Abstract
Unsafe water, sanitation, and hygiene (WASH) conditions in healthcare facilities (HCFs) can increase the risk of disease transmission, yet WASH coverage is inadequate in HCFs in most low- and middle-income countries. In September 2017, we conducted a baseline survey of WASH coverage in 100 HCFs in three rural Tanzanian districts. Based on needs calculated from the baseline, we distributed handwashing and drinking water stations, soap, and chlorine solution; we repeated the survey 10 months later. The intervention improved coverage with handwashing stations (82% vs. 100%, p < 0.0001), handwashing stations with water (59% vs. 96%, p < 0.0001), handwashing stations with soap and water (19% vs. 46%, p < 0.0001), and handwashing stations with soap and water within 5 m of latrines (26% vs. 53%, p < 0.0001). Coverage of drinking water stations increased from 34% to 100% (p < 0.0001) HCFs with at least one drinking water station with free chlorine residual (FCR) > 0.2mg/ml increased from 6% to 36% (p < 0.0001), and in a sample of HCFs, detectable E. coli in stored drinking water samples decreased from 46% to 5% (p < 0.001). Although the program increased access to handwashing stations, drinking water stations, and safe drinking water in HCFs in rural Tanzania, modest increases in soap availability and water treatment highlighted persistent challenges.
Highlights
The 2014 and 2018 Ebola epidemics in West and Central Africa underscored the threat to global health security and healthcare worker safety posed by inadequate infection prevention and control practices, including lack of access to basic water, sanitation, and hygiene (WASH) infrastructure in healthcare facilities (HCFs) [1]
This evaluation showed that distinct improvements were made in the provision of basic handwashing and drinking water facilities to rural HCFs in Tanzania, 8 months later, substantial room for improvement remained
These outcomes likely resulted from a combination of several factors: the donation of handwashing and drinking water stations and supplies, which overcame immediate financial and logistical barriers; training that may have helped motivate HCF staff to maintain water stations and supply them with soap and water; national WASH in HCF guidelines; and engagement of district-level health personnel at implementation, which may have motivated adherence
Summary
The 2014 and 2018 Ebola epidemics in West and Central Africa underscored the threat to global health security and healthcare worker safety posed by inadequate infection prevention and control practices, including lack of access to basic water, sanitation, and hygiene (WASH) infrastructure in healthcare facilities (HCFs) [1]. In May in HCFs, citing the urgent problems of low coverage and high attendant risk of disease spread [3]. His call reinforced Sustainable Development Goal number 6 (SDG6), the achievement of which would require universal WASH coverage in HCF by 2030 [4]. Global estimates from 78 low- and middle-income countries in 2018 found that 50% of HCFs had access to an improved water source (piped water, public tap, tubewell, protected well, rainwater collection) on site, 66% had access to improved sanitation, 61% had soap for handwashing, and 61% had access to safe waste disposal [6]
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