Preventing sepsis in health care – It’s in your hands: A World Health Organization call to action

Sepsis is a serious disease condition which harms our populations and challenges healthcare delivery. In recent years, prevention, early diagnosis and management have risen to the fore in pursuit of saving lives. Addressing sepsis requires a multidisciplinary and comprehensive approach at the global level. Sepsis is estimated to affect more than 30 million people each year (Fleischmann et al., 2016) and the burden of sepsis is most likely highest in low- and middle-income countries (Shrestha et al., 2017) and higher among vulnerable populations (Mayr et al., 2014). In particular, neonatal sepsis can cause up to half a million newborn deaths every year (Liu et al., 2016), and maternal sepsis accounts for about one in ten maternal deaths (Say et al., 2014). Sepsis also frequently results from avoidable infections acquired in healthcare settings, one of the most frequent adverse events during care delivery. Sepsis resulting from surgical procedures accounts for 30% of all sepsis in healthcare (World Health Organization [WHO], 2011).

In 2017, the Seventieth World Health Assembly (WHA) adopted a resolution on sepsis: Improving the prevention, diagnosis and clinical management of sepsis (WHO, 2017c). An emphasis was placed on the importance of advocacy efforts to raise awareness of sepsis and also to strengthen infection prevention and control (IPC). Focusing on the United Kingdom, the Sepsis Trust has led the way in raising awareness to the diagnosis, management and prevention of sepsis for some years, and has strongly supported the Global Sepsis Alliance and World Sepsis Day. In 2013, the Trust also led on the development of ‘The Trinity of Infection Management: United Kingdom Collation Statement’ and outlined their commitment to a joined-up action-orientated approach, with IPC at the core (Daniels et al., 2014).

All these activities highlight that prevention of avoidable infection is still essential in healthcare and also directly contributes to sepsis prevention. This means appropriate hand hygiene action in healthcare, as well as access to vaccines, improved sanitation, and water quality and availability, as well as other IPC best practices (WHO, 2016). These actions can subsequently make a significant impact on diagnosis and clinical management of sepsis. Antimicrobial resistance (AMR), another important global health agenda (WHO, 2015), can jeopardise effective treatment of underlying infection and sepsis, making effective IPC programmes and actions such as hand hygiene even more important. In fact, sepsis in healthcare can result from multidrug-resistant organisms and WHO’s guidelines on carbapenem-resistant organisms recommend hand hygiene best practices to control such organisms (WHO, 2017b).

The WHO SAVE LIVES: Clean Your Hands annual global campaign, every 5 May, has played a major role in promoting hand hygiene in healthcare around the world (Kilpatrick et al., 2017). Each year the campaign features a slogan and calls for action. It has previously linked to relevant broader global health topics such as surgical site infection and AMR prevention, in order to spread the hand hygiene message outside of the IPC community. In 2018, in addition to the ongoing commitment of IPC campaign advocates, the participation of other disciplines such as intensive care medicine professionals will be essential to further campaign spread and, more importantly, the prevention of infections leading to sepsis in healthcare. Thus, a multidisciplinary community is invited to join the campaign and promote this year’s slogan and social media hashtags ‘It’s in your hands – prevent sepsis in health care’ (Figure 1).

Figure 1.

5 May 2018: ‘It’s in your hands – prevent sepsis in health care’. WHO SAVE LIVES: Clean Your Hands campaign slogan and main promotional image (2018 hashtags: #HandHygiene #Sepsis). Campaign participants are invited to submit photos/selfies holding a board with the slogan and hashtags at www.CleanHandsSaveLives.org. 5 May 2018 tools available at http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/.

The campaign calls for action across different target audiences are listed in Table 1.

Table 1.

5 May 2018 WHO SAVE LIVES: Clean Your Hands campaign calls to action.

Health workers	‘Take 5 Moments* to clean your hands to prevent sepsis in healthcare’
IPC leaders	‘Be a champion in promoting hand hygiene to prevent sepsis in healthcare’
Health facility leaders	‘Prevent sepsis in healthcare, make hand hygiene a quality indicator in your hospital’
Ministries of health	‘Implement the 2017 WHA sepsis resolution. Make hand hygiene a national marker of healthcare quality’
Patient advocacy groups	‘Ask for 5 Moments of clean hands to prevent sepsis in healthcare’

^*Refers to the ‘My 5 Moments for Hand Hygiene’ as published in the WHO guidelines on hand hygiene in health care (WHO, 2009).

See 5 May 2018 tools for action at http://www.who.int/infection-prevention/campaigns/clean-hands/5may2018/en/.

IPC, infection prevention and control; WHA, World Health Assembly.

The campaign, however, is not only about awareness raising on the role of hand hygiene in preventing sepsis in healthcare but is always focused on supporting longer-term behaviour change in health workers. Use of WHO hand hygiene tools and multimodal promotion strategy based on the WHO Guidelines for hand hygiene in health care (WHO, 2009), with proven efficacy in pilot testing on a large scale (Allegranzi et al., 2013), is another crucial leverage. A recent report from the WHO, based on a systematic review that informed the Guidelines on core components of IPC programmes at the national and acute health care facility level (WHO, 2016), highlighted evidence that hand hygiene multimodal improvement strategies are effective in improving practices and preventing microbial transmission and infections (WHO, 2017a). The WHO multimodal improvement strategy is described as system change, training and education, evaluation and feedback, reminders in the workplace and safety climate. Or in other words, ‘build it, teach it, check it, sell it, live it’ (WHO, 2017d).

As of 2018, over 20,000 hospitals and health facilities in 179 countries or areas have demonstrated their commitment to hand hygiene action by signing up to the campaign. The WHO invites more health facilities to become part of this community by registering at http://www.who.int/infection-prevention/campaigns/clean-hands/register/en/.

Working towards sepsis prevention in healthcare through the WHO global hand hygiene campaign should be seen as an opportunity for every health professional to unite and strengthen the link of the communities working on prevention, diagnosis and management of sepsis. It is also another step forward in the promotion of sustained hand hygiene improvement and behaviour change. On 5 May 2018, the focus for everyone everywhere should be ‘It’s in your hands – prevent sepsis in healthcare’.