How clean hands have helped save lives in Chile
Being admitted to hospital in Chile during the 1980s could be a risky affair. In some hospitals, there was a 1 in 5 chance a patient would pick up an infection – some of them life-threatening – during the course of their treatment. Getting an infection was often considered a “normal complication” of healthcare.
Many infections were due to poor practices by health care workers such as failing to clean their hands before performing medical procedures or use sterile equipment.
“Thirty years ago there was a lack of awareness among health care workers that hospital care practices that were intended to help patients could frequently be the cause of hospital infections,” says Dr Fernando Otaiza, Chief of Infection Control in Chile’s Ministry of Health.
Starting in 1983 a national infection-fighting initiative led by Dr Otaiza, set about turning the tide. It started by targeting six infections commonly acquired in hospitals, including infections contracted during surgery, infections of the uterus after childbirth, urinary tract infections and others.
First, the program focused on ensuring infections were recognised and reported. That meant training appointed nurses in every hospital to improve standards and change practices. Guidelines were developed on the safest way to perform surgery, insert catheters, use ventilators and so on.
The results were dramatic and almost instantaneous. For some infections, such as those involving catheters, infection rates fell within months to drastically lower rates, and for the most part have stayed there.
Between 2000 and 2009, infections during surgery fell by as much as 30%.
“This is just good medicine,” Dr Otaiza says. “We’re not talking about very complicated stuff. It’s good medicine, good nursing, good care.”
One of the secrets to Chile’s success is that the approach to tackling infections was multi-pronged and didn’t rely on any one intervention. But Dr Otaiza says hand hygiene was the single-most important measure in reversing the trend.
“It’s not the only one and sometimes it doesn’t work alone, but without hand hygiene we wouldn’t have been able to show these kinds of results,” he says.
Good hand hygiene is also helping to protect Chile against the threat of antibiotic-resistant infections. While Chile has seen a small number of infections that are resistant to carbapenems, the antibiotics of last resort, Dr Otaiza says the problem has not become widespread.
“This is because we have good hand hygiene practices,” he says. “But we are aware that this can change at any moment.”
Chile has about 180 public hospitals, and about the same number of private hospitals.
Getting top-level hospital management to see the need for change
One of the key lessons, Dr Otaiza says, is that making progress against health care-associated infections isn’t just a matter of getting health workers to change their behaviours – it’s about getting the top levels of hospital management to see the need for change.
“This doesn’t work unless you have leaders of the hospital on board. If you have data to show where the infections are, and if you can show that you can reduce the number of infections with the activities that you implement, you can effect change,” he says.
Dr Otaiza remembers a day in the early 1990s when he and his team took chiefs of departments at a major hospital on a tour of the wards to visit every patient with a catheter.
“At the end of the day they could see that 90% of the catheters had one reason or another why they shouldn't have been there,” he says. “So we started taking catheters out, or not putting them in to start with, or using better catheter systems, and the infections dropped immediately.”
Dr Otaiza says the benefits haven’t only been in terms of infections averted and lives saved – they’ve also been financial. While the exact economic return is difficult to quantify, a Ministry of Health study a decade ago concluded the infection prevention programme could triple its budget and still save money.
The challenge now is to sustain the gains and guard against health workers and hospital managers becoming bored with or complacent about hand hygiene. Changing technologies also present a challenge – every new medical device is a new opportunity for infections, often requiring a unique method for disinfection.