Humanitarian emergencies, an opportunity for fresh start in providing sustainable, long-term mental health services

16 August 2013 | Geneva - Humanitarian agencies work hard to help people with their mental health and psychosocial needs in the aftermath of emergencies, but too often opportunities are missed to strengthen mental health systems for the long-term, according to a new World Health Organization (WHO) report, "Building back better: Sustainable mental health care after emergencies" released for World Humanitarian Day (August 19).

“In spite of their tragic nature, emergency situations are opportunities to improve the lives of large numbers of people through improving mental health services,” says Dr Bruce Aylward, WHO’s Assistant Director-General overseeing the Organization’s work in humanitarian emergencies. "We can do better for emergency-affected populations by working with the government on sustainable mental health care from the outset.”

The report provides guidance for strengthening mental health systems after emergencies and examples from Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, Somalia, Sri Lanka, Timor-Leste, and West Bank and Gaza Strip.

Contributors from each area report not only their major achievements, but also their most difficult challenges and how they were overcome. Key overlapping practices emerging from these experiences are summarized.

Findings from the report include:

• Indonesia (Aceh): Like many provinces in Indonesia, Aceh had only institution-based care before the tsunami of 2004. Today, most districts have primary mental health services supported by secondary care at district general hospitals.
• Iraq: Since 2004, significant progress has been made toward the creation of a comprehensive mental health system. More than 50% of general practitioners have received mental health training.
• Kosovo: Starting from a hospital-based model of care in 1999 after the conflict, a system of community-based mental health care is now available.
• Sri Lanka: Since the 2004 tsunami, a new national mental health policy has guided reform, which now extends to most parts of the country. Several new cadres of community-based mental health workers have been developed.
• Timor-Leste: Building from a complete absence of mental health services in 1999, the country today has a comprehensive community-based mental health system.

The possibilities presented by emergency situations are significant because major gaps remain worldwide in the realization of comprehensive, community-based mental health care.

“The current situation is alarming,” says Dr Shekhar Saxena, WHO Director for Mental Health. “Health systems have not yet adequately responded to the burden of mental disorders. We know that the vast majority of people with severe mental disorders receive no treatment whatsoever in low-income and middle-income countries.”

Transforming the mental health care systems in turn would improve the well-being, functioning, and resilience of individuals, societies, and countries recovering from emergencies, the report notes.

By releasing this report, WHO aims to help guide policymakers to reform their mental health systems, especially those which may be susceptible to future emergencies. Already in 2013, the world has witnessed numerous emergency situations, from the crisis in Syria and neighbouring countries to heavy fighting in Mali and the Central African Republic, major flooding in parts of the Americas, Africa, and Asia, and others.

For more information please contact:

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here

WHO hand hygiene strategy feasible and sustainable for health-care settings around the world

23 August 2013 | Geneva - WHO’s strategy for improving hand hygiene is easy for health-care workers to practise, according to a new study published today in "Lancet Infectious Diseases". Health care-associated infections are a major threat to patient safety worldwide and transmission in these settings is mainly from the hands of health-care workers.

Strategy shown to increase hand hygiene compliance

In six sites in Costa Rica, Italy, Mali, Pakistan and the Kingdom of Saudi Arabia, the research team implemented WHO’s strategy in 55 departments in 43 hospitals. During the two-year period between December 2006 and December 2008, compliance with best practices increased from 51% before the study to 67% and infrastructures and staff knowledge were also significantly improved in all sites. The study also demonstrated that this change in practices and safety culture was sustained up until at least two years since the conclusion of the testing phase.

“The WHO strategy was based on a multimodal approach previously proven to have a dramatic effect in reducing the number of health-care related infections at the WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, but now for the first time we have evidence of its feasibility and successful effect to improve hand hygiene in a variety of different geographical and income settings, with even greater impact in low-income and middle-income countries than in high-income countries,” said Dr Benedetta Allegranzi, Programme Manager, Clean Care is Safer Care, WHO Patient Safety Programme and lead author of the paper.

Hand contact the leading cause of infections

Health care-associated infections usually occur when germs are transferred by health-care providers’ hands touching the patient. The most common infections are urinary tract and surgical site infections, pneumonia and infections of the bloodstream and are often caused by multi-drug resistant germs such as methicillin-resistant S. aureus (MRSA). Of every 100 hospitalized patients, at least seven in developed and 10 in developing countries will acquire a health care-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100. Practising good hand hygiene during health care reduces the risk of these infections and the spread of antimicrobial resistance.

“As resistance to antibiotics and other key medicines becomes more common, it is more essential than ever to reduce the number of avoidable infections in hospital,” said Edward Kelley, Coordinator of the Patient Safety Programme at WHO. “The best way of reducing the number of people contracting antimicrobial resistant infections is to protect them from cross-transmission of germs through health-care workers’ hands in the first place.”

Infection prevention and control is one of the key policy pillars identified by WHO to combat the growing problem of antimicrobial resistance. The other pillars include: appropriate national policies and plans, improving surveillance of these resistant pathogens; uninterrupted access to good quality essential medicines; proper use of medicine, and more research and development of new treatments.

The WHO hand-hygiene compliance strategy

WHO’s hand-hygiene compliance strategy consists of five main components:

• ensuring health-care workers have access to alcohol-based handrub at the point of patient care;
• training and education of health-care workers on the most important times in patient care for hand hygiene;
• monitoring and feedback on compliance;
• visual reminders at the point of care in the workplace;
• creation of a culture of attention to patient and health-care worker safety within the institution.

A simple, cost-effective intervention

“Sometimes the simplest and most cost-effective interventions can have the greatest impact,” said Sir Liam Donaldson, WHO Envoy for Patient Safety. “We now have the effective methods to eliminate millions of avoidable sicknesses and death, and reduce the growing problem of antimicrobial resistant infections.”

According to the WHO Clean Care is Safer Care Programme, when working with patients, hand hygiene should be performed at 5 key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:

• before touching a patient;
• before clean and aseptic procedures (e.g., inserting devices such as catheters);
• after contact with body fluids;
• after touching a patient;
• after touching patient surroundings.

“WHO’s hand-hygiene improvement strategy is recommended by both the US and European Centres for Disease Control, the Joint Commission International and accredited bodies, and almost all professional organizations worldwide,” said Professor Didier Pittet, Director, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and senior author of the paper.

The strategy has been implemented so far in more than 15 700 health-care settings in 168 countries worldwide and more than 50 governments have based their national hand hygiene campaigns on it. The current study validates its use as a universal gold standard of patient care.

For more information please contact:

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here

Humanitarian emergencies, an opportunity for fresh start in providing sustainable, long-term mental health services

16 August 2013 | Geneva - Humanitarian agencies work hard to help people with their mental health and psychosocial needs in the aftermath of emergencies, but too often opportunities are missed to strengthen mental health systems for the long-term, according to a new World Health Organization (WHO) report, "Building back better: Sustainable mental health care after emergencies" released for World Humanitarian Day (August 19).

“In spite of their tragic nature, emergency situations are opportunities to improve the lives of large numbers of people through improving mental health services,” says Dr Bruce Aylward, WHO’s Assistant Director-General overseeing the Organization’s work in humanitarian emergencies. "We can do better for emergency-affected populations by working with the government on sustainable mental health care from the outset.”

The report provides guidance for strengthening mental health systems after emergencies and examples from Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, Somalia, Sri Lanka, Timor-Leste, and West Bank and Gaza Strip.

Contributors from each area report not only their major achievements, but also their most difficult challenges and how they were overcome. Key overlapping practices emerging from these experiences are summarized.

Indonesia (Aceh): Like many provinces in Indonesia, Aceh had only institution-based care before the tsunami of 2004. Today, most districts have primary mental health services supported by secondary care at district general hospitals.Iraq: Since 2004, significant progress has been made toward the creation of a comprehensive mental health system. More than 50% of general practitioners have received mental health training.Kosovo: Starting from a hospital-based model of care in 1999 after the conflict, a system of community-based mental health care is now available. Sri Lanka: Since the 2004 tsunami, a new national mental health policy has guided reform, which now extends to most parts of the country. Several new cadres of community-based mental health workers have been developed. Timor-Leste: Building from a complete absence of mental health services in 1999, the country today has a comprehensive community-based mental health system.

The possibilities presented by emergency situations are significant because major gaps remain worldwide in the realization of comprehensive, community-based mental health care.

“The current situation is alarming,” says Dr Shekhar Saxena, WHO Director for Mental Health. “Health systems have not yet adequately responded to the burden of mental disorders. We know that the vast majority of people with severe mental disorders receive no treatment whatsoever in low-income and middle-income countries.”

Transforming the mental health care systems in turn would improve the well-being, functioning, and resilience of individuals, societies, and countries recovering from emergencies, the report notes.

By releasing this report, WHO aims to help guide policymakers to reform their mental health systems, especially those which may be susceptible to future emergencies. Already in 2013, the world has witnessed numerous emergency situations, from the crisis in Syria and neighbouring countries to heavy fighting in Mali and the Central African Republic, major flooding in parts of the Americas, Africa, and Asia, and others.

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here

WHO hand hygiene strategy feasible and sustainable for health-care settings around the world

23 August 2013 | Geneva - WHO’s strategy for improving hand hygiene is easy for health-care workers to practise, according to a new study published today in "Lancet Infectious Diseases". Health care-associated infections are a major threat to patient safety worldwide and transmission in these settings is mainly from the hands of health-care workers.

In six sites in Costa Rica, Italy, Mali, Pakistan and the Kingdom of Saudi Arabia, the research team implemented WHO’s strategy in 55 departments in 43 hospitals. During the two-year period between December 2006 and December 2008, compliance with best practices increased from 51% before the study to 67% and infrastructures and staff knowledge were also significantly improved in all sites. The study also demonstrated that this change in practices and safety culture was sustained up until at least two years since the conclusion of the testing phase.

“The WHO strategy was based on a multimodal approach previously proven to have a dramatic effect in reducing the number of health-care related infections at the WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, but now for the first time we have evidence of its feasibility and successful effect to improve hand hygiene in a variety of different geographical and income settings, with even greater impact in low-income and middle-income countries than in high-income countries,” said Dr Benedetta Allegranzi, Programme Manager, Clean Care is Safer Care, WHO Patient Safety Programme and lead author of the paper.

Health care-associated infections usually occur when germs are transferred by health-care providers’ hands touching the patient. The most common infections are urinary tract and surgical site infections, pneumonia and infections of the bloodstream and are often caused by multi-drug resistant germs such as methicillin-resistant S. aureus (MRSA). Of every 100 hospitalized patients, at least seven in developed and 10 in developing countries will acquire a health care-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100. Practising good hand hygiene during health care reduces the risk of these infections and the spread of antimicrobial resistance.

“As resistance to antibiotics and other key medicines becomes more common, it is more essential than ever to reduce the number of avoidable infections in hospital,” said Edward Kelley, Coordinator of the Patient Safety Programme at WHO. “The best way of reducing the number of people contracting antimicrobial resistant infections is to protect them from cross-transmission of germs through health-care workers’ hands in the first place.”

Infection prevention and control is one of the key policy pillars identified by WHO to combat the growing problem of antimicrobial resistance. The other pillars include: appropriate national policies and plans, improving surveillance of these resistant pathogens; uninterrupted access to good quality essential medicines; proper use of medicine, and more research and development of new treatments.

WHO’s hand-hygiene compliance strategy consists of five main components:

ensuring health-care workers have access to alcohol-based handrub at the point of patient care;training and education of health-care workers on the most important times in patient care for hand hygiene;monitoring and feedback on compliance;visual reminders at the point of care in the workplace;creation of a culture of attention to patient and health-care worker safety within the institution.

“Sometimes the simplest and most cost-effective interventions can have the greatest impact,” said Sir Liam Donaldson, WHO Envoy for Patient Safety. “We now have the effective methods to eliminate millions of avoidable sicknesses and death, and reduce the growing problem of antimicrobial resistant infections.”

According to the WHO Clean Care is Safer Care Programme, when working with patients, hand hygiene should be performed at 5 key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:

before touching a patient;before clean and aseptic procedures (e.g., inserting devices such as catheters);after contact with body fluids;after touching a patient;after touching patient surroundings.

“WHO’s hand-hygiene improvement strategy is recommended by both the US and European Centres for Disease Control, the Joint Commission International and accredited bodies, and almost all professional organizations worldwide,” said Professor Didier Pittet, Director, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and senior author of the paper.

The strategy has been implemented so far in more than 15 700 health-care settings in 168 countries worldwide and more than 50 governments have based their national hand hygiene campaigns on it. The current study validates its use as a universal gold standard of patient care.

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

View the original article here