A helping hand for patient safety

Abstract

Worldwide over the years, patient safety has received little attention. In 1999, the Institute of Medicine's landmark report, To err is human: building a safer health system estimated that as many as 98 000 people die annually due to medical errors, incurring a cost of $29 billion. Since the report, there have been some improvements but overall progress has fallen short of expectations, and the statistics remain largely unchanged. Furthermore, a US public opinion survey in 2004 showed that public dissatisfaction in the quality of healthcare was extremely high. There is now an urgent need to restore public confidence in health care. A global initiative to address safety and quality of care is long overdue. In October 2004, the WHO launched the World Alliance for Patient Safety. Led by the UK's Chief Medical Officer, Sir Liam Donaldson, the initiative's goal is to improve the safety of health care in all member states. For the first time, policy makers, heads of institutions, and clinical and patient groups have come together from around the world to advance the patient safety goal of “first do no harm”, and to reduce the adverse health and social consequences of unsafe health care. A core element of the new Alliance is the Global patient safety challenge programme. The “challenge” is a topic that covers an important aspect of risks threatening patients in health care, and will change every 2 years. The first challenge for 2005–2006 focuses on the prevention of health-care associated infection (HAI). The slogan for this year's challenge is Clean care is safer care. It will primarily be promoting hand hygiene but also blood safety, injection and immunisation safety, safer clinical practices, and safe water, sanitation, and waste management. On October 13, 2005, at WHO, Geneva, ministers of health and major associations of health-care professionals from the developed and developing world will formally pledge their commitment to tackling HAIs within their countries, and share results and learning internationally. It is encouraging to hear that every country approached has expressed interest in taking up the challenge. Having ministerial support provides an opportunity for HAIs to feature on the political agenda, where they have not been before. In the USA alone over 100 000 people a year die of HAIs. The risk of HAIs in developing countries is two to 20 times higher than in developed countries. Rich or poor, no country is free from the burden of these infections. Choosing to prevent HAIs is thus an appropriate first challenge. Hand hygiene is the simplest and most effective means of preventing the spread of infection but compliance of health-care workers with hand washing is disappointingly low. Educating and motivating good practice and pushing behavioural changes among health-care workers will be a challenge in itself. But new approaches, such as alcohol hand-rubs at the point of care should improve adherence. The WHO guidelines on hand hygiene in health care have been developed by an expert global task force, and are currently being tested in each of the six WHO regions to obtain the most reliable and adaptable strategies to be applied worldwide. Pilot sites range from modern high-technology hospitals in developed countries to remote dispensaries in resource-poor villages. Constraints such as unsafe water and poor funding of health systems in resource-poor settings could hinder the implementation of the challenge at these sites, so it is important to tailor the challenge accordingly. In terms of keeping costs down, a WHO formulation of alcohol-based hand-rub that is currently in preparation will be helpful. Studies have shown the costs of the alcohol hand-rub are only between 0·1 and 1% of the extra costs attributable to nosocomial infections. But what happens after 2006 when the challenge is over? Sustainability will be a key issue. Strategies with this in mind are already being tested during the challenge. In August 2005, the WHO announced the formation of the world's first WHO collaborating centre in Washington dedicated solely to patient safety. One of the centre's goals will be to continue the work of the challenge. What is encouraging is that there is considerable enthusiasm from developing world countries to design systems to include safety from the start. For example, when donors provide support for initiatives such as improving HIV treatment, they bring with it a responsibility to assure that harm due to treatment is kept to a minimum. This patient safety challenge provides a unique opportunity to begin to quantify HAIs, especially in countries where this information is not currently available. This information could lead to the identification of best practices, which could then be applied universally.