1. Hand Hygiene | Weapon of Microbe Destruction
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    Hand Hygiene | Weapon of Microbe Destruction

    May 05, 2017
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    Hand Hygiene: Resist Antimicrobial Resistance

    Antimicrobial resistance has become a global nightmare: the increased and indiscriminate use of antibiotics gives birth to drug resistant superbugs. How do we stop this?

    Hand Hygiene: Resist Antimicrobial Resistance

    Antimicrobial resistance has become a global nightmare: the increased and indiscriminate use of antibiotics gives birth to drug resistant superbugs. How do we stop this?

    Hand Hygiene: Resist Antimicrobial Resistance

    Antimicrobial resistance has become a global nightmare: the increased and indiscriminate use of antibiotics gives birth to drug resistant superbugs. How do we stop this?

    • Weapon of Microbe Destruction

      Hand Hygiene: Resist Antimicrobial Resistance

      Has the evolution and use of antibiotics and antimicrobials become too much of a good thing?

      In our war against disease, have we landed up scoring a self-goal?

      If the development of multi-drug resistant organisms (MDRO) is anything to go by, this would certainly seem so.

      Bugs & Drugs: Antimicrobial resistance (AMR)

      AMR is not a recent or sudden phenomenon: it is something that has grown stealthily and steadily with the indiscriminate use of antimicrobials/antibiotics over several decades. Infection-causing bacteria have developed resistance to various drugs including new formulations over time.

      Antibiotics kill sensitive bacteria while failing to destroy their resistant cousins. The latter’s tribe thus increases, and we are forced to escalate our battle against resistant bacteria with new drugs. In turn, with the widespread use of these new drugs, bacteria evolve once again to resist anew. Thus, this is a never-ending war.

      There is an urgent need to halt AMR from developing into a global crisis.

      Hospital Acquired Infections (HAIs)

      WHO estimates 1 in 4 admitted to a hospital in developing countries like our own would develop an HAI.

      The poor diagnostic ability in these HAIs to accurately identify the pathogen, either by cultures (issues with sensitivity and quality control) or molecular diagnosis (issues with cost and availability) means de-escalation is not an effective strategy.

      This takes on additional significance because the high rates of multi-drug resistant organisms (MDRO) as a cause for HAI in our scenario necessitate the upfront use of broad-spectrum antibiotics to treat HAI empirically. Thus, prevention of HAIs to reduce antibiotic use is crucial.

      Sounding the alarm

      The WHO has issued a major global reportilluminating the high rates of AMR in the environment of health care facilities in common infections like pneumonia, bloodstream infections, urinary tract infections, and surgical site infections. A devastating example is the population of Methicillin-resistant Staphylococcus aureus (MRSA) which is documented at a staggering 44% in Latin America, 40% in West Africa and 38% in Europe. MRSA causes serious skin infections, surgical site infections and infections of the lungs, bloodstream and urinary tract.

      “Fight antibiotic resistance- It’s in your hands.”

      The WHO has not chosen its theme for 2017 in vain. Hand hygiene is a cost-effective strategy for reducing HAI and thence AMR. The WHO strategy is simple: hand hygiene protocols-> control HAIs -> control the use of antibiotics ->and thus AMR.

      WHO figures put the number of hospitalised patients affected by HAIs to be 7 out of every 100 in high-income countries and 10 out of every 100 in middle- and low- income nations. These figures are an alarming 30% when the patients are critically ill or are in intensive care.

      Patients infected with resistant germs that the hospital environment breeds do not respond well to the antibiotics prescribed. As a result, outcomes are worse, and costs are higher as are fatalities.

      The Big 5 of hand hygiene

      Health Care workers (HCWs) can play a vital role in protecting patients and themselves from HAIs that are difficult to treat by practicing a hand hygiene protocol stringently. The short and sweet recommendations for Health Care Workers to maintain hand hygiene irrespective of the use of gloves are:

      • before touching a patient.
      • after touching a patient.
      • after touching patient surroundings.
      • before and after clean and aseptic procedures such as inserting devices such as catheters, food tubes, and IV fluids.
      • after contact with body fluids.

      Simply sanitizer

      The use of alcohol-based rubs is preferred unless hands are visibly dirty. Washing with soap and water to get rid of the grime should be followed up with proper and complete drying of the hands. Only then should the alcohol-based sanitizer be used. Damp hands make the sanitizer less effective as they dilute it.

      • Sanitizers should be kept in easy access for convenient use.
      • They destroy skin bacteria almost instantly.
      • They dry immediately and do not necessitate the use of a tissue or a towel which may themselves be sources of contamination.
      • Well formulated hand sanitizers also retard the regrowth of bacteria on hands, so they are to be preferred over soap and water or should be used in addition to it.

      Did you know that there are 1,500 bacteria resident on every square centimeter of your skin?

      Can you imagine that there are 21,000 germs per square inch on work desks? And 2,29,000 germs per square inch on frequently used faucet handles?

      All these are facts. The saga of human survival is the story of waging war on infections, pestilence, and disease. This is a continuous and continuing process. If AMR is not limited by limiting the use of antibiotics, the super bugs that are thus being created may well be the victors.

      Hand hygiene is now to be our WMD - Weapon of Microbe Destruction!

      Author: Dr. Anup Warrier, Consultant -Infectious Diseases, Healthcare Quality and Patient Safety Advocate, Aster Medcity - Multi Speciality Hospital, Kochi

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