Unlocking the Power of Hand Hygiene: An Underutilized Weapon to Contain HAIs and AMR

I extend my warmest greetings to everyone on World Hand Hygiene Day 2024.

As we commemorate WHHD 2024, it's an opportune moment to reflect on and discuss Hand Hygiene (HH), its crucial role in today's Healthcare (HC) systems, the impact of Healthcare-Associated Infections (HAI) and Antimicrobial Resistance (AMR), the challenges in improving HH, and our objectives to enhance HH adherence. While some of these points may seem commonplace, their emphasis is vital, particularly on this special day.

Hand Hygiene, a simple and effective method of cleaning our hands, significantly reduces the presence of potential pathogens. This includes practices such as Surgical Hand Hygiene/Antisepsis, the use of Alcohol-Based Hand Rub (ABHR), regular Handwashing, and Antiseptic Handwash.

It's worth noting that Hand Hygiene Day (HHD) and Global Handwashing Day (GHW) are separate observances. The latter, celebrated on October 15, is a global advocacy day dedicated to increasing awareness about the importance of handwashing with soap as an economical means to prevent diseases and save lives.

The year 1847 was a landmark year in this global movement for Hand Hygiene compliance for improved patient safety. Dr Ignaz Semmelweis made pioneering efforts to bring scientific evidence to change practices in clinical settings. His revolutionary work on antiseptic procedures and postpartum infections earned him the title of "saviour of mothers". Despite his logical findings backed by solid evidence, widespread acceptance came only years after his death. This acceptance was facilitated when Louis Pasteur confirmed the germ theory, providing a theoretical explanation for Semmelweis' observations. While acting on Pasteur's research, Joseph Lister practised and operated hygienic methods with great success.

Subsequent efforts by Florence Nightingale and others have built on this foundation, heightening awareness and improving hygiene practices. From the 1960s onwards, these efforts were redoubled with the introduction of evidence-based guidelines from organizations such as the US Public Health Service, CDC, APIC, HICPAC, WHO, SHEA, IDSA, ICMR, and NCDC.

Given the low compliance to HH despite the plethora of guidelines and evidence, it's crucial to ask ourselves why sharing knowledge about hand hygiene remains so important and why we should continue to build evidence. The reason is that, while the importance of hand hygiene in preventing diseases and promoting healthier communities is undeniable, resistance to this simple procedure persists even today. This resistance results in approximately half a million Healthcare-Associated Infections (HAIs) daily and 16 million deaths yearly. It's also estimated that 63.5% of infections with antibiotic-resistant bacteria are associated with healthcare.

With the rise in modern hospitals with poorly equipped & ill-managed mechanical ventilation in many settings, an increasing number of beds each year, and a sharp growth in invasive and non-invasive procedures, we can anticipate a further worsening of HAI rates and treatment failures related to Antimicrobial Resistance (AMR). Moreover, let's not forget that 50% of Healthcare Facilities (HCFs) still lack clean water, especially in resource-limited settings where the burden of HAIs and AMR is significantly higher.

Even during the COVID-19 pandemic, when we reached near-ideal levels of hand hygiene practices in healthcare settings, compliance rates in some hospitals worldwide never crossed 60-70%. With the diminishing threat perception of COVID-19 and HCW fatigue, we are again witnessing a slip in compliance rates, even in the best of hospitals worldwide. We must reverse this trend and set the ambitious target of 10% annual improvement in HH compliance rates until we reach safe levels.

That's why supporting global and local efforts, including observance of Hand Hygiene Day, is essential. The 2024 Hand Hygiene Day theme, "Promoting knowledge and capacity building of health and care workers through innovative and impactful training and education on infection prevention and control, including hand hygiene," is very apt and vital.

Let's consider a few facts and figures to appreciate better the role of Infection Prevention and Control (IPC) and Hand Hygiene in stopping the spread of harmful germs in healthcare and to understand better the objectives of World Hand Hygiene Day (WHHD) 2024:

• IPC interventions reduce HAIs and AMR by 35-70% and are cost-saving.

• Preventing an infection and its spread reduces human suffering, loss of lives, and produces economic advantages.

• High-quality water, sanitation, hygiene services, and effective IPC programs based on the WHO core components, including hand hygiene action, can reduce HAIs by up to 70%.

• Hand hygiene saves millions of lives when performed at the right times in healthcare; investing INR 1 in improving hand hygiene in healthcare settings returns about 25X in economic returns.

What are the barriers to this simple yet powerful intervention?. While there are many, including infrastructure issues, running water, availability of hand rubs etc, the most significant is HCW behaviour. We need to work on external motivators, such as social, organizational, and community, as well as internal motivators, such as knowledge, attitude, beliefs, and values, to improve practice and compliance.

If we believe that as HCW, our primary responsibility is First to do no harm (primum non nocere) then our natural action is to practice HH routinely.

In our pursuit to fulfil the objectives of WHHD 2024, particularly the primary goal of "Enhancing learning methodologies to facilitate the implementation of innovative and effective training that empowers health and care workers to improve hand hygiene and IPC at the point of care with advanced knowledge, skills, and behaviours", we at Infection Control Academy of India (IFCAI), in collaboration with other like-minded organizations, have been diligently working on enhancing the IPC knowledge of health and care workers and establishing career pathways for IPC professionals to build capacity.

In our journey ahead, we aim to collaborate with various stakeholders to advocate for IPC and AMSP, with a special focus on Hand Hygiene. To establish a robust platform for the global south, we are organizing the Global South Conference on Infection Prevention and Control Antimicrobial Stewardship, scheduled for October 3-5, 2024, in Hyderabad. You can find more information on our website, G-SPARC. We eagerly look forward to welcoming you all to this event.

Let's join hands to make a difference!