Executive Summary:

Hundreds of millions of people are affected annually by infections associated with healthcare, leading to high mortality and illness rates. The risks of healthcare-associated infections (HAIs) are 2-3 times higher in low-income countries and account for 75% of neonatal deaths in sub-Saharan Africa and parts of Asia. HAIs lead to tremendous healthcare costs, and the use of antibiotics contributes to the growing threat of antimicrobial resistance. Preventing HAIs requires minimal budget or changes in healthcare practices. Save the Children, WaterAid, London School of Hygiene and Tropical Medicine, and Kinnos will integrate evidence-based solutions to prevent HAIs. Bold Action to Stop Infections in Clinical Settings (BASICS) will launch in four demonstration countries. In five years, it will prevent 105,000 infections, save $12 million in health costs and avoid 1.4 million patient stay days. BASICS is designed to scale globally to prevent HAIs and save millions of lives.

Challenge Statement

Infection prevention in healthcare settings is one of the most urgent global health priorities of our time. Contaminated hands, surfaces and medical instruments commonly cause infections, putting mothers, newborns and other vulnerable patients at heightened risk. Two recent studies found that infections accounted for 919,000 newborn deaths and 28,000 maternal deaths each year. The threat is increasing as more people in lower-resourced countries seek healthcare and high antibiotic use contributes to the alarming increase in antimicrobial resistance. Seventy percent of newborn infections are untreatable in low-resource settings, primarily due to drug resistance. Studies also show that simple handwashing and thorough cleaning can significantly reduce infections. Unfortunately, healthcare staff often lack control over their work environment and work without proper cleaning materials, training, motivation and full awareness of risks. Lack of data and monitoring systems lead to poor individual and collective accountability. A sustained and successful solution embeds system-wide changes that simultaneously address all contributing factors to ensure healthcare workers are empowered and encouraged to make effective infection prevention practices part of a daily routine. Such a solution must ensure that adequate WASH infrastructure, effective training platforms, reliable supply chains and effective monitoring and accountability systems are all integrated into national healthcare structures to achieve independent and sustained government ownership. This ambitious but achievable solution uses the levers of better hygiene and cleanliness to bring about improved health outcomes at scale for all patients, but concentrates on high-risk wards (labor and delivery, postnatal, intensive care and surgical).

Solution Overview

Achieving lasting reductions in HAIs requires system-wide change. BASICS addresses all facets of infection prevention in four countries to establish a fully equipped healthcare workforce that can sustainably implement an effective infection prevention program. Working in partnership with national and local governments, BASICS will create and measure improvements in the availability of WASH services and infection prevention supplies, healthcare facility cleanliness, behaviors compliance (staff, patients, visitors) and patient health. BASICS will have impacts across individual facilities and national health systems, but we will focus monitoring efforts in delivery and postnatal care wards, which serve as indicator wards. We will measure institutionalization through advancements in public policy and through funding and resource allocation improvements. These improvements will result in a 50% reduction in HAIs, along with savings in healthcare costs for families and the health system, and reduced patient stay times, antibiotic use and healthcare staff time. By demonstrating these savings, BASICS will establish a cost-effective roadmap for ministries of health to expand and sustain quality service across entire health systems. We will show success across contexts and geographies, demonstrating that broad global impact is not only possible, but within reach. While all patient populations will benefit, our interventions will primarily serve populations that depend on public healthcare – which typically include families of low economic status, excluded populations and those living in rural or peri-urban settings. Vulnerable patient populations, such as pregnant women, new mothers, newborns, post-surgical and ICU patients and the elderly will be primary beneficiaries.