Infection Prevention and Control Saving lives Budapest, 6 March 2019 Dr Masoud Dara Coordinator, Communicable Diseases WHO Regional Office for Europe

This is a teleconference between us and Ignaz Semmelweis, Joseph Lister, Louis Pasteur, John Snow, Robert Koch and Florence Nightingale to discuss their legacy and Global health priorities of the 21st century. What would be the agenda of this meeting? Health-care associated infections Antimicrobial resistance Hand hygiene Clean water, sanitation Maternal, infant and under-5 mortality Early Childhood development Health security Ignac Semmelweis made his landmark discovery between 1846 and 1861, long before the medical profession was ready to accept it, long before Louis Pasteur’s germ theory in 1860, Joseph Lister’s pioneering work of antiseptic surgery and Roberth Koch’s discoveries in 1876

Back to basics Infection prevention and control (IPC) are practices and activities that prevent patients and health workers from being harmed by avoidable infections. Ensuring good IPC avoids harm, and at times even death, saves money, reduces the spread of antimicrobial resistance (AMR) and supports delivery of high quality health services.

The global and European burden of Healthcare Associated Infections (HAI) is unacceptable 7% of patients in developed and 10% in developing countries will acquire at least one HAI on average ; death from HAI occurs in about 10% of affected patients; European region Over 4 million patients are affected by 4.5 million HAI episodes annually leading to 16 million extra days of hospital stay, 37 000 attributable deaths and contributing to an additional 110 000 deaths per year. Let me start with the healthcare-associated infections (HAIs) which are among the most common complications of hospital stays.  On average at any given time 7% of patients will acquire at least one Healthcare Associated Infection. Death from HAI occurs in about 10% of affected patients. Please see shocking figures on the slide Death from HAI occurs in about 10% of affected patients. (500,000 patients each day, 16 million deaths every year) According to WHO, in addition to the global figures on the slide, defective infection prevention and control practices in health institutions also cause harm to hundreds of millions of patients worldwide every year.    On any given day, about 80 000 patients have at least one HAI (one in 18 patients) in a European hospital (ECDC, 2013 Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals).  No country or health system, even the most developed or sophisticated, can claim to be free of HAIs. This topic is very relevant for Hungary as well and I am sure the new leadership will pay special attention to this – which we will fully support from WHO. The financial impact of this is huge! Report on the endemic burden of healthcare-associated infection worldwide. Geneva: World Health Organization; 2011

Joining forces for the greatest impact Joining forces for the greatest impact! Infection Prevention and Control contributes to achieving the global health priorities Effective IPC requires constant action at all levels of the health system, from policymakers to facility managers, health workers, hygiene specialists and those who access health services.  It would also help effective implementation of other major global health priorities, including the International Health Regulations, antimicrobial resistance (AMR) action plans, patient and health worker safety, and integrated people-centred care, prevention and control of infectious diseases.

Standard Precautions All patients, at all times “Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used, as a minimum, in all patient care settings.“ "Risk assessment is critical. Assess all health-care activities to determine the personal protection that is indicated." Standard precautions in health care: Aide-memoire. WHO October 2007 http://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf.

How are we doing in terms of Infection Prevention and Control Programmes in the European region?

Strengthening infection control in European hospitals is a public health priority Almost all countries (96%) have a national IPC programme Almost all hospitals (96%) have infection control objectives on hand hygiene (87%) HIA reduction (84%) and antibiotic stewardship (66%). Infection control staffing and policies vary broadly across Europe The good news: hand hygiene receives considerable attention. The good news is that almost all countries have an IPC national program and nearly all hospitals have infection control objectives. There is, however, problem with the adherence, and control. We also have to invest more in infection control staffing and also in training of health professionals overall. The good news is that hand hygiene receives considerable attention but a long way to go to ensure full compliance. J Hosp Infect. 2015 Dec;91(4):338-45.

Infection Prevention and Control (IPC) in human health care % No national IPC programme or operational plan is available. 4% A national IPC programme or operational plan is available. National IPC and water, sanitation and hygiene (WASH) and environmental health standards exist but are not fully implemented. 17% A national IPC programme and operational plan are available and national guidelines for health care IPC are available and disseminated. Selected health facilities are implementing the guidelines, with monitoring and feedback in place. 25% National IPC programme available according to the WHO IPC core components guidelines and IPC plans and guidelines implemented nationwide. All health care facilities have a functional built environment (including water and sanitation), and necessary materials and equipment to perform IPC, per national standards. IPC programmes are in place and functioning at national and health facility levels according to the WHO IPC core components guidelines . Compliance and effectiveness are regularly evaluated and published. Plans and guidance are updated in response to monitoring. 29% Global Monitoring of Country Progress on Antimicrobial Resistance (AMR) Global Database Country Self Assessment -2018

Capacity for infection prevention and control and chemical and radiation decontamination 3% Level 1 A national IPC programme and WASH standard for infectious diseases are under development 11% Level 2 Access to health services according to national IPC programme and national WASH standards for infectious diseases are in place at major hospital centres 33% Level 3 Access to health services according to national IPC programme and national WASH standards for infectious diseases are in place at all health care facilities Level 4 Designated health care facilities for chemical events have access to the capacity to decontaminate 42% Level 5 Designated health care facilities for radiation emergencies have access to the capacity to decontaminate State Party self-assessment annual reporting 2018 International Health Regulations (‎2005)

Effective IPC requires constant action at all levels of the health system, from policymakers to facility managers, health workers, hygiene specialists and those who access health services. 

Core components of infection prevention and control programmes at the national and acute health care facility level Core Component 1 IPC Programme Core Component 2 IPC Guidelines Core Component 3 IPC Training/Education Core Component 4 HAI Surveillance These are the first international evidence-based guidelines on the core components of IPC programmes. These new WHO guidelines are applicable for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences. The Guidelines describe what is necessary (that is, recommendations) to effectively improve infection prevention and control (IPC). 8 Core components 11 evidence based recommendations 3 good practice statements http://www.who.int/infection-prevention/publications/ipc-components-guidelines/en/ Core Component 8 Built environment, materials & equipment for IPC Core Component 5 Multimodal Strategies Core Component 6 Monitoring, audit & feedback Core Component 7 Workload, staffing & bed occupancy

The implementation approach IPCAT2 Step 1 Preparing for action Step 2 Baseline assessment Step 3 Developing and executing the plan Step 4 Evaluating impact Step 5 Sustaining the programme over the long-term Infection Prevention and Control Assessment Tool Infection prevention and control assessment framework at the facility level National Implementation packages 5-Step implementation cycle WHO Guidelines Health facility IPCAF

Adapting IPC Core Components multimodal/multidisciplinary strategies patient-centred integrated within clinical procedures innovative and locally adapted tailored to specific cultures and resource level The world is full of frameworks, roadmaps and action plans that sit on shelves collecting dust, and never make a difference to people. I urge you, starting now, to translate your good intentions into concrete actions that transform the health of your people When people speak with one voice, politicians listen. So speak up for universal health coverage. Speak up for health for all.

Conclusion Demonstrate leadership and commitment Exchange good practices Support consolidated Actions Continuous awareness Full cycle of programme management for improvement

Acknowledgment Dr Zsuzsanna Jakab, WHO Regional Director for Europe Dr Dorit Nitzan, Coordinator for Health Emergency, WHO Regional Office for Europe Ms Ana Paula Coutinhou Rehse, Technical Officer, WHO Regional Office for Europe Member States and Partners

Thank you very much for your attention