October 14, 2016

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Handwashing with soap – one defence against antimicrobial resistance

Penny Dutton

This Saturday October 15 is Global Handwashing Day and a chance to remind ourselves and others of the importance of handwashing with soap as an easy, effective, and affordable way to prevent diseases and save lives.
In health care facilities, handwashing with soap, along with clean water and sanitation, is a critical defence against the growing threat of infection and antimicrobial resistance.
Discussions in the United Nations General Assembly last month show the treat of drug-resistant micro-organisms to human health and development globally. All around the world, many common infections are becoming resistant to the antimicrobial medicines used to treat them, resulting in longer illnesses and more deaths. According to the UK Government’s Review on Antimicrobial Resistance published earlier this year, by 2050 up to 10 million people may die every year from drug-resistant infections. This is not just a health problem, but an economic one too. It is thought that growing resistance to antibiotics could not only cost enormously in loss of lives but could also cost the global economy up to $ 85 trillion by 2050.
At the local level, midwives deal with practical challenges to infection prevention and control on a daily basis. Before a WaterAid intervention earlier this year, in Kimboi hospital, in the Iramba district of Tanzania, the hospital’s taps were dry for 23 hours per day, leaving medical professionals faced with a difficult choice: risk the transmission of infection during childbirth because the delivery room and instruments could not be properly cleaned, or prescribe precious antibiotics as a preventive measure, possibly contributing to the emerging problem of drug-resistant infections. During a three week water shortage earlier this year, midwives were not able to do their jobs safely without readily available clean water. At least 12 babies developed sepsis during this period, and two of them died. Midwives faced the torturous question of whether those babies’ deaths were their fault: were those infections transmitted in the delivery process?
The experience of Kiomboi hospital is not an isolated one. The World Health Organisation (WHO) estimates that 38% of healthcare facilities in low and middle income countries lack access to a basic water source. 19% do not have adequate sanitation, and 35% do not have soap for handwashing. The situation in Myanmar raises concerns as not all hospitals and health centres have infection prevention and control measures, nor adequate hand hygiene practices, water of sufficient quantity and quality, and enough clean toilets for medical staff, patients and carers.
All UN member states have promised to ensure healthy lives for all by 2030. Clean water, proper sanitation, rigorous hand and environmental hygiene, and infection and control practices are critical to delivering quality health care. They can prevent infections and save mothers’ and babies’ lives. Using antibiotics to do the job of clean water, good sanitation, and good hygiene runs counter to good public health practice, and contributes to the global rise in drug-resistant infection.
What we need is for decision-makers to
. Commit that by 2030 every healthcare facility will have a reliable and sufficient supply of clean running water, safe toilets for patients and staff ( with locks and lights, child-friendly, and accessible to people with disabilities), functional sinks, soap and alcohol-based hand rubs for health workers and patients in all treatment and birthing rooms, and sufficient supplies of cleaning materials to maintain a hygienic and sterile environment.
. Ensure that no new healthcare facilities are built without adequate, sustainable water and sanitation services.
.Ensure that all healthcare workers are given professional training and support to practice and promote good hygiene.


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