Why is sharing knowledge about hand hygiene and infection prevention and control still so important?

Abstract

The global health care workforce is estimated to exceed 65 million [1]. Broken down by cadre, this “stock” comprises 29.1 million nurses, 12.7 million medical doctors, 3.7 million pharmacists, 2.5 million dentists, 2.2 million midwives, and 14.9 million in additional occupations, including cleaners and health care waste workers. These numbers have not accounted for external contractors. Each of these numbers represents a person requiring training and education in infection prevention and control (IPC) to support the overall safety and quality of health care delivery. Training and education is identified as one of the least performing core components of IPC programs around the world at the national and facility level [2]. In 2016, the World Health Organization (WHO) outlined evidence-based core components for IPC programs, emphasizing the importance of IPC education and training for all health and care workers. The recommendation advocates for participatory team and task-based strategies, incorporating bedside and simulation training. These measures aim to mitigate health care–associated infections and combat antimicrobial resistance [3]. A 2019 WHO global survey evaluated hand hygiene programs across 3206 health care facilities in 90 countries, using the WHO hand hygiene self-assessment framework to gauge progress. The findings showed an intermediate implementation level of overall progress, with significant disparities according to the income level of participating countries. Training and education had a weighted median score of 75 (interquartile range 45-90). Despite a large proportion of health care facilities reporting regular training, less than half made it mandatory and, similarly, only (42.8%) of the 3182 reporting facilities had a designated budget for educational initiatives [4]. The WHO links training directly to competence, specifically for IPC-competent practitioners defining this as individuals capable of applying their knowledge, skills, and abilities in professional and personal growth. For IPC practitioners, WHO core competencies also exist [5] and several countries and societies have developed their own competency and education frameworks for health and care workers, with a focus on IPC. The world continues to experience many infectious threats, including those in health care settings. Health care–associated infections continues to be among the most frequent adverse events occurring in the context of health service delivery. For instance, 136 million cases of health care–associated antibiotic resistant infections occur worldwide every year [6]. Such drivers fueled the overwhelming support for a global IPC strategy in 2023, approved by all WHO member states at the World Health Assembly. The strategy [7] was developed by involving representation from all three (global, regional, and country) levels of the WHO and the IPC Taskforce, coordinated by the WHO, with a wider voice being included from the areas of antimicrobial resistance; water, sanitation, and hygiene (WASH); and patient safety. The guiding principles of this strategy lie in a person-centered approach, ensuring the protection of health and care workers and prioritizing patient safety, including compassion. The strategy and its accompanying action plan feature education and training as integral to achieving the outlined IPC “vision 2030,” with the proposed interventions stated as proven to be scalable and adaptable to local contexts. Specifically, one of the eight strategic directions focuses on health and care workers’ knowledge on IPC, as well as addressing IPC curricula targeted at different levels of competence.