Hand hygiene: essential for health
On the World Health Organization’s Save Lives: Clean Your Hands Day and International Day of the Midwife, Madelinne Miller reflects on the need for water, sanitation and hygiene in health facilities to reduce antibiotic resistance.
Last month I was fortunate to travel to Kathmandu, Nepal, for a global meeting on improving water, sanitation and hygiene in health care facilities. The meeting brought together representatives from over 25 countries from around the world to discuss solutions to improving hygiene in health centres. Though efforts are improving basic conditions and safety of medical care in several countries, I couldn’t help wonder why such efforts were being described as innovative or new in this day and age.
We have known for centuries that washing hands is essential for providing safe care and preventing infection. Despite this, almost 40% of hospitals and health centres in low and middle income countries don’t have a water supply. Equally alarming is that 35% lack equipment to wash hands such as soap or alcohol based hand rub. This failure to provide the basics of safe health care demands urgent action.
In support of hand hygiene improvement globally and to coincide with the World Health Organizations’ Save Lives: Clean Your Hands Day on the 5th May 2017 and the International Day of the Midwife, I am highlighting the need for water, sanitation and hygiene initiatives to support hand hygiene and to reduce the growing threat of antibiotic resistance to ensure mothers and newborns can deliver and midwives can work in safe and clean conditions.
Antibiotic resistance is not new news. However, the threat of antimicrobial resistance as a global health crises is escalating. As microorganisms that cause infections such as bacteria, viruses, parasites and fungi change with exposure to medications, they gradually develop resistance. When this happens, the frontline medications we have available for treatment no longer work. Infections persist for longer, increasing the risk of spreading to others. Growing attraction to antibiotic use for animal growth and agriculture and health care treatment and infection prevention has resulted in overuse and misuse and is speeding up the rate at which bacteria are becoming resistant to treatment.
Infection is one of the leading causes of death among mothers and newborn babies. No woman or newborn should risk dying during childbirth from preventable causes. Sepsis caused by severe infections is responsible for about 10-15% of all deaths among mothers and newborns and is largely preventable. Health care workers including midwives should also not be at risk of infections when supporting the safe delivery of a child. Recent efforts to prevent infections through improving water, sanitation and hygiene have been targeted to support reductions in maternal and newborn death. However, this needs urgent scale up as there is a parallel reliance on antibiotic use as a preventative measure when not required clinically rather than ensuring a clean and safe environment to deliver. This threatens to undo progress by accelerating the process of antibiotic resistance.
A recent study showed that in India and Bangladesh, 13 out of 15 health facilities gave antibiotics to all labouring women whether or not it was clinically required. In low- and middle-income countries where water and soap are scarce, this may be considered the easiest option when in fact it is an unnecessary, expensive and risky alternative to ensuring a clean environment for women to give birth and midwives to practice safe care.
With 5th May hosting International Day of the Midwife and Hand Hygiene Day, this is a perfect opportunity to highlight the pivotal work of midwives and the need to support them to support clean births, and reduce the need, overuse and misuse of antibiotics. If we don’t act, global progress on reducing maternal and newborn deaths will likely stall, or worse, reverse.
Ensuring prevention first and putting the water, sanitation and hygiene basics in place is a simple solution.
Hand washing is one of the cheapest and most effective methods to prevent infection yet as previously mentioned, equipment to support it is absent in 35% of health facilities in low and middle income countries. The role of health facilities is to provide safe, quality care and treatment for people in need but how can this be possible when both health workers and patients are deprived of the ingredients needed to practice good hand hygiene?
Quality care for patients and a clean, respectful work place should begin with the basics - safe and consistent supply of water and soap and alcohol-based rub and disinfectant. The role of water, sanitation and hygiene goes beyond just hand washing for infection prevention. Ensuring adequate, functional toilets and a minimum amount of safe water daily and disinfectants to clean all surfaces, bedding and equipment should also be embedded into basic health centre requirements.
With more women choosing to give birth in hospitals and health centres globally, the focus now more than ever should be on ensuring these women and babies have the highest chance of survival by increasing water, sanitation and hygiene activities and positioning cleanliness in health care facilities as a core component in all national and health facility strategies, benefiting not just the vulnerable, but all people, everywhere.
Madelinne Miller, Intern – Health policy and programs, WaterAid Australia