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Commonest complications affecting patients in hospitals

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MINISTER of Local Government and Housing, Datuk Dr. Sim Kui Hian (fourth left) in a photo with State Health Director, Dr Jamilah Hashim (fifth left), Director of Infection Control Programme & WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine and Lead Adviser, Clean Care is Safer Care & African Partnerships for Patient Safety, Health Service Delivery and Safety, WHO Headquarters, Geneva, Switzerland; Professor Didier Pittet (third left), State Health Deputy Director (Medical), Dr Kamaruddin bin Lajim (sixth left) and Director of the Sarawak General Hospital, Dr Chin Zin Hing (second left) after officiating the “Clean Care Is Safer Care World Wide Action 2005-2017” event at the Auditorium CRC Sarawak General Hospital (SGH) in Kuching yesterday.

KUCHING: Healthcare associated infections are some of the commonest complications affecting patients in hospitals and these include urinary tract infections (UTI), pneumonia, surgical site infections (SSI), blood stream infection (BSI) and clinical sepsis.

According to Minister of Local Government and Housing Datuk Dr. Sim Kui Hian, these infections might result in serious clinical, public health and economic costs by prolonging hospital stays, increasing long term disability and preventable deaths as well as increasing antimicrobial resistance.

He said in 2005, the World Health Organisation (WHO) launched the First Global Patient Safety Challenge, “Clean Care is Safer Care” to reduce Healthcare Associated Infections (HCAI) and cross transmission of antimicrobial resistant (AMR) pathogens.

On May 15, 2006, the Malaysian Minister of Health affirmed Malaysia’s commitment towards this First Global Patient Safety Challenge and the country has, since then, adopted the WHO multimodal hand hygiene (HH) improvement strategies.

The hand hygiene compliance rate in Malaysia is measured yearly through the Hand Hygiene Compliance Audit , which is done every quarter of the year.

The prevalence of health acquired infections meanwhile, is being observed through the Healthcare Associated Infections (HCAI) surveillance programme. In this way, the prevalence is determined through a one-day hospital wide point prevalence survey(PPS) which is conducted twice a year.

According to Dr Sim, in his address when officiating at the “Clean Care Is Safer Care WorldWide Action 2005-2017” event at the Auditorium CRC Sarawak General Hospital (SGH) here, yesterday a survey done had shown that overall hand hygiene compliance rate had increased from 56.6 per cent in 2008 to 79.8 per cent in 2015.

And this, in turn, was parallel to the progressive reduction of Healthcare Associated Infections (HCAI) prevalence rate from the baseline of 31.7 to 15.9 per cent per 1,000 patients surveyed in 2008 and 2015 respectively.

Dr Sim said in view of the strong correlation between hand hygiene practice with HCAI and established evidence that hand hygiene compliance was the primary measure effective in preventing HCAI and the spread of antimicrobial resistance , it was vital for all healthcare personnel to practise strict hand hygiene.

“This is where the collaborative project between the WHO and Ministry of Health Malaysia comes in. This project examines a specific problem in health services research that is centrally concerned with culture and organisational change, and leadership behaviours in complex environments,” he said.

Dr Sim said while the problem of hand hygiene (HH) was specific, the findings and lessons would provide new knowledge of interest and transferability to other settings including other parts of the health system, and other industries beyond health services.

Dr Sim hoped that from this project, an empirical model would be created and that it could be used by the WHO to be shared among other state members. The study outcomes may also impact policies in Malaysia as well as internationally.

The most important effect, he said, was that the time and cost associated with dedicated HCAI committee meetings, specifically trained surveillance staff.

HAI diagnostic tests and laboratory staff, pharmacy staff trained in the treatment of antimicrobial resistant HAI and the burden of additional ill health in patients who acquired HAI would be reduced with improved levels of hand hygiene.

Sarawak Health Director, Dr Jamilah Hashim disclosed Sarawak had a total of 23 government hospitals comprising one state hospital, four major specialist hospitals , four minor specialist hospitals, 12 non specialist district hospitals and two special institutions.

As of 2016, there were 3,978 official beds in these hospitals with a bed occupancy rate of 189.6 per cent and a total number of admission of 202,304. There was also one infection disease physician.

Dr Jamilah said ensuring good infection control practices are practised within all the facilities and controlling healthcare associated infection with such number of admission then becomes huge challenge for just one person to bear.

But with the help of the infection control nurses and link nurses throughout the facilities, the burden has been made much lighter.
Yearly, without fail, she said, the health facilities in the state organised their own local level of Hand Hygiene campaign.

She disclosed a survey conducted throughout the 23 hospitals using the WHO’s Hand Hygiene Self-Assessment Framework back in February this year showed majority of the hospitals in state had actually reached the advanced or highest level of progress in hand hygiene movement, as defined by the framework.

The Hand Hygiene Train the Trainers Programme 2017, conducted by Hospital University Geneva, the World Health Organisation Collaborating Centre and endorsed by the the Malaysian Ministry of Health from August 14- 17, was attended by over 80 participants.

A pledge was made by Dr. Jamilah on hehalf of all at the Sarawak State Health Department and witnessed by Dr Sim and Professor Didier Pittet, Director, Infection Control Programme & WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine and Lead Adviser, Clean Care is Safer Care & African Partnerships for Patient Safety, Health Service Delivery and Safety, WHO Headquarters, Geneva, Switzerland.

The event yesterday was also attended by State Health Deputy Director (Medical), Dr Kamaruddin bin Lajim, Director of the Sarawak General Hospital, Dr Chin Zin Hing and also the team from Geneva, Switzerland.

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