Save the Children medical staff urgently prepare treatment for Sohai*, two, in the inpatient ward at Save the Children’s primary healthcare centre (PHCC) in Cox’s Bazar, Bangladesh.

BASICS: This is the Moment to Unleash a Solution to Healthcare-Associated Infections and Antimicrobial Resistance

BASICS (Bold Action to Stop Infections in Clinical Settings) will launch at a propitious moment in a growing global movement to reduce the number of healthcare-associated infections (HAIs) and to tackle antimicrobial resistance (AMR).

These extraordinary threats to the delivery of safe, clean and effective healthcare are already responsible for millions of deaths and debilitating new infections worldwide annually, tremendous cost burdens to families and health systems and an over-dependence on antibiotics as a stopgap against larger structural issues such as fractured health systems, inequality and productivity demands.

Here’s why introducing BASICS’ low-cost, evidence-based solution in healthcare systems now is crucial:

  • An estimated 46 million people acquire an HAI annually while seeking treatment. Many HAIs are caused by dirty medical instruments, improperly cleaned surfaces or health staff who can’t or don’t wash their hands. Research has proven that proper hand hygiene reduces infection risks by 50% and proper disinfection is associated with risk reductions up to 80%.
  • Disease outbreaks like the ongoing coronavirus outbreak (Covid-19) pose an extreme risk to healthcare workers. In China, as of February 11, an estimated one-third of reported infections had occurred among healthcare workers.[1]
  • Every use of an antibiotic, whether appropriate or inappropriate, gives resistant bacteria an advantage and accelerates the development of resistance. An estimated 700,000 people die annually of an AMR infection. Around 200,000 are newborns, whose infections simply do not respond to drugs.

Two researchers at the London School of Hygiene and Tropical Medicine have conducted extensive research in East Africa on the roles that antibiotics play in low- and middle-income countries beyond their immediate curative effects. Their findings suggest that antibiotics are often used as a “quick fix,” papering over underlying structural issues related to substandard health care, marginality, inequality and violence.

Antibiotics have also become a “quick fix” for the demand for ever-increasing productivity among people, animals and crops.

The researchers stress that it’s vital to understand the extent to which daily life has become intertwined with antibiotic use in order to also understand the consequences of resistance and the best ways to reduce the threat of AMR. Recognizing many of our AMR solutions as “quick fixes” allows us to raise our line of sight to the longer term, generating more systemic solutions that have a greater chance of achieving equitable impact.

BASICS projects a 50% reduction in HAIs in participating healthcare facilities based on robust evidence linking improvements in hygiene and cleanliness with improved patient outcomes.[2-5] These improvements will also significantly reduce the use of antibiotics – and, in turn, dramatically curb the development of new AMR pathogens.

Events like the ongoing COVID-19 pandemic and recent Ebola outbreaks highlight the ever-present infection risks faced by patients and their healthcare providers. In China, it’s been estimated that one-third of reported COVID-19 infections occurred among healthcare workers. [1] During the Ebola outbreak in West Africa, it is estimated that healthcare workers were 32 times more likely to be infected with Ebola compared to adults from the general population. These events underscore the need for countries around the world to achieve and maintain basic hygiene, cleaning and infection prevention standards as a cornerstone to outbreak unpreparedness and response systems.

Acknowledgements: Professor Wendy Graham and Professor Clare Chandler from the Londons School of Hygiene and Tropical Medicine – a BASICS partner – provided comments and review.

[1] Brown, Troy. “Healthcare Workers in China Hit Hard by Novel Coronavirus.” Medscape, 11 Feb. 2020,
[2] P.C. Carling et al., “Improving environmental hygiene in 27…,” Crit. Care Med., vol. 38, no. 4, Apr. 2010.
[3] R. Orenstein et al., “A targeted strategy to wipe out Clostridium…,” Infect. Control Hosp. Epidemiol., vol. 32, no. 11, Nov. 2011.
[4] S. J. Dancer et al., “Measuring the effect of enhanced cleaning…” BMC Med., vol. 7, p. 28, Jun. 2009.
[5] B. Allegranzi et al., “A multimodal infection control and patient safety…,” Lancet Infect. Dis., vol. 18, no. 5, May 2018.


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