Hand hygiene in low- and middle-income countries

Abstract

A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview evidence based strategies to reduce the transmission of pathogens via the hands of healthcare workers and the subsequent incidence of hospital acquired infections with a focus on implementing these strategies in low-and middle-income countries. Existing data suggests that hospital patients in low-and middle-income countries are exposed to rates of healthcare associated infections at least 2-fold higher than in high income countries. In addition to the universal challenges to the implementation of effective hand hygiene strategies, hospitals in low-and middle-income countries face a range of unique barriers, including overcrowding and securing a reliable and sustainable supply of alcohol-based handrub. The WHO Multimodal Hand Hygiene Improvement Strategy and its associated resources represent an evidence-based framework for developing a locally-adapted implementation plan for hand hygiene promotion.

Using effective hand hygiene practice to prevent and control infection

“…One reason that it is important to use soap and water when caring for patients with a diarrhoeal illness is that alcohol-based hand gel is ineffective against Clostridium difficile spores. Therefore, the use of soap and water is a vital component of hand hygiene interventions in C. difficile infection (Barker et al 2017, Loftus et al 2019. As it can sometimes be unclear initially whether patients with a diarrhoeal illness have a C. difficile infection, it is prudent to use soap and water for hand hygiene practice at the outset in these patients.…”

“…It is important to remember that during the continued emphasis on effective hand hygiene associated with the COVID-19 pandemic, people from some cultures and religions may prefer not to use alcohol-based products (Loftus et al 2019). concerning the use of alcohol-based hand gel in people from countries such as the United Arab Emirates (Ng et al 2019).…”

Coronavirus Disease 2019 (COVID-19) and healthcare-associated infections: Emerging and future challenges for public health in Brazil

“…Regarding COVID-19, measures are being taken with protocols already developed during other crises such as SARS (2003) and pandemic influenza (2009). However, it is strongly maintained that in low and middle income countries, mainly hand hygiene is not a reality, and this is among the most efficient measures to contain microorganisms such as those reported here [5]. Regarding HAI, we will have to wait to determine what impacts the COVID-19 epidemic will leave for our health system.…”

“…In relation to the emergence of microorganisms, some factors are also important in the epidemiology of infections in these countries, including: (1) critically ill patients in ICUs, that are often exposed to numerous invasive devices and heavy use of inappropriate empirical therapy; (2) the current social mobility, with the ease of making international air travel; (3) poor implementing of infection prevention and control practices by the lack of resources, human, both in qualitative and quantitative terms and finally not least; (4) healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized nations; (5) microorganisms such as COVID-19 and high-risk clones of multiresistant bacteria with better adaptation in the environment and faster dissemination capacity have a selective advantage.…”

Isolation frequency of medically important fungi and fluconazole resistant of Candida sp from hospital cockroaches.

“…Moreover, the inability to regularly monitor and evaluate HAIs in these settings, may result in the delayed detection of outbreaks. Subsequently increasing the morbidity mortality and cost associated with these types of infections (14)(15)(16).…”