‘Fight antibiotic resistance – it’s in your hands’ was this year’s slogan for the World Health Organization’s (WHO) Hand Hygiene Day on May 5, emphasising the link between infection and control practices like handwashing and the prevention of antibiotic resistance.

Healthcare-associated infections (HAI) have caused harm, and even death, particularly in those with impaired immunity.

HAI account for a significant proportion of harm caused by healthcare and are associated with much financial and personal cost.

The widespread use of antibiotics in agriculture, animals and humans have led to increasing antibiotic resistance worldwide. This occurs when the bacteria changes and can no longer be destroyed by antibiotic(s) – it becomes resistant to the antibiotic(s) and continues to multiply in the body, causing more harm.

Antibiotic resistance is due to the misuse and abuse of antibiotics.

Antibiotic resistance is due to the misuse and abuse of antibiotics. Photo: AFP

The WHO estimates that globally, one in 10 patients get HAI, and up to 32% who have a surgical operation get infected after the operation, of which 51% are resistant to antibiotics.

It also estimated the incidence of HAI in Malaysia as 14% for the period of 1995 to 2010.

The organisation issued a call to action this year to various groups involved in healthcare delivery:

• Healthcare staff: “Clean your hands at the right times and stop the spread of antibiotic resistance.”

• Hospital chief executive officers and administrators: “Lead a year-round infection prevention and control programme to protect your patients from resistant infections.”

• Policymakers: “Stop antibiotic resistance spread by making infection prevention and hand hygiene a national policy priority.”

• Infection and Prevention Control leaders: “Implement WHO’s Core Components for infection prevention, including hand hygiene, to combat antibiotic resistance.”

What individuals can do

Everyone is exposed to, and can get, infections in daily life. The body has mechanisms that respond to any such exposure.

This response is reduced if one’s immunity is impaired. As such, infections can be prevented by a healthy lifestyle – healthy diet, exercise, avoidance of substance abuse and practising good hygiene habits.

When there is no infection, antibiotics are not necessary.

Infections can be avoided at home, office, school and restaurants by the regular cleaning of hands, particularly after visiting the toilet and other dirty places.

When sick, it is always advisable to consult a doctor who will make a diagnosis as to whether there is an infection, and if there is evidence of an infection, whether the infection is likely to be bacterial, viral or fungal.

Good hand hygiene helps prevent infections, which in turn means that antibiotics are therefore not required. Phoro: TNS

There may be need for laboratory and other investigations for confirmation of the diagnosis.

Better hand hygiene reduces risks for patients and their families. It is essential to remember that hand hygiene is vital before and after touching a patient; before handling an invasive device for patient care, regardless of whether or not gloves are used; after contact with body fluids or excretions, mucous membranes, non-intact skin or wound dressings; if moving from a contaminated body site to another body site during care of the same patient; after contact with inanimate surfaces and objects in the immediate vicinity of the patient; after removing sterile or non-sterile gloves; and before handling medicines.

Hand hygiene is necessary after going to the toilet, or after changing diapers or cleaning up a child who has used the toilet, as it will prevent contamination of the hands by excretory materials.

Hand hygiene is necessary after blowing the nose, coughing or sneezing, to prevent contamination of the hands and surrounding surfaces by microbes that can be harmful to others.

Patients, their families and visitors to a healthcare facility are advised to observe if doctors and nurses have cleaned their hands prior to treatment, and if not, request them to do so.

Doctors and nurses are always encouraged to clean their hands in the presence of a patient prior to touching the patient.

It would be beneficial for patients, their families and friends to learn and apply the correct hand hygiene technique and indications to ensure they are aware of the correct moments for hand hygiene.

In short, increased compliance, as well as timely and appropriate hand hygiene, go a long way in reducing HAI and antibiotic resistance.

It is advisable not to demand that antibiotic(s) be prescribed. This habit is detrimental to health.

Antibiotics act only against bacteria and not against viruses which are the cause of common infections. An appropriate antibiotic needs to be prescribed for a bacterial infection.

In the event that antibiotic(s) are prescribed, it is always advisable to ask how it will help in curing the current illness.

All antibiotics should be taken as prescribed. It is usual for the doctor to prescribe a course of antibiotic(s).

Sometimes, one feels better soon after taking the antibiotic(s). One should not stop or skip taking the antibiotic(s) when this happens as there may be residual infection.

Although many infections appear similar in their presentation, the cause(s) may be different.

It is, therefore, important that the remainder of antibiotic(s) from an uncompleted course are not saved and taken for another illness.

The sharing of antibiotic(s) with others is not advisable. This can lead to misuse and abuse, which promotes antibiotic resistance.

It is important to remember that antibiotics are powerful medicines that can have negative side effects.

Self-diagnosis and purchase of antibiotics over the counter can lead to serious consequences for the person who consumes it.

Sometimes, cost considerations may lead to purchase of antibiotics from sellers who are not from healthcare facilities. This practice is strongly discouraged. It is important to remember that all antibiotics should be dispensed by a doctor or pharmacist.

Only when necessary

The message that antibiotic(s) should be taken only when necessary has to be shared with family and friends.

Last but not least, patients and their families can advance the cause of safer healthcare by asking doctors, nurses, administrators of healthcare facilities and policy makers about their commitment and response to WHO’s call for action.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of any organisation the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.