facilities, and patient factors such as underlying health conditions (includingHIV and nutritional status).
Antimicrobial resistance The spread of infections with microorganisms that are discovered to be resistant to antibiotics is a modern and vital issue in the treatment of patients in healthcare facilities. Good IPC practices including hand hygiene for example can make a significant difference in reducing the risk of spread, as well as optimal diagnostic and antimicrobial stewardship. In 2019, antimicrobial resistance (AMR) was
found to be directly responsible for about 1.27 million deaths globally. Sustained action is required to curb inappropriate use of antibiotics, the main driver of AMR. The UK has a five-year action plan to reduce
the incidence of AMR, the second five-year plan was published in 2024 through to 2029. The updated plan6
commits the UK to restricting the
unnecessary use of antibiotics in humans and animals, strengthening the surveillance of drug- resistant infections and incentivising industry to develop the next generation of treatments. To confront antimicrobial resistance, a number of specific targets were identified. The National Action Plan contains a number
of ambitions, including: l By 2029, the aim is to prevent any increase in a specified set of drug-resistant infections in humans from the 2019 to 2020 financial year baseline.
l By 2029, the aim is to prevent any increase in gram-negative bloodstream infections (which are described as difficult to treat infections)
Eight core targets at global level
1 Increase of proportion of countries with a costed and approved National Action Plan and monitoring framework
2 Increase of proportion of countries with legislation/ regulations to address IPC 3 Increase of proportion of countries having an identified protected and dedicated budget allocated to the national IPC programme and action plan
4 Increase of proportion of countries meeting all WHO IPC minimum requirements for IPC programmes at national level (through WHO global IPC portal)
5 Increase of proportion of countries with national IPC programmes at level 4 or 5 according to SPAR C 9.1 and levels D and E in TrACSS
6 Increase of proportion of countries with 1) basic water 2) sanitation 3) hygiene and 4) waste services in all healthcare facilities
7 Increase of proportion of countries that have achieved their national targets on reducing HCAIs 8 Increase of proportion of countries with a national HCAI surveillance System
Table 1: Core targets of the IPC monitoring framework at the global and national level. in humans from the FY 2019 to 2020 baseline.
l By 2029, the aim is to increase UK public and healthcare professionals’ knowledge on AMR by 10%, using 2018 and 2019 baselines, respectively.
l By 2029, the aim is to reduce total antibiotic use in human populations by 5% from the 2019 baseline.
l By 2029, the aim is to achieve 70% of total use of antibiotics from the access category (new UK category) across the human healthcare system.
These are challenging aims.
Data from the ECDC point prevalence study 2022-20237
shows that the prevalence of
antimicrobial use was highest in ICU patients. They were most frequently prescribed for treatment of an infection (70.2%), of a community-acquired infection (49.3%), of a hospital-acquired infection (18.4%), and an infection acquired in a long-term facility (2.5%). Surgical prophylaxis was an indication for 14.9% of the prescriptions and was prolonged for more than one day for 48.3% of surgical prophylaxis
prescriptions. Medical prophylaxis was the indication for 10.2% of prescriptions. Information about change of antimicrobials during the treatment of an infection was reported for 83% of prescriptions. Participation in AMR surveillance networks,
according to the European Antimicrobial Resistance Surveillance network (EARS-Net), was reported by 54% hospitals and participation in a network for hospital-based surveillance of antimicrobial consumption was reported by 42% of hospitals. The core component ‘built environment,
materials and equipment for IPC’ was evaluated by the availability of AHR dispensers at the point of care, the number of single rooms and the number of airborne infection isolation rooms. The median percentage of beds with an AHR dispenser at the point of care was 63% and varied from less than 10% in Bulgaria, Romania, Kosovo and Serbia to more than 90% in Hungary, Luxembourg, Portugal and Spain. High availability of AHR dispensers was significantly associated with high consumption of AHR and a low composite index of AMR at country level.
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