Using common sense to combat antibiotic resistance
An interview with Uga Dumpis
“Because of an economic crisis, Latvia is a low-resource country, with no additional funding for new health initiatives. But the hospital administration where I work understood the burden of hospital-acquired infections and antimicrobial resistance, and with common sense, we have managed to keep our rates comparatively low. Much can be done with hand-hygiene procedures and promoting the correct use of antibiotics.”
“Surgical procedures, inadequate hygiene and antibiotic resistance go hand in hand in compounding the problem of hospital-acquired infections. As head of infection control efforts at the Pauls Stradins Clinical University Hospital in Latvia, I make ward rounds and it is easy to see the patients suffering from hospital-acquired infections (in the hospital where I work and throughout the country, often every third patient is in an intensive-care unit). In 2004, nearly 30% of patients with Staphylococcus aureus bacteraemia at my hospital and others in Latvia were infected with methicillin-resistant Staphylococcus aureus. I realized something needed to be done right away, not just where I work, but in other hospitals as well.”
Some of the affordable, common-sense techniques Uga Dumpis has been heavily involved in implementing to improve conditions at his hospital include:
- staff washing hands with an alcohol-based solution and teaching others to do the same;
- using WHO posters and other information to promote hand hygiene;
- training staff on infection control;
- forming infection control teams and committees;
- screening high-risk patients as soon as they enter the hospital;
- isolating patients with multiresistant bacterial infections;
- surveying around the hospital to gauge antibiotic use and creating guidelines on use; and
- using free WHO software to enter and analyse microbiological data (WHONET 5) and to conduct epidemiological surveillance (EPI INFO).
Through informal networking, other hospitals have followed Uga Dumpis’ lead. Since staff adapted these procedures, the rates of infection with methicillin-resistant Staphylococcus aureus have declined to less than 10% at his hospital and other major ones in Latvia, with most of them even below 5%, according to Uga Dumpis.
Snowball effect
Uga Dumpis says he started out as the only infection control specialist at his hospital, and other hospitals in his country did not have infection control teams, either. He has managed to build his department into a team of six people, and all six major hospitals in Latvia have now formed infection control teams. The Latvian government has contributed to the cause by passing legislation requiring hospitals to adopt hygiene and infection control procedures, which Uga Dumpis pushed and provided expertise for. The European Union and Norway have contributed as well, by giving Latvian hospitals funds to introduce an early warning system for hospital-acquired infections and to train staff on its use.
Still a growing problem
“We see it everyday. People are dying from these infections, and because of antimicrobial resistance, the problem is growing very rapidly. It is one of the major health problems these days.”
“Although antibiotic misuse in Latvia is low compared with other countries and methicillin-resistant Staphylococcus aureus infection rates have declined in our hospitals, other bacterial infections continue to grow. Ten years ago, there were two or three major highly antibiotic-resistant bacteria species at my hospital; now, there are seven. This is a large number because, despite better hygiene and screening procedures, medical procedures are more invasive now, which raises the risk of infections, and patients bring bacteria in from other countries with higher rates of antibiotic misuse. This is a problem without borders, dramatically increasing in Latvia and the world. I believe there still needs to be more national legislation on the matter.”
About Uga Dumpis
For 10 years, Uga Dumpis has been head of the Department of Infection Control at Pauls Stradins Clinical University Hospital in Latvia. He is a member of various networks and task forces dealing with antimicrobial resistance, an issue in which he has both a clinical and scientific interest. Uga Dumpis studied medicine in Latvia, Sweden and the United Kingdom, besides attending shorter courses in Belgium, the Netherlands and the Russian Federation. He was a Soros scholar at Oxford University in the 1990s and received his PhD degree from the United Kingdom’s Open University in 2000.
