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lthough strict hand hygiene is standard procedure for healthcare workers, the compliance rate in Indonesia is low, heightening the risk of healthcare associated infections, the government says.

Health Minister Endang Rahayu Sedyaningsih said here Sunday that although a ministerial decree had been issued in 2007, containing managerial guidelines to prevent and control infections in hospitals and other healthcare institutions, its implementation was "a far cry from ideal".

Cipto Mangunkusumo General Hospital (RSCM) director Akmal Taher said in 2008 his hospital had adopted a patient safety program, which includes hand hygiene protocol. However, only between 20 and 40 percent of hospital workers adhered to the protocol, he said.

"It requires a change in behavior, so I think it will take years to improve the compliance rate," Akmal said.

The poor hand hygiene standards at RSCM have had impacts.

"The Doctors' lack of confidence in the hospital's hygiene has led them to prescribe antibiotics unnecessarily," Akmal said.

Doctors at his hospital prescribe twice as many antibiotics than the norm, making treatments more costly, he said.

Henri A. Verbrugh of Erasmus University Medical Center in Rotterdam, the Netherlands, who has been visiting hospitals in various regions in Indonesia, said the influences from big pharmaceutical companies were also one reason doctors were irrational in prescribing antibiotics.

"*The companies* certainly promoted *their drugs* very actively in the sense that they have direct access to prescribers... *their influence* goes too far," he told The Jakarta Post on Sunday.

Unnecessary prescription of antibiotics can also result in bacteria becoming multi-resistant.

Usman Chatib Warsa, a microbiologist from the School of Medicine at the University of Indonesia, said multiresistant bacteria, such as Methicilline-Resistant Staphylococus Aureus (MRSA) or Multiresistant Pseudomonas Aeruginosa, infected around 40 percent of patients treated in intensive care units in Indonesia in 2009.

According to World Health Organization data, 1.4 million hospital patients worldwide are suffering healthcare associated infections at any given time.

The poor hand hygiene standards and increasing risk of such infections had prompted the Health Ministry to launch a hand hygiene campaign on Sunday, targeting hospitals throughout the country.

The Health Ministry has adopted the WHO's hand hygiene initiative and targets not only healthcare workers, but also visitors and patients, to institutionalize alcohol-based hand-cleaning.

The hand hygiene campaign had already shown promising results, WHO First Global Patient Safety Challenge director Didier Pittet said.