A global view

In the containment of antimicrobial resistant infections good hygiene, sanitation and handwashing cannot be overlooked, said Prof Antonio Carlos Pignatari, Professor of Infectious Diseases and Director of the Special Clinical Microbiology Laboratory of
the Division of Infectious Diseases, Federal University of São Paulo, Brazil.

Good hygiene is essential for infection control in the community and hospital settings for decreasing the transmission rates of pathogens including multidrug resistant bacteria between people and patients. Many respiratory viral and bacterial infections are transmitted via contact, droplets or aerosols. Therefore, the use of surgical masks if a patient presents symptoms of respiratory tract infection (RTI) and avoiding physical contact is recommended. However, it is difficult to implement the routine use of masks in the community, whereas at the hospital this can work very well. Correct handwashing with water and soap is very effective in the prevention of transmission from person to person, particularly for gastrointestinal infections and also community acquired RTIs. The importance of handwashing is underlined by initiatives from both the WHO and the Global Hygiene Council who have worked to convey the information that if you wash your hands, you can save lives.

Good hygiene can contribute to the prevention of infections, particularly for children and in developing countries with poor sanitation. CleanHandsNet, from the WHO, is a campaignled informal network working to embed hand hygiene promotional campaigns across the globe. Currently, there are 48 participating countries and Prof Pignatari stressed the importance of additional countries joining and broadening the CleanHandsNet network.

Changing gears, Prof Pignatari also highlighted the impact broad-spectrum antibiotics have on the gut microbiome. Scientific research has shown that broad-spectrum antibiotics will indiscriminately kill both the “good” and “bad” bacteria living in the gut and that the use of just one antibiotic will likely permanently alter the microbiome. If the majority of gut microflora are wiped out through the use of an antibiotic, this can create perfect conditions for some particularly nasty bacteria such as Clostridium difficile to proliferate. Colonisation with C. difficile is not typically a problem, however the overgrowth of this bacteria in the absence of other gut microflora can cause them to produce cytopathic toxins and may lead to severe complications such as toxic megacolon. These complications are largely preventable through the appropriate use of antibiotics.