The first comprehensive, authoritative review of one of the most fundamental and important issues in infection control and patient safety, hand hygiene. Developed and presented by the world's leading scholar-clinicians, Hand Hygiene is an essential resource for all medical professionals.

Developed and presented by the world leaders in this fundamental topic
Fully integrates World Health Organization (WHO) guidelines and policies
Offers a global perspective in tackling hand hygiene issues in developed and developing countries
Coverage of basic and highly complex clinical applications of hand hygiene practices
Includes novel and unusual aspects and issues in hand hygiene such as religious and cultural aspects and patient participation
Offers guidance at the individual, institutional, and organizational levels for national and worldwide hygiene promotion campaigns

Frequently asked questions

Simply head over to the account section in settings and click on “Cancel Subscription” - it’s as simple as that. After you cancel, your membership will stay active for the remainder of the time you’ve paid for. Learn more here.

At the moment all of our mobile-responsive ePub books are available to download via the app. Most of our PDFs are also available to download and we're working on making the final remaining ones downloadable now. Learn more here.

Both plans give you full access to the library and all of Perlego’s features. The only differences are the price and subscription period: With the annual plan you’ll save around 30% compared to 12 months on the monthly plan.

We are an online textbook subscription service, where you can get access to an entire online library for less than the price of a single book per month. With over 1 million books across 1000+ topics, we’ve got you covered! Learn more here.

Look out for the read-aloud symbol on your next book to see if you can listen to it. The read-aloud tool reads text aloud for you, highlighting the text as it is being read. You can pause it, speed it up and slow it down. Learn more here.

Yes, you can access Hand Hygiene by Didier Pittet, John M. Boyce, Benedetta Allegranzi in PDF and/or ePUB format, as well as other popular books in Medicina & Medicina interna y diagnóstico. We have over one million books available in our catalogue for you to explore.

Information

Publisher

Wiley-Blackwell

Year

2017

ISBN

9781118846858

Edition

Topic

Medicina

Subtopic

Medicina interna y diagnóstico

Chapter 1
The Burden of Healthcare-Associated Infection

Benedetta Allegranzi¹, Sepideh Bagheri Nejad² and Didier Pittet³

¹Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland

²Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland

³Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

Key Messages

The World Health Organization (WHO) estimates that hundreds of millions of patients are affected by healthcare-associated infection (HAI) worldwide each year, leading to significant mortality and financial losses for health systems, but precise data of the global burden are not available.
Of every 100 hospitalized patients at any given time, 6 to 7 will acquire at least one HAI in developed countries and 10 in developing countries.
In low- and middle-income countries, HAI frequency, especially in high-risk patients, is at least two to three times higher than in high-income countries, and device-associated infection densities in intensive care units are up to 13 times higher.

Healthcare-associated infections (HAIs) affect patients in hospitals and other healthcare settings. These infections are not present or incubating at time of admission, but include infections appearing after discharge, and occupational infections among staff. HAIs are one of the most frequent adverse events during healthcare delivery. No institution or country can claim to have solved this problem, despite many efforts. Healthcare workers' (HCWs') hands are the most common vehicle of microorganisms causing HAI. The transmission of these pathogens to the patient, the HCW, and the environment can be prevented through hand hygiene best practices.

What We Know – The Evidence

Although a national HAI surveillance system is in place in most high-income countries, only 23 developing countries (23/147 [15.6%]) reported a functioning system when assessed in 2010.¹ In 2010, all 27 European Union (EU) Member States and Norway contributed to at least one of the four components of the Healthcare-Associated Infections Surveillance Network (HAI-Net), coordinated by the European Centre for Disease Prevention and Control (ECDC). Among these, 25 and 23 countries participated in the point prevalence surveys of HAI and antimicrobial use in long-term care facilities (LTCF) and acute care hospitals, respectively; 13 countries participated in the surveillance of surgical site infections (SSI); 14 in surveillance of HAI in intensive care units (ICUs); and 7 countries contributed to all surveillance components.²

Based on a 1995–2010 systematic review and meta-analysis of national and multicenter studies from high-income countries conducted by the WHO, the prevalence of hospitalized patients who acquired at least one HAI ranged from 3.5% to 12%. Pooled HAI prevalence was 7.6 episodes per 100 patients (95% confidence interval [CI], 6.9–8.5) and 7.1 infected patients per 100 patients admitted (95% CI, 6.5–7.8).¹ Very similar data were issued in 2008 by the ECDC based on a review of studies carried out between 1996 and 2007 in 19 countries.³ Mean HAI prevalence was 7.1%; the annual number of infected patients was estimated at 4,131,000 and the annual number of HAI at 4,544,100.³ In 2011–2012, a point prevalence study coordinated by ECDC in 29 countries indicated that, on average, 6% (range, 2.3%–10.8%) of admitted patients acquired at least one HAI in acute care hospitals.⁴ Based on these data, ECDC estimated that approximately 80,000 patients in Europe on any given day develop at least one HAI for a total annual number of 3.2 million patients (95% CI 1.9–5.2) with a HAI.⁴

The estimated HAI incidence in the United States was 4.5% in 2002, corresponding to 9.3 infections per 1000 patient-days and 1.7 million affected patients.⁵ In the United States and Europe, urinary tract infection (UTI) used to be considered the most frequent type of infection hospital-wide (36% and 27%, respectively).^{3, 5} In the recent European point prevalence study, lower respiratory tract infection (23.4%) was the most frequent HAI, followed by SSI (19.6%) and UTI (19%).⁴ According to several studies, the frequency of SSI varies between 1.2% and 5.2% in high-income countries.¹ In European countries, SSI rates varied according to the type of operation; the highest were in colon surgery (9.9%) and the lowest in knee prosthesis (0.7%).⁴

HAI incidence is much higher in severely ill patients. In high-income countries, approximately 30% of ICU patients are affected by at least one episode of HAI with substantial associated morbidity and mortality.⁶ Pooled HAI cumulative incidence density in adult high-risk patients was 17 episodes per 1000 patient-days (range 13.0–20.3) in a meta-analysis performed by WHO.¹ Incidence densities of device-associated infections in ICUs from different studies including WHO reviews are reported in Table 1.1. In a large-scale study conducted in some middle-income countries in Latin America, HAIs were the most common type of incidents occurring in hospitalized patients; the most frequent were pneumonia and SSI.⁷

According to a systematic review, WHO reported that HAIs are at least two to three times more frequent in resource-limited settings than in high-income countries.^{1, 8} In low- and middle-income countries, HAI prevalence varied between 5.7% and 19.1% with a pooled prevalence of 10.1 per 100 patients (95% CI, 8.4–12.2); the reported prevalence was significantly higher in high- than in low-quality studies (15.5% vs. 8.5%, respectively).⁸ In contrast to Europe and the United States, SSI was the leading infection hospital-wide in settings with limited resources, affecting up to one-third of patients exposed to surgery; SSI was the most frequently surveyed HAI in low- and middle-income countries.^{1, 8} The reported SSI incidence ranged from 0.4 to 30.9 per 100 patients undergoing surgical procedures and from 1.2 to 23.6 per 100 surgical procedures, with pooled rates of 11.8 per 100 patients exposed to surgery (95% CI, 8.6–16.0) and 5.6 per 100 surgical procedures (95% CI, 2.9–10.5).⁸ This is up to nine times higher than in high-income countries.

Table 1.1 Cumulative Incidence Density of HAI and Device-Associated Infections in Adult ICU Patients in High-, and Low/Middle-Income Countries

Surveillance Networks/Reviews, Study Period, Country

HAI/1000 Patient-Days (95% CI)

Patient-Days

CR-BSI/1000 Central Line- Days (95% CI)

Catheter-Days

CR-UTI/1000 Urinary Catheter-Days (95% CI)

Urinary Cathete...

Cover
Title Page
Copyright
Table of Contents
Contributors
Preface
Foreword
Chapter 1: The Burden of Healthcare-Associated Infection
Chapter 2: Historical Perspectives
Chapter 3: Flora and Physiology of Normal Skin
Chapter 4: Dynamics of Hand Transmission
Chapter 5: Mathematical Models of Handborne Transmission of Nosocomial Pathogens
Chapter 6: Methodological Issues in Hand Hygiene Science
Chapter 7: Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research?
Chapter 8: Hand Hygiene Agents
Chapter 9: Methods to Evaluate the Antimicrobial Efficacy of Hand Hygiene Agents
Chapter 10: Hand Hygiene Technique
Chapter 11: Compliance with Hand Hygiene Best Practices
Chapter 12: Barriers to Compliance
Chapter 13: Physicians and Hand Hygiene
Chapter 14: Surgical Hand Preparation
Chapter 15: Skin Reaction to Hand Hygiene
Chapter 16: Alcohol-Based Handrub Safety
Chapter 17: Rinse, Gel, Foam, Soap … Selecting an Agent
Chapter 18: Behavior and Hand Hygiene
Chapter 19: Hand Hygiene Promotion Strategies
Chapter 20: My Five Moments for Hand Hygiene
Chapter 21: System Change
Chapter 22: Education of Healthcare Professionals
Chapter 23: Glove Use and Hand Hygiene
Chapter 24: Monitoring Hand Hygiene Performance
Chapter 25: Performance Feedback
Chapter 26: Marketing Hand Hygiene
Chapter 27: Human Factors Design
Chapter 28: Institutional Safety Climate
Chapter 29: Personal Accountability for Hand Hygiene
Chapter 30: Patient Participation and Empowerment
Chapter 31: Religion and Hand Hygiene
Chapter 32: Hand Hygiene Promotion from the US Perspective: Putting WHO and CDC Guidelines into Practice
Chapter 33: WHO Multimodal Promotion Strategy
Chapter 34: Monitoring Your Institution (Hand Hygiene Self-Assessment Framework)
Chapter 35: National Hand Hygiene Campaigns
Chapter 36: Hand Hygiene Campaigning: From One Hospital to the Entire Country
Chapter 37: Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare
Chapter 38: A Worldwide WHO Hand Hygiene in Healthcare Campaign
Chapter 39: The Economic Impact of Improved Hand Hygiene
Chapter 40: Hand Hygiene: Key Principles for the Manager
Chapter 41: Effect of Hand Hygiene on Infection Rates
Chapter 42A: Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients
Chapter 42B: Hand Hygiene in Specific Patient Populations and Situations: Neonates and Pediatrics
Chapter 42C: Hand Hygiene in Long-Term Care Facilities and Home Care
Chapter 42D: Hand Hygiene in Ambulatory Care
Chapter 42E: Hand Hygiene in Hemodialysis
Chapter 42F: Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology
Chapter 43: Hand Hygiene in Resource-Poor Settings
Chapter 44A: Role of Hand Hygiene in MRSA Control
Chapter 44B: Role of Hand Hygiene in Clostridium difficile Control
Chapter 44C: Role of Hand Hygiene in Respiratory Diseases Including Influenza
Chapter 44D: Handborne Spread of Noroviruses and its Interruption
Chapter 45: Conducting a Literature Review on Hand Hygiene
Appendix
Index
End User License Agreement