Poor hand hygiene – a leading factor for healthcare-associated infections, warns BAPZG

Poor hand hygiene is among the primary causes of healthcare-associated infections (HAIs), which pose a serious risk to patients, medical professionals, and visitors to healthcare facilities. Addressing this issue requires comprehensive measures, including the rational use of antibiotics, changes in the behavior of staff and the public, as well as continuous training, according to the Bulgarian Association of Health Care Professionals (BAPZG).

In this regard, BAPZG, in collaboration with the Bulgarian “One Health” Association, is launching a campaign to enhance the knowledge and competencies of healthcare professionals in the field of HAI prevention. The next training session within the initiative will take place on November 24 in Sofia.

Healthcare-associated infections are defined as infections that were not present upon the patient’s admission to the healthcare facility but occurred during their stay or after discharge. They affect not only patients but also medical and non-medical staff, students, and visitors.

According to World Health Organization data, over 7% of hospitalized patients in developed countries and over 10% in developing nations develop healthcare-associated infections. In Europe, according to an ECDC study for the 2022–2023 period, 8% of hospitalized patients, or approximately 4.8 million people, are affected by HAIs. The most common are respiratory infections, followed by urinary tract infections, surgical site infections, sepsis, and gastrointestinal infections.

For Bulgaria, data was collected from 23 healthcare facilities, where nearly 4,000 hospitalizations were monitored. Among them, 4% of patients had HAIs—a value lower than the European average. At the same time, however, the percentage of infections of unknown origin in our country reaches 29%, which, according to BAPZG, calls into question the reliability of reporting and indicates a need for improving monitoring and control systems.

The primary mode of transmission for these infections is the hands of medical personnel. Microorganisms can survive on hands and various surfaces for minutes to several hours, and for some pathogens, this period can exceed 3–4 hours. ECDC data shows that the use of alcohol-based disinfectants in our country is significantly lower than the European average, which is an indicator of gaps in hand hygiene within healthcare facilities.

Another serious issue contributing to the complexity of the situation is antimicrobial resistance. The irrational use of antibiotics leads to a decrease in their effectiveness and an increase in mortality from resistant infections. Global data indicates that mortality related to antimicrobial resistance is rising, with Bulgaria reporting significantly higher resistance in certain bacteria compared to average European values.

According to BAPZG, reducing HAIs and antimicrobial resistance requires a comprehensive approach, including the introduction and strict implementation of infection prevention and control programs, staff training, effective surveillance and realistic reporting of cases, improvement of hand hygiene, optimization of antibiotic policy, and increasing awareness and vaccination coverage among the population.

BAPZG and the Bulgarian “One Health” Association state that they will continue their educational initiatives and call for targeted policies from institutions and all participants in the healthcare system to limit one of the most serious threats to patient safety.