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WHO Global Hand Hygiene Campaign 2018: “It’s in your hands –
prevent sepsis in health care”
http://www.who.int/infection-prevention/en/
Dr Benedetta Allegranzi, MD
Infection Prevention and Control Global Unit
World Health Organization (WHO) Service Delivery and Safety
4 May 2018
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SAVE LIVES: Clean Your Hands 5 May 2018 campaign
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Scientific definition: sepsis is a life-threatening organ
dysfunction caused by a dysregulated host response to
infection.
Sepsis arises when an
infection alters the
body's normal response
causing injury to tissue
and organs.
3
WHO Infographic, How to prevent sepsis, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
Singer M et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315: 801-10.
What is sepsis?
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• Sepsis is estimated to affect more than 30 million people
worldwide every year, potentially leading to 6 million deaths
• The burden of sepsis is most likely highest in low- and
middle-income countries (LMICs)
4
Sepsis as a global health problem (1)Global epidemiological estimate of sepsis
WHO Infographic, How to prevent sepsis, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
Fleischmann C, et al. Am J Respir Crit Care Med 2016; 193(3): 259-72.
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• Hospital mortality of sepsis: 17%
• Hospital mortality of severe sepsis: 26%
5
WHO. Report by the Secretariat. WHA A70.13. http://www.who.int/servicedeliverysafety/areas/sepsis/en/
Sepsis as a global health problem (2)Sepsis has high mortality rate
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• 3 million newborns and 1.2 million children suffer from sepsis globally
every year
• 3 out of every 10 deaths due to neonatal sepsis are thought to be
caused by resistant pathogens (i.e., 214 000 neonatal deaths annually)
• Hospital mortality in paediatrics: 25%
Paediatric / Neonatal sepsis
- Fleischmann-Struzek C, et al. The Lancet Respiratory medicine 2018; 6(3): 223-30.
- Laxminarayan R, et al. Lancet 2016; 387(10014): 168-75.
- UN Inter-agency Group for Child Mortality Estimation, Levels & Trends in Child Mortality Report 2017.
Sepsis as a global health problem (3)
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• 1 in 10 deaths associated with pregnancy and childbirth is
due to maternal sepsis
• > 95% of deaths due to maternal sepsis occur in LMICs
• 1 million newborn deaths are associated with maternal
infection, each year
Maternal sepsis
7
- Say L, et al. The Lancet Global health 2014; 2(6): e323-33.
- Reproductive, Maternal, Newborn, and Child Health:
Disease Control Priorities, Third Edition (Volume 2).
Sepsis as a global health problem (4)
• Caesarean section is
the single most
important risk factor
for maternal infection
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• Intensive care:
▪ In high-income countries, up to 30% of patients are affected by
at least one HAI in ICU; in LMICs the frequency is at least 2─3
times higher
▪ HAI is a risk factor for mortality in ICU septic patients (Brazil)
• Neonatal care:
▪ Neonatal sepsis: 6·5-38/1000 live hospital-born babies
▪ Among hospital-born babies, infections are responsible for 4%
to 56% of all causes of death in the neonatal period (3/4 in
South-East Asia and sub-Saharan Africa)
• Surgical care:
▪ Surgical sepsis accounts for approximately 30% of all septic
patients in the USA
▪ In Africa, up to 20% of women delivering through caesarian
section get a wound infection
Global burden of health care associated infections (HAIs)
8
• WHO Report on the burden of endemic health care-associated infections worldwide, http://www.who.int/infection-prevention/publications/burden_hcai/en/
• Allegranzi B et al. Lancet 2011;377:228-41
• Machado FR et al. Lancet Infect Dis 2017;17:1180–89
• Zaidi et al. Lancet Infect Dis 2005;1175–88
• Angus DC et al. Crit Care Med 2001;29:1303–1310
Sepsis can be health care-associated
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70th World Health Assembly (WHA)Sepsis report and resolution
http://www.who.int/servicedeliverysafety/areas/sepsis/en/
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• Background – definition
• Who is at risk? – elderly people,
pregnant women, neonates etc.
• Signs and symptoms – esp. for early
recognition
• Prevention (detailed later)
• Diagnosis and management –
importance of early recognition,
diagnosis, treatment, interlink with
antimicrobial resistance (AMR)
• Sepsis and the Sustainable
Development Goals – how improving
sepsis can contribute to SDGs
achievement
• WHO’s work on sepsis
WHO Sepsis Fact Sheet and Web pages
10
• http://www.who.int/mediacentre/factsheets/sepsis/en/
• http://www.who.int/servicedeliverysafety/areas/sepsis/en/
Overview of Sepsis
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WHO Infographic, How to prevent sepsis, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
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WHO animation video
WHO animation video, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
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WHO Infographic, How to prevent sepsis, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
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14WHO Infographic, How to prevent sepsis, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
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15
2 major ways to prevent sepsis
WHO Infographic, How to prevent sepsis, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
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Prevention at the health facility level
WHO Infographic, How to prevent sepsis, http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/
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• Improved hand hygiene practice in health care can reduce
health care associated infection (HAI) by as much as 50%
• Effective IPC programmes lead to more than a 30%
reduction in HAI rate.
07/05/2018 | Title of the presentation 19
Luangasanatip N, et al. British Medical Journal. 2015;351:h3728.
Haley RW, et al. Am J Epidemiol 1985;121(2):182-205.
Impact of preventing infection in health care
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http://www.who.int/infection-prevention/en/
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Allegranzi B et al, Lancet ID 2013
WHO hand hygiene strategy impact
• Significant increase of health-
care workers hand hygiene
compliance across all
professional categories in all
sites (OR 2·15, 1·99–2·32; HH
compliance from 51.0% to 67.2%).
• Greater effect in low-income and
middle-income countries (OR
4.67, 95% CI 3.16–6.89; p<0·0001)
Meta-analysis from 22 studies confirmed
that the WHO hand hygiene strategy
is effective at increasing health care
workers compliance and results of 19
studies showed reduction of health
care associated infections
Allegranzi B et al, Lancet ID 2013 Luangasanatip N et al, BMJ 2015
Luangasanatip N et al, BMJ 2015Allegranzi B et al, Lancet ID 2013
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Luangasanatip N et al, BMJ 2015
• all intervention strategies indicated an improvement in
compliance with hand hygiene
• WHO-5 & WHO 5+ were more effective
• WHO-5+ had the highest probability (67%) of being the
best strategy in improving compliance
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Effective IPC programmes, including hand hygiene reduce HAIs
• http://www.who.int/infection-prevention/publications/ipc-components-guidelines/en/
• Zingg W et al. Lancet Infect Dis 2015
• Storr J et al. ARIC 2017
• Presley L et al. Lancet Infect Dis 2017
Focus on
preventing
HAIs and
combating
AMR
WHO Core Components of IPC programmes
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Implementation resources for the WHO IPC Core Components Guidelines
http://www.who.int/infection-prevention/tools/core-components/en/ http://www.who.int/infection-prevention/tools/core-
components/en/
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Implementation manual and assessment tool for the national level
http://www.who.int/infection-prevention/tools/core-components/en/ http://www.who.int/infection-prevention/tools/core-components/en/
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New!
Implementation manual and assessment framework for the health facility level
http://www.who.int/infection-prevention/tools/core-components/en/
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http://www.who.int/infection-prevention/tools/core-components/en/
http://www.who.int/infection-prevention/tools/hand-hygiene/training_education/en/
New!
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http://www.who.int/infection-prevention/campaigns/clean-hands/2017/en/
51/116 (44%) studies used as the primary evidence for 6/8
IPC core components included hand hygiene as part of IPC
interventions
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2 recommendations dedicated to HAND HYGIENE
• Evidence for 6b: 1 RCT
• Evidence for 8b: 6 studies
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Hand hygiene multimodal improvement strategies improve practices and reduce HAI and AMR
IPC Core Component 5: out of 44
high-quality studies supporting the
recommendation, 28 (64%) were on
hand hygiene
Additional 27 lower-quality studies
were on hand hygiene
These studies showed that hand
hygiene multimodal strategies:
➢Increase hand hygiene compliance
➢Reduce MRSA transmission
➢Reduce HAIs
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▪ Accessibility to handrub
▪ Targeted training
▪ Role models
▪ Opinion leaders and champions
▪ Positive reinforcement
▪ Leveraging leadership commitment
▪ Principles of product marketing
▪ Financial incentives for high level hand hygiene
performance
Successful components in Multimodal Strategies
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https://onlinelibrary.wiley.com/doi/book/10.1002/9781118846810
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WHO multimodal strategy
http://www.who.int/infection-prevention/publications/ipc-cc-mis.pdf?ua=1
Allegranzi B, et al. Lancet Infect Dis 2018; 18:507-515
Multimodal improvement strategy for IPC implementation
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SAVE LIVES: Clean Your Hands 5 May 2018 campaign
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5 May 2018 - Calls to Action
www.who.int//infection-prevention/campaigns/clean-hands/5may2018/en/index.html
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Advocacy material - supporting 5 May 2018
• Banners (for websites) - sticker template
• Posters
• A branded social media photo board & dedicated web page to feature advocates’ photos
• A WHO video message
• A video on preventing sepsis through hand hygiene improvement
• Campaign registration web page & map
SAVE LIVES: Clean Your Hands 5 May 2018 campaign
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Advocacy Posters
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Send your 5 May 2018 campaign photos to
www.CleanHandsSaveLives.org
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WHO acknowledges those organisations who make every effort to support 5 May activities
Source : http://www.who.int/infection-prevention/campaigns/clean-hands/SLCYH_support/en/
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As of April 2018, 20 935 facilities in 180 countries –
covering over 12 million staff and almost 5 million beds
Achieving impact:health facility registrations
We still need
more to join!http://www.who.int/infection-prevention/campaigns/clean-hands/register/en/
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A WHO dedicated 5 May 2018 webpage - find all resources here -
www.who.int//infection-prevention/campaigns/clean-
hands/5may2018/en/index.html
Use WHO hand hygiene improvement tools all year round - find them here:
http://www.who.int/infection-prevention/tools/hand-hygiene/en/