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

2. 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

3. 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.

4. 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, attributable deaths and contributing to an additional 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 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

5. 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.

6. 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

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

8. 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 Dec;91(4):

9. 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

10. Capacity for infection prevention and control and chemical and radiation decontamination3%
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)

11. 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. 

12. 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
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

13. 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

14. 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.

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

16. 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

17. Thank you very much for your attention