Frustration and Optimism: My Mixed Emotions for Reducing Healthcare-associated Infections at Birth

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by Wendy J. Graham
Professor of Obstetric Epidemiology, Department of Infectious Disease Epidemiology

Today, advances in healthcare routinely enable miracles of survival and recovery. But some discoveries have been forgotten or demoted in the race to implement the latest. The importance of hygiene at the time of birth goes back centuries.* Yet here in the 21st century, so-called “places of care” bring increased risks of infection to patients and health workers when basic preventive principles are not followed. Safe water to drink, a clean surface to deliver upon, and good hand hygiene by those attending you – how more basic can it be?

After nearly 40 years in public health, I am re-invigorated by the chance to be part of what the BASICS partnership proposes: integrating four agencies’ best practices and learning in infection prevention in healthcare settings into one systematic approach in partnership with countries to dramatically reduce infection rates at the point of care.

Health facilities – and especially maternity wards – are the natural environment of my interest and passion for change. Initial work in Botswana in the late 1970s and early 1980s – at the time when HIV/AIDS was just emerging, gave me a firm grounding in the tough realities of healthcare in under-resourced settings, together with a lifelong admiration for health workers who provide care 24/7 in such circumstances.

It’s in these maternity wards where many mothers and newborns acquire infections. They’re often busy and overcrowded places, with invasive procedures, instruments that may not be sterilized between use, and major infrastructural and supply challenges to maintaining cleanliness and hygiene. The photo here of a ward in West Africa captures this situation – indeed, with women being asked to bring their own bottle of bleach when they came to deliver as there had been no cleaning fluids in the maternity for months.

This is a striking reminder of the hidden costs of care families endure and the weakness in the health system, which means women deliver where “safe care” cannot be guaranteed and where health workers cannot protect themselves from infection risks either. Both “cannot’s” are violations of basic human rights.

This is why I’m so excited about the potential of BASICS to empower all health workers about proper hygiene and infection prevention practices and enable health systems to provide safe care equitably and routinely. And we mean “all” – acknowledging the crucial role in facilities played by workers who are not care practitioners – such as cleaners, orderlies and maintenance staff –  in creating a clean environment. These often-forgotten “workers for health” also have great potential to be agents for change.

But, of course, it’s not just the four BASICS collaborators and the crucial country partners who want better health outcomes for mothers and their newborns, and for them to leave a facility without a life-threatening infection.

Access to health facilities providing clean care was the second-highest demand of the 1.2 million women and girls in 114 countries who took part in the White Ribbon Alliance’s 2018 global What Women Want campaign on reproductive and maternal health needs. Women and girls overwhelmingly demanded clean facilities, clean toilets in maternity wards, a clean bed, and skilled health providers with sterile supplies and clean hands. 

None of these demands are impossible to achieve. The crucial innovation proposed by BASICS is to take the best evidence-based practices of each partner and create one comprehensive package of training, access to clean water in facilities, an innovative cleaning product and systems change in order to institutionalize and sustain clean care in the partner countries.

I am optimistic that BASICS can result in better quality healthcare that will save tens of thousands of lives and millions of dollars by averting healthcare-acquired infections.

In the time it has taken to read this, many more health workers’ could have washed their hands, many more women could have delivered on clean beds and with sterile instruments, and many more babies could have been discharged home without an infection from the facility. This advance does not require a new discovery – we know what to do now.

BASICS will be a catalyst for the miracle of survival and good health for mothers and newborns. 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

 

*Graham WJ, Dancer SJ, Gould IM, Stones W. (2015) Childbed fever: history repeats itself? BJOG, 122:156–159.

The Blue Dye Innovation that Makes Disinfecting Health Facilities More Effective and More Visible

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by Jason Kang, Co-founder and CEO, Kinnos

In 2014, I co-founded Kinnos in response to the West Africa Ebola crisis. At the time, one of the biggest problems contributing to high rates of infection was ineffective surface decontamination caused by human error and gaps in training.

Disinfectants like bleach are transparent, making it easy to miss spots; hydrophobic, making it bead up and roll off the surfaces it’s meant to disinfect; and only effective if used for a specific contact time, meaning healthcare workers must ideally wait for a certain period for pathogens to be inactivated. These problems are universal to disinfection in facilities outside the scope of epidemic outbreaks.

Highlight, our patented additive, colorizes the disinfectant so that users can easily see where it has been applied. Highlight modifies the liquid properties to eliminate droplet formation and improve adherence to surfaces. The color fades as the contact time needed for the disinfectant to work passes, indicating when decontamination is done.

To put this into context, our time at the Ebola Treatment Unit in Ganta, Liberia, was particularly memorable – I remember the intense heat and how incredible it was that staff were wearing layers of stuffy, personal protective equipment for 4 to 6 hours at a time. However, this also meant that they were only too eager to remove their protective gowns and coveralls, often not waiting the requisite contact time for the disinfectant sprayed on their protective garments to work.

Combined with the inherent difficulties of achieving full coverage with bleach, we quickly understood why health staff were up to 32 times more likely to be infected with Ebola than the average person.

When healthcare workers started telling us that Highlight was making them feel more confident in their own safety and easing their stress in such high-risk situations, we realized that our technology was tapping into an invaluable resource: peace of mind. Interacting with the healthcare workers who had volunteered to put themselves directly in danger to help others was humbling and inspiring, and doing our part to make their lives even a little bit better was incredibly motivating.

The breakthrough that Highlight represents – the ability to overcome training and language barriers to empower health workers and those who clean facilities with a feeling of confidence through disinfection they can see – can have a profound impact in reducing healthcare-associated infections globally as part of the BASICS solution. In our mission to prevent infections and improve patient safety, we have not forgotten about the people who are tasked with the important step of disinfection.

In addition to our humanitarian focus in low- and middle-income countries, Kinnos is working to radically reduce healthcare-associated infections and the prevalence of antimicrobial resistance within the U.S. healthcare system.

We’ve partnered with leading medical organizations to pilot our technology in hospitals, ambulatory surgical centers and other facilities. It’s a sober reminder that infections affect society at large and are an urgent global problem that require a concerted effort to solve.

The fact that someone today can receive a life-threatening infection from a place where they expect medical care and treatment is unacceptable, and we are motivated to make this a problem of the past.

Historically, so many resources have been devoted to diagnosis and treatment, even though it’s recognized that prevention is key to sustainable healthcare. We always knew that surface disinfection was only one key part of the larger infection prevention ecosystem, so having the opportunity to enact a system-wide program with the rest of the BASICS team is extremely exciting to me.

The world has been waiting too long for an initiative like BASICS to set the standard of infection prevention.

Why I’m Passionate About Reducing Infections in Health Care Facilities

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by Alison Macintyre, Health Technical Lead – WaterAid

Having spent a lot of my childhood in and out of hospitals, I believed that hospitals were a place where you go to get better, get well; where you leave feeling more positive and healthier than when you arrived. And, I still do.

As I embarked on my career in the field of water, sanitation and hygiene (WASH), I realized for most of the world, that isn’t true. We, the global health community, are currently failing to achieve the absolute basics. Right now, we can’t ensure we are, at an absolute minimum, doing no harm to the millions of people who use health care systems every day. Too many health care facilities operate without water, without toilets that everyone can use, and without water and soap to stop the spread of infection.

This failure is what motivates me. We will only see dramatic, sustained changes in health if we get the basics right. 

Early in my WASH career I was in Papua New Guinea, undertaking a study on the role of WASH during childbirth for women. Most of the women I interviewed were unable to reach a facility to give birth and had to deliver their babies, often alone, on coffee plantations, in pig pens or on the side of the road.

As part of the study, we also visited health facilities. I had hoped that they would provide a potential solution for improving maternal and newborn mortality in these remote communities. One facility has always stuck in my mind.

Despite the newness of the facility (it was only five-years old), water, sanitation and hygiene were not available. A refrigerated, fully stocked drug cabinet was present, but gloves and soap were not. There was a sophisticated rainwater collection system, but the pump to distribute the water to the facility was broken and they weren’t able to fix it. There were two modern toilets, but they were locked and reserved for staff – patients had to go out to a hole dug in the back of the facility, passing an open waste pit on the way, to relieve themselves.

The lack of water also meant women were turned away if they arrived in labour. The next hospital was 2 hours away on a treacherous road.

How did a hospital have sophistical equipment, but couldn’t fix a water supply and women weren’t able to deliver their babies? How were antibiotics kept cold-chain with a reliable supply, yet soap and gloves were not available?

I left the facility angry, wondering how health systems neglected WASH in so many ways.

This visit made me realize that when statistics show us that health care facilities do not have basic WASH services, it doesn’t always mean the infrastructure is completely absent. Often, it may not suitable (for instance in the case of toilets not being accessible to people of limited mobility) or it is not functioning, or basic commodities like soap are not part of general supply lists.

I also realized that it is the system that’s broken, not just the infrastructure. Health systems that have monitoring and budgets for WASH, trained operation and maintenance staff, in-service and pre-service training on hygiene and cleaning, WASH standards and accountability mechanisms, are uncommon. This should be the norm.

That’s why I’m excited about the prospect of leading the WASH element of BASICS (Bold Action to Stop Infections in Clinical Settings), on behalf of WaterAid. Through the work I’ve done, I have learned the importance of integrating basic WASH into broader patient safety and infection prevention control programes. Without such integration, a system-wide approach is not possible and WASH will never become part of the day-to-day routine of health center operations.

BASICS brings together NGOs, researchers and the private sector to support health systems to sustainably address WASH and patient safety. The BASICS team has a wealth of expertise on health, WASH and evidence-based behavior change. This combination is essential for improving patient safety, health and the quality of health care facilities for all.

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

Why I Don’t Want Another Mother to Experience My Health Care Scare

Written by Soha Ellaithy
Senior Director, Strategic Foundation Partnerships and Senior Partnership Director, BASICS

I was born and raised in Egypt, a middle-income country that has a functioning healthcare system and universal healthcare coverage – albeit of often dubious quality.

In 2008, one in 10 Egyptians had chronic Hepatitis C, the highest rate of infection in the world. The direct cause of this catastrophic situation is a mass-treatment campaign conducted by the Egyptian government in the 1970’s and 80’s to eradicate schistosomiasis infection. The repeated use of needles resulted in Hepatitis C, a virus not yet known, being inadvertently spread to millions of people.

When, in 2011, my oldest son went on a school trip to Nepal, he contracted a diarrheal infection and had to be rushed to a local hospital to receive intravenous fluids. He called me and, to my horror, described stepping over pools of blood on the floor to get to a bed with no covering. My heart dropped – and to this day it still does when I think about that moment.

I knew exactly what the implications could be.

I’ve witnessed firsthand the terrible devastation of a healthcare-acquired infection on families and could not bear the thought of my son contracting Hepatitis C or HIV. It took a full three agonizing months of tests to clear my son of any possible infections that he might have picked up from a needle prick in an unclean hospital.

Photo courtesy of: FACEBOOK PAGE/ SO THAT HE'S NOT SURPRISED
Egypt’s doctors have been anonymously sharing pictures of the conditions they work in – with stray animals and overflowing sewage on display – after the country’s Prime Minister said he was “surprised” at the state of the country’s run-down hospitals. Photo courtesy of FACEBOOK PAGE/ SO THAT HE’S NOT SURPRISED via BBC

Despite a fairly strong medical education system and a tireless and dedicated medical staff, public health care systems in many countries like Egypt, continue to be plagued by poor adherence to proper hygiene standards and the devastating consequences that result.

As the Senior Partnership Director leading the submission to 100 & Change, when my colleagues first discussed with me the idea of eliminating this risk globally, I was immediately engaged. As we fine-tuned our idea in meeting after meeting, I became very excited that in BASICS (Bold Action to Stop Infections in Clinical Settings) we truly have a solution that will change the way healthcare is delivered across the world.

I feel very passionate about this project because it is inconceivable that in this day and age, we are still grappling with a problem whose solution is so simple: wash your hands, clean your working surfaces and be diligent in using sterilized equipment.

BASICS tackles the root causes of the problem and builds a solution that is self-sustaining. Using behavioral science to modify individual behavior so that simple hygiene routines can become “second nature,” we will build the supporting infrastructure and design a national system that ensures this new normal is part of a fully functioning and supportive national health system.

I dream of the day when no mother would ever take her child for a simple procedure only to go home with a child who has a life-threatening disease for absolutely no good reason!

 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.

Photo credit: Allan Gichigi/ Save the Children, March 2016

A Clean Maternity Ward Is Every Woman’s Right

Written by Janti Soeripto
Chief Operating Officer and President, Save the Children 

Two things never fail to strike me when visiting health facilities as part of my work. First, without exception, is the absolute dedication of healthcare professionals to want to help mothers and children survive and thrive.

Secondly, it’s the incredible frustration of seeing basic gaps in delivery that interrupt that service. From access to clean water, the availability of consistent power sources to affordable referral options and a reliable cold chain to keep drugs safe for use, it must seem a constant game of solving one problem even as another arises for those running health clinics to consistently achieve the outcomes we all want.

Getting to one huge outcome – a sustainable, significant global reduction in healthcare-acquired infections that cause tragic deaths of newborns and mothers and needless pain and suffering – is at the heart of the BASICS partnership. Each partner – Save the Children, WaterAid, the London School of Hygiene & Tropical Medicine and Kinnos – brings a proven approach for tackling one of the factors that contribute to millions of newly acquired infections every year.

Integrating them into one strategy is an elegant solution.

And if we know why infections get passed to mothers and newborns in maternity wards (and to anyone in a health facility, for that matter); if we know what to teach health workers and cleaners to change their behavior and which tools they need; and if we know how to work with governments to set and institutionalize cleanliness standards for facilities; then why wouldn’t we make BASICS one of every partners’ highest health priorities?

The short answer is, we have.

BASICS’ objective of improving health outcomes couldn’t be a more natural fit for each partner’s aspirations, especially for Save the Children, which has been at the fore of maternal and child health programming for decades. Our 2030 ambitions for children include the global breakthrough that no child under age 5 anywhere will die from a preventable cause.

The teams of staff who’ve designed BASICS (Bold Action to Stop Infections in Clinical Settings) are deeply committed to transforming health care to make it safer for everyone … starting with women and newborns but then benefiting anyone who seeks care at a facility.

Each year, 17 million women give birth in facilities where cleanliness is questionable. BASICS will catalyze a simple, low-cost change in practices that can save many of them and their infants from death or illness by infection.

Who is to say these women and babies don’t deserve the same right to a clean maternity ward that I had when my own children were born?

As I step into the role of leading Save the Children, I’m putting the weight of the agency behind BASICS. We’re all eager to begin transforming health care as the recipient of this next 100&Change award.

 

To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings) is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%, visit savethechildren.org.