The 2018 World Health Organization SAVE LIVES: Clean Your Hands Campaign targets sepsis in health care.

Sepsis is a serious disease condition which harms populations and challenges health care delivery. In recent years, early diagnosis, management and prevention have been raised to the foreground in the pursuit of saving lives [1]. Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection [2]. It is a cross-cutting health issue, requiring a comprehensive, multidisciplinary approach that every health care professional needs to understand and act upon. Sepsis is estimated to affect more than 30 million people each year [3], and its burden is most likely highest in low and middle-income countries [4, 5], and higher among vulnerable and critically ill populations [6]. In particular, neonatal sepsis is the leading reported infectious cause of mortality among newborns [7], and maternal sepsis accounts for one in ten maternal deaths [8]. While community-onset sepsis is often presented as the clinical deterioration of common and preventable infections, sepsis can also result directly from care practices or complicated healthcare-associated infection (HAI), which is the most frequent severe adverse event during care delivery. Without collective decisions and actions, sepsis will continue to pose a significant threat to public health given its high mortality and morbidity.

The World Health Organization (WHO) has recognized sepsis as an important public health agenda, and, in 2017, the 70th World Health Assembly (WHA) adopted a resolution: “Improving the prevention, diagnosis and clinical management of sepsis” [9]. Outlining the many perspectives to be addressed, the resolution emphasizes the importance of advocacy efforts to raise the awareness of sepsis. It also urges every country to strengthen infection prevention and control (IPC), as well as calling on the WHO Director General to collaborate with partners and stakeholders to achieve this goal.

Sepsis is a major issue in critical care and has been the focus of attention of critical care specialists for decades [10]. While it frequently affects patients admitted to intensive care units (ICUs), sepsis also complicates care provided to large proportions of ICU patients, mostly through procedures required to support organ function and control severe underlying conditions. Device-associated infections are the most common ICU-acquired HAIs and frequently result in sepsis. Preventing ventilator-associated pneumonia and bloodstream and urinary tract infections relies on multimodal interventions (sometimes bundling only a few elements) that always include IPC practice improvement, particularly hand hygiene [11]. The preferred recourse to alcohol-based handrubbing instead of soap and water handwashing [12], a system change considered as standard of care today [13], is part of an evidence-based multimodal strategy [12], further adapted and promoted by WHO [13], that results in major improvements in hand hygiene practices [13-15]. Importantly, system change was validated in critical care [16] and proved to be linked with significant reductions in HAI and antimicrobial resistance (AMR) spread, including in ICUs [12, 17].

Preventing avoidable infections directly contributes to sepsis prevention. Timely and appropriate hand hygiene action [13], access to vaccines, improved sanitation and water quality and availability, as well as other IPC best practices remain at the core of sepsis prevention in health care. Effective IPC measures, in particular hand hygiene, can have a significant impact on the diagnosis and clinical management of sepsis. AMR, another important global health agenda [18], can jeopardize effective treatment of underlying infections and sepsis, making actions such as hand hygiene at the right time even more important. IPC, particularly hand hygiene, combined with antibiotic stewardship, has proved to better control AMR than antibiotic stewardship alone [19]. Therefore, hand hygiene not only contributes to sepsis prevention, but also facilitates appropriate diagnosis and better clinical management of infections leading to sepsis.

The World Health Organization SAVE LIVES: Clean Your Hands global campaign, launched in 2009 and celebrated annually on 5 May, plays a major role in promoting hand hygiene in health care around the world [20]. Each year, the campaign features an unique call to action. Previously, it has linked relevant broad global health topics such as surgical site infection and AMR to spread the message of hand hygiene beyond the IPC community. For 5 May 2018, the theme of sepsis in health care was chosen with consideration for the current global concern about the burden of HAI and AMR spread in health care facilities. In addition to the committed IPC campaign advocates, the participation of other disciplines such as critical care medicine professionals is essential. Thus, a multidisciplinary community is invited to join the campaign: “It’s in your hands—prevent sepsis in health care” (Fig. 1, see also http://www.CleanHandsSaveLives.org).

Fig. 1

“It’s in your hands; prevent sepsis in health care”. The 5 May 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign slogan and main promotional image (2018 hashtags: #HandHygiene #Sepsis). Campaign participants are invited to submit photos/selfies of them holding a board with the slogan and hashtags at http://www.CleanHandsSaveLives.org

Calling for actions and reaching out to a range of stakeholder groups for advocacy support (Table, in a supplement) through a diversity of media including newsletters, social media, webinars, and diffusion through a variety of networks allows for campaign success year after year. Success means not only awareness of the role of hand hygiene in preventing sepsis but also health workers’ longer-term behaviour change. As of February 2018, over 20,000 hospitals and health facilities from 179 UN Member States (countries and regions) demonstrated their commitment to hand hygiene action by signing up for the campaign. WHO invites more health facilities to become part of this community by registering at http://www.who.int/infection-prevention/campaigns/clean-hands/register/en/. This is only one marker of campaign success. Use of WHO hand hygiene improvement tools, which include a tested toolkit as well as yearly new campaign materials are also markers of the campaign’s success. A dedicated 2018 campaign web page progressively features new resources leading up to 5 May (http://www.who.int/infection-prevention/campaigns/clean-hands/en/). WHO also aims to acknowledge those who make efforts to support the campaign and posts links to websites that feature and promote the campaign and names supporter’s social media feeds (for 2017, see http://www.who.int/infection-prevention/campaigns/clean-hands/SLCYH_support/en/).

This year is another turning point in extending the reach of the SAVE LIVES: Clean Your Hands global campaign through collaborations with communities working on prevention, diagnosis, and management of sepsis. HAI, AMR and sepsis are universal and timely hand hygiene can reduce their burden and eventual spread. On and around 5 May 2018, the focus for all supporters of infection prevention should be “It’s in your hands – prevent sepsis in health care”.

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 22 kb)