Hospital-acquired Infections — A Clean Bill of Health?

This yearmarks the 150th anniversary of theuntimely death of Ignaz Semmelweis. His namemight be unfamiliar to many of you, but he was a pioneer of antiseptic policy whose recommendations revolutionized healthcare by limiting the spread of hospital-acquired infections (HAIs). While working as a physician in Viennese obstetric clinics, Semmelweis observed that the incidence of puerperal fever (caused by a bacterial infection of the female reproductive tract) could be drastically reduced when doctors washed their hands in chlorinated lime. Helped by Pasteur's germ theory, which offered a scientific explanation to Semmelweis' observational evidence, the practice of handwashing in hospitals eventually earned widespread acceptance. Despite this preventativemeasure, HAIs currently affect approximately 10% of patients throughout the USA and Europe, causing respiratory, gastrointestinal, urinary tract, surgical site and blood-borne infections, complicating recovery and contributing to patient mortality. Prolonged hospital stays andadditional therapeutic interventions, oftenusing antibiotics, add to the financial burden on already strained healthcare systems. Complicating matters further, the drugs that have been routinely used to treat many of these infections are losing their potency as bacteria develop antibiotic resistance. The emergence of ‘superbugs’ that are either intrinsically resistant, or acquire resistance by the transfer of genetic material, is driven by the selection pressure imposed by antibiotic use, allowing resistant bacteria to flourish at the expense of their sensitive counterparts. Compounding this situation is the fact that as bacteria evolve mechanisms to bypass previously effective antibiotics, there is a paucity of new antibiotics in development. This disparity threatens to revert healthcare to a pre-antibiotic era, leading to a dire situation with significant public health ramifications. Recently, theWorld Health Organization published “Worldwide country situation analysis: Response to antimicrobial resistance”, highlighting the current situation and outlining how best to address the issue on a global scale. On May 25, 2015, delegates at the World Health Assembly endorsed this global action plan, urgingmember states tomake it a national priority andmobilize additional resources for its implementation. Progress will be reported to the Health Assembly in 2017. Many factors have contributed to the escalation of antibiotic resistance. From amedical practitioner's standpoint, inappropriate prescription of antibiotics and complacent use of wide-spectrum antibiotics have exerted selection pressure on a similarly broad group of microbes. The general public plays a part when demanding antibiotics from their doctors for self-limiting viral infections, failing to complete a full course of antibiotics, or by propagating the black-market sales of antibiotics— an immediate problem in developing countries. Crucially, farmers use antibiotics as prophylaxis against infection and as a means to promote the growth of their animals (although the latter practice is banned in the EU), which expedites widespread resistance. Governments have, until recently, seemed ill-informed of the impending danger, or chose