Good hand hygiene is a simple way to save lives

Good hand hygiene is the cornerstone of safe and effective health care. Just 20-30 seconds of washing with an alcohol-based product, or 30-40 seconds with soap and water, will help anyone in a health care setting stop the spread of infection, control the risk of bacterial mutations (and therefore antimicrobial resistance) and advance the safety and quality of health care for all. Importantly, they will also help make health care more effective, saving billions of dollars in associated costs.
The benefits of good hand hygiene in health care settings – from the primary level up – have long been known. In the mid-19th century handwashing was identified as a key factor in driving down maternal mortality and reducing the risk of childbirth. More recent studies have confirmed the critical role good hand hygiene plays in preventing the spread of a range of health care-associated pathogens.
In particular, good hand hygiene is vital to preventing sepsis, a potentially life-threatening condition that can result from the body’s response to infection, and which kills over 30 million patients across the world annually. The bulk of these deaths are in low- and middle-income countries, including those of the World Health Organisation (WHO) Southeast Asia region.
By promoting good hand hygiene in practice and policy, patients, health workers, administrators and policymakers can dramatically enhance the safety, quality and effectiveness of health care at all levels. In doing so, they can also accelerate progress towards the Sustainable Development Goal target of universal health coverage, at the same time as combating the threat of antimicrobial resistance – one of the region’s flagship priorities.
To achieve these outcomes, a series of key initiatives – outlined in WHO’s guidelines on hand hygiene in health care – should be embraced, implemented and enforced with immediate effect.
Core among them is ensuring health workers are aware of and habitually practice the “five moments for hand hygiene”. This is a formula that requires health workers to wash their hands before touching a patient, before clean/aseptic procedures, after bodily fluid exposure, after touching a patient, and after touching patient surroundings.
Facility-based infection prevention and control leaders should meanwhile seize all opportunities to champion hand hygiene. That can – and should – include communicating the critical importance of implementing WHO guidelines on hand hygiene to policymakers, hospital chief executive officers, administrators and health workers. It should also include advocating for the health facility they are responsible for to sign up to WHO’s global “Save Lives: Clean Your Hands” campaign, which all facilities can be a part of.
Health facility leaders and senior management should similarly make hand hygiene a key quality monitoring indicator. Compliance with hand hygiene standards should be a core part of every health facility’s infection control regimen. Where compliance is found wanting, clear means of enforcement must be created and implemented.

Clear guidelines
Importantly, promoting good hand hygiene goes beyond health facilities themselves, requiring buy-in at the highest levels of government. Ministries of health from across the region, for example, should fully implement the 2017 World Health Assembly resolution on sepsis, which makes improving the prevention, diagnosis and management of sepsis a critical imperative. One of the best ways to tackle the problem is via good hand hygiene and the development of clear, country-wide guidelines on the issue.
Individual citizens, too, have a role to play. Patient advocacy groups, for example, should continue to insist on good hand hygiene as a way to limit the occurrence of health care-associated infection and sepsis, and advocate for the development and implementation of effective hand hygiene-related policies at national and local levels,
Clean hands remain one of the most powerful ways to prevent health care-associated infections, save lives and transform the quality of health care at all levels. Across the WHO Southeast Asia region, good hand hygiene is a tool that can – and must – be harnessed to decisive effect.

Dr Poonam Khetrapal Singh is the regional director of WHO Southeast Asia