According to a new Position Paper published in the American Journal of Infection Control (AJIC) online, improved everyday hygiene practices, such as hand-washing, reduces the risk of common infections by up to 50%, reducing the need for antibiotics, by up to 30%. Global public health experts responsible for the Position Paper, are now calling for home and community hygiene to become part of strategic plans to reduce hundreds of thousands of deaths from AMR globally each year.
As witnessed during the recent global efforts to delay the spread of COVID-19, hygiene practices, including hand-washing, have become an essential part of everyone's daily routine and are considered to be the first line of defence in reducing the spread of common infections. However, national and international AMR strategies, while focussing on the important role of hygiene in the healthcare setting, fail to recognise the key role that home and community hygiene plays.
This Position Paper, developed on behalf of the Global Hygiene Council (GHC), and published online in AJIC, explores the role of targeted hygiene in the home and everyday life settings to reduce antibiotic prescribing and its likely impact on antibiotic resistance. It provides evidence that practising hand hygiene in homes and community settings can prevent infections and therefore reduce the need for antibiotics. One intervention study demonstrated a 30% reduction of antibiotic prescriptions for common respiratory infections in a group who used hand sanitisers compared with a control group.
The Position Paper, also demonstrates the increasing prevalence of multidrug-resistant bacteria in the home and community. It is considered that 35% of common infections occurring in healthcare and the community are already resistant to antibiotics, and that in some low-and middle-income countries, resistance to antibiotics is as high as 90%,4 causing 2,000 people to die every day globally.
According to the lead author, Jean-Yves Maillard, Professor of Pharmaceutical Microbiology at the School of Pharmacy and Pharmaceutical Sciences, at Cardiff University; "In light of the current COVID-19 pandemic and evidence presented in this Paper, it is more urgent than ever for policy makers to recognise the role of community hygiene to minimise the spread of infections, which in turn will help in reducing the consumption of antibiotics and help the fight against AMR.
To coincide with the publication of the Paper, the GHC has launched a Manifesto calling upon national and international policy makers, health agencies and healthcare professionals to further recognise the importance of hygiene in the home and everyday life settings and acknowledge the following:
1/ IPC committees, responsible for implementing national AMR plans, should recognise that improved hand and surface hygiene in the home and community are key to minimise the spread of infections and as a consequence the consumption of antibiotics, which will then help in the fight against AMR. To achieve this, recommendations for improved hygiene in the wider community should be included in global AMR action plans by 2022 and in all national plans by 2025.
2/ IPC advice, guidance and education for HCPs on hand and surface hygiene and its relation to AMR should not be limited to healthcare settings, but also include recommendations to influence the wider community with immediate effect.
3/ Relevant medical associations should ensure messaging around home and community hygiene is cascaded to members through amending on-going and existing AMR training and education.
With evidence to show that home and community hygiene urgently needs to be taken more seriously, it is time for the global community to collaborate and recognise that reducing the need for antibiotic prescribing and the circulation of AMR strains in healthcare settings cannot be achieved without also reducing the circulation of infections and AMR strains in the community.
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Notes to Editors:
The Position Paper 'Reducing antibiotic prescribing and addressing the global problem of antibiotic resistance by targeted hygiene in the home and everyday life settings,' was developed on behalf of the Global Hygiene Council, following a scientific meeting in London 2019 with global hygiene, AMR and public health experts.
Available online: https://www.ajicjournal.org/article/S0196-6553(20)30209-1/fulltext
The Global Hygiene Council is supported by RB, global leaders in health and hygiene products.
Experts available for interview:
- Professor Jean-Yves Maillard: Professor of Pharmaceutical Microbiology at the School of Pharmacy and Pharmaceutical Sciences, at Cardiff University. Prof Maillard is a member of the Healthcare Infection Society and an independent expert for the European Commission on matters related to bacterial resistance and cross resistance to microbicides.
- Professor Sally Bloomfield: Honorary Professor at the London School of Hygiene and Tropical Medicine. Additionally, Prof Bloomfield is a Consultant in Hygiene and Infectious Disease Prevention and Chairman and member of the Scientific Advisory Board of the International Scientific Forum on Home Hygiene (IFH).
- Professor Elizabeth Scott: Assistant Professor in the Department of Biology, the Director of the Undergraduate Program in Public Health, the Co-director of the Simmons Center for Hygiene and Health in Home and Community and a member of the International Scientific Forum on Home Hygiene (IFH).
- Professor Sabiha Essack: Professor of Pharmaceutical Sciences in the School of Health Sciences, at the University of KwaZulu-Natal (UKZN). Prof Essack is also the South African Research Chair holder in Antimicrobial Resistance and One Health, an expert consultant on antimicrobial resistance to the World Health Organization and the Vice Chairperson of the South African Ministry Advisory Committee on Antimicrobial Resistance.
Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. May 2003; 3 (5): 275-81
Azor-Martinez E, Yui-Hifume R. Effectiveness of a hand hygiene program at child care centers: a cluster randomized trial. Pediatrics. November 2018;142 (5). Available from:ncbi.nlm.nih.gov/pubmed/30297500 (Accessed 15 April 2020)
Interagency Coordination Group on Antimicrobial Resistance. No Time to Wait. Securing the Future from Drug-Resistant Infections. April 2019. Available from: https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1. (Accessed April 15, 2020.)
Review on Antimicrobial Resistance: Tackling Drug-resistant Infections Globally. 2014. Available from: https://amr-review.org/Publications.html. Accessed July 3, 2019.
American Journal of Infection Control