WHO, hand hygiene, 5 moments, infection prevention, hand washing

Basic hygieneHand hygiene

Professor Didier Pittet:
The right to hand hygiene

“Around the globe, medical patients may experience a healthcare-associated infection (HAI) while receiving care, representing the most frequent adverse event 1. It is fair to ask just how significant these infections are – and the answer to this question is startling. It is currently understood that about 16 million people annually die from such infections and their complications globally. This represents a larger cause of death annually than even AIDS, tuberculosis and malaria combined. In many settings, from hospitals to ambulatory and long-term care, HCAI appears to be a hidden, cross-cutting problem that no institution or country can claim to have solved yet. But while we haven’t yet solved the problem, we have research-based knowledge about it, and the evidence is clear: clean hands among medical professionals can prevent infections. And we also have evidence that small improvements in compliance can cut the rates of infection – as well as related issues such as antibiotic resistance.

Washing hands for global health

From an economic and resource point of view, washing hands is much more than a daily act that is too often inadequately performed. Poor handwashing that results in HCAI leads to prolonged hospital stays, long-term disability, increased resistance of microorganisms to antimicrobials, a massive additional financial burden for health systems, high costs for patients and their families, and, in the worst case a high number of deaths. In Europe, HCAIs cause 16 million extra-days of hospital stay, with 37,000 attributable deaths, and they contribute to an additional 110,000 deaths every year. Annual financial losses are estimated at approximately € 7 billion, but this includes direct costs only. In the United States, approximately 99,000 deaths were attributed to HCAI in 2002, and the annual economic impact was estimated at approximately $ 6.5 billion US in 2004. Information is scant for low- and middle-income countries, and no data are available at national or regional levels. A review of several studies showed that increased length of stay associated with HCAI varied between 5 and 29.5 days. Although global HCAI estimates are not yet available, by integrating data from published studies, there is clear evidence that hundreds of millions of patients are affected every year worldwide, with the burden of disease much higher in low- and middle-income countries1.

Having said that, we need to consider another crucial impact factor, the human. In addition to an annual 16 million likely preventable deaths, we are talking about the exponential growth of antibiotic resistant pathogens. And while there are many causes for this development, we should consider how to prevent infections from occurring in the first place.

Fortunately, the medical community is fully eager to change these outcomes, and regional as well as local governments and their medical facilities have globally embraced changes in policies, procedures and mindsets about what it takes to keep hands clean, and thus patients healthy. Our initial research started in 1994 and ever since then, we have collected data which proves that significant reductions in HCAI are possible even by modest increases in compliance. The global rate remains around 10-20 percent compliant. But if a facility moves to even 40-50 percent compliance, our research shows that some infections can be reduced up by at least 50 percent, and others up to 90 percent or more.

A sustainable approach to hand hygiene

Over the past 25 years, and this makes us deeply optimistic as well, we have come up with economical, sustainable materials – alcohol-based hand rubs – alongside a multi-modal approach that includes system change and emphasis on the vital importance of hand hygiene. Today, more than 250 million people are following our campaign (via the web and social media). In addition, alcohol-based hand rubs * have joined WHO’s Essential Medicines list.

This inclusion has been particularly important, both practically and symbolically. The motto of the 2019 WHO campaign is: ‘Clean Care for All – It’s in Your Hands.’ Clean hands means universal care. Whether you are in the developed or developing world, patient rights must be honoured, whatever the resources of the hospital or medical facility. Being included in the WHO’s Essential Medicines list, alcohol-based rubs at the point of care is a human right.”


By Prof. Didier Pittet
Pittet serves as the director of the Infection Control Programme at the University of Geneva Hospitals and Faculty of Medicine. The expert of infectious diseases was also the lead adviser of World Health Organization’s First Global Patient Safety Challenge: Clean Care is Safer Care.

further information

  1. Report on the Burden of Endemic Health Care-Associated Infection Worldwide, WHO

*commercial communication

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