MANIFESTO for patient safety




Improving patient safety in today’s hospitals worldwide requires a systematic approach to combat antimicrobial resistance (AMR) and to prevent healthcare-associated infections (HAIs). The two go hand-in-hand.

AMR has emerged as one of the principal public health problems of the 21st century. This has resulted in a public health crisis of international concern, which threatens the practice of modern medicine, animal health and food security. The threat of AMR represents arguably the greatest patient safety challenge of our time. It has been widely reported that the world is on the cusp of a ‘post-antibiotic era’, with the growth in multidrug resistant bacteria raising the prospect that modern medicine will be increasingly unable to treat what are currently considered to be routine infections. AMR is a natural phenomenon that occurs as microbes evolve. However, human activities have accelerated the pace at which bacteria develop and disseminate resistance. The burden of AMR is difficult to quantify in some regions of the world because enhanced surveillance requires personnel, equipment and financial resources that are not always available. However, the worldwide impact of AMR is very significant in terms of economic and patient outcomes; due to untreatable infections or those requiring antibiotics of last resort leading to increased length of hospital stay, morbidity, mortality and treatment cost. Addressing the rising threat of AMR requires a holistic and multisectoral approach – referred to as One Health – because antibiotics used to treat various infectious diseases in animals may be the same or similar to those used for humans. Resistant bacteria arising in humans, animals or the environment may spread from one to the other, and from one country to another. AMR does not recognize geographic or human–animal borders. Although the current magnitude of the problem, healthcare workers play a central role in preventing the emergence and spread of AMR.

Antibiotics can be life-saving when treating bacterial infections but are often used inappropriately, specifically when unnecessary or when administered for excessive durations or without consideration of pharmacokinetic principles. Although the phenomenon of AMR can be attributed to many factors, there is a well-established relationship between antibiotic prescribing practices and the emergence of AMR. Of significant importance in limiting antibiotic exposure are efforts to prevent HAIs. Prevention of HAIs can limit significantly the need for antibiotic therapy. It is well known that HAIs show higher resistance rates to antibiotics than community-acquired infections. European Centre for Disease Prevention and Control (ECDC) estimated that approximately 4 million patients acquire a HAI each year in all EU Member States and that approximately 37,000 deaths directly result from these infections. A large proportion of these deaths are due to the most common multidrug-resistant bacteria, i.e. Staphylococcus aureus, Enterobacteriaceae, Pseudomonas aeruginosa.

Patients with medical devices (central lines, urinary catheters, ventilators) or who undergo surgical procedures are at risk of acquiring HAIs. HAIs result in significant patient illnesses and deaths (morbidity and mortality), prolong the duration of hospital stays, and necessitate additional diagnostic and therapeutic interventions, which generate added costs to those already incurred by the patient’s underlying disease. However, the perception of the phenomenon is not yet sufficiently high both among healthcare workers, thus resulting in a low level of intervention request and relative adequate responses. HAIs are considered an undesirable outcome, and as many are preventable, they are considered an indicator of the quality of patient care, an adverse event, and a patient safety issue. Surgical site infections (SSIs) are the most common HAIs among surgical patients. It is obviously important to improve patient safety by reducing the occurrence of surgical site infections. Both the WHO and the Centers for Disease Control and Prevention (CDC) have published guidelines for the prevention of surgical site infections. Despite clear evidence and guidelines to direct SSIs prevention strategies, compliance is uniformly poor and major difficulties arise when introducing evidence and clinical guidelines into routine daily practice. High rates of inappropriate infection prevention and control practices in surgery continue to be reported.

Although most physicians are aware of the problem of AMR, most underestimate this problem in their own hospital where inappropriate use of antibiotics, as well as poor prevention and control of infections, are contributing to its development.

Join us now as we embark on this global cause, by pledging support for this manifesto and accepting the responsibility that patient safety is a fundamental part of our work.

 All health workers in the world can contribute by:

  • Following international and locally-developed customized guidelines and clinical pathways,
  • Developing a multidisciplinary, interdisciplinary and collaborative patient management,
  • Supporting and enhancing infection prevention and control including correct hand hygiene protocols,
  • Supporting and enhancing surveillance of healthcare-associated infections,
  • Prescribing and dispensing antibiotics only when they are truly required,
  • Identifying and controlling the source of infection when it is needed,
  • Prescribe appropriate antibiotics(s) with adequate dosages and for adequate duration,
  • Educating staff to improve infection prevention and control and appropriate antibiotic prescribing practice.

We all have to participate in this challenge!