5 June 2018, Budapest, Hungary

1. The impact of
Ignac Semmelweis on
global health priorities
Dr Zsuzsanna Jakab
WHO Regional Director for Europe
5 June 2018, Budapest, Hungary

2. The man who saved more lives than any other
physician in the history of humanity combined
• Dr Ignac Semmelweis was a Hungarian
obstetrician working in the 1800s.
• He practiced before Louis Pasteur came
up with his germ theory and Joseph
Lister with antiseptic surgery.
• Despite being shunned, ignored and
ridiculed, he continued to promote his
ideas until his dying day.
• He is an inspiration to all who continue
to question the status quo.

3. 1840s: General Hospital of Vienna, Austria
The hospital was divided
into 2 clinics, alternating
admissions every 24
hours:
• first clinic: doctors and
medical students;
• second clinic: midwives. 0
2
4
6
8
10
12
14
16
Maternalmortality,1842
First Clinic Second
Clinic

4. Florence Nightingale

5. The intervention:
hand scrub with chlorinated lime solution
Hand hygiene basin at the Lying-in Women’s Hospital in Vienna, Austria, 1847.

6. How did Semmelweis impact the
global health priorities of today?

7. Some global health priorities
of the 21st century
• Health care-associated infections (HAIs)
• Antimicrobial resistance (AMR)
• Hand hygiene
• Clean water, sanitation
• Maternal, infant and under-5 mortality
• Early childhood development
• Broader health priorities linked to development:
health status, equity, universal health coverage

8. The global and European burden of HAIs
is unacceptable
Global burden
• 7% of patients in developed and 10% in developing countries will
acquire at least one HAI on average.
• Death from HAI occurs in about 10% of affected patients.
WHO European Region burden
• Over 4 million patients are affected by 4.5 million HAI episodes
annually.
• This leads to 16 million extra days of hospital stay and 37 000 attributable
deaths. It contributes to an additional 110 000 deaths per year.
Source: Report on the endemic burden of health care-associated infection worldwide. Geneva: World Health Organization; 2011.

9. Impact of HAI in Europe
• The financial impact is huge!
• 16 million extra days of hospital stay
• 37 000 attributable deaths
• Contribution to an additional 110 000 deaths
• Approximately €7 billion (direct costs only)
Source: European Centre for Disease Prevention and Control, 2013; WHO, 2010.

10. Effective infection prevention
and control (IPC) programmes
lead to a more than 30%
reduction in HAI rates.
Improving hand hygiene practices
reduces pathogen transmission
in health care by 50%.
Surveillance contributes to a
25–57% reduction in HAIs.

11. AMR is related to use of antibiotics
and to IPC practices
• IPC action is a key strategic
objective of the European (2011)
and global (2015) AMR action
plans.
• Effective IPC is a key strategy to
address public health threats of
international concern, such as
AMR.
o International Health Regulations
(2005)

12. Every infection prevented
is an antibiotic treatment avoided
• Effective IPC in health-
care settings can avoid
more than 1 in 3 HAIs.
• This means reducing
the need for antibiotics,
and in turn AMR.

13. Hand hygiene compliance is 40% overall
– Intensive care units: 30%–40%
– Other settings: 50%–60%
– Physicians: 32%
– Nurses: 48%
– Before patient contact: 21%
– After patient contact: 47%
The Ebola epidemic provided a
number of lessons regarding HAIs..
Source: Infect Control Hosp Epidemiol. 2010;(31)3:283–94.

14. Fast forward to 2018:
hand hygiene and sepsis
• HAIs are a risk factor for developing
sepsis, but can be prevented.
– Effective hand hygiene plays a key role.
• WHA resolution A70/13: Improving the
prevention, diagnosis and clinical
management of sepsis
• Sepsis is the most preventable cause
of death and disability in Europe.
– To stop sepsis, prevent infection. Take 5
moments to clean your hands to prevent
sepsis in health care.

15. IPC contributes to
achieving global health priorities

16. Water, sanitation and hygiene deserve a high
level of attention in European schools
• Most countries have standards in
place, but full implementation and
improvement of water and
sanitation in schools is
impeded.
• The proportion of populations with
improved sanitation facilities stands
at 92.9% in Europe.
Source: The situation of water, sanitation and hygiene in schools in the pan-European region.
Copenhagen: WHO Regional Office for Europe; 2016.

17. Maternal, infant and child mortality in Europe
• Maternal mortality: 11 per 100 000 live births
• Infant mortality: 6.7 per 1000 live births
• Children vaccinated against measles and rubella: 94%
• Populations with improved sanitation facilities: 92.9%
18

18. Trends in maternal deaths per 100 000 live births
in the WHO European Region, 2000–2014

19. HEALTH
programme
EMERGENCIES
Under-5 mortality still high in some
countries

20. 5 targets for early childhood development
Goal 1, target 1.2:
By 2030, reduce at least by half the proportion of men, women and
children of all ages living in poverty in all its dimensions according to
national definitions.
Goal 2, target 2.2:
By 2030, end hunger and ensure access by all people, in particular
the poor and people in vulnerable situations, including infants, to
safe, nutritious and sufficient food all year round.
Goal 3, target 3.2:
By 2030, end preventable deaths of newborns and children under 5
years of age, with all countries aiming to reduce neonatal mortality
to at least as low as 12 per 1000 live births and under-5 mortality to
at least as low as 25 per 1000 live births.
Goal 4, target 4.2:
By 2030, ensure that all girls and boys have access to quality early
childhood development, care and pre-primary education so that they
are ready for primary education.
Goal 6 : Clean water and sanitation
Goal 16, target 16.2:
By 2030, end abuse, exploitation, trafficking and all forms of
violence against and torture of children.
Sustainable Development Goals and Global Strategy targets

21. Health at the centre of development
22

22. Moving towards joint commitments
1. Strengthen governance for health
2. Leave no one behind
3. Strengthen health systems, primary health care,
public health and financial protection to achieve
universal health coverage
4. Address all the determinants of health and invest in
prevention and health promotion, and health literacy
5. Engage communities, places and settings to
strengthen health and well-being
6. Strengthen emergency preparedness and response
23

23. Discrepancies remain

24. Sales
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
“… all people and communities receive the quality services
they need, including health promotion, disease prevention,
treatment and rehabilitiation, without financial hardship.”
Universal health coverage
25
Health systems for universal
health coverage

25. “It is unacceptable that
people become poor as a
result of ill health.”
– The Tallinn Charter
26

26. Out-of-pocket payment share of total health spending
is high in many countries
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
Out-of-pocketpaymentas%oftotalhealthspending
DANGER ZONE: > 30%
WARNING
SAFE: < 15% with pro-poor policies
Source: WHO data for 2014
High- and middle-income countries in the WHO European Region
27

27. 28

29. https://youtu.be/YDOkkoqi-70
Transforming and retaining
Thank you