Abstract
AbstractPrevention and control of healthcare-associated infections through the provision of water, sanitation, and hygiene (WASH) in healthcare facilities (HCF) is inadequate in low- and middle-income countries (LMICs), resulting in high patient morbidity and mortality, additional costs, and increased risk of antibiotic resistance. There is little evidence describing factors leading to improved WASH conditions in LMICs. We aim to identify the extent to which WASH is implemented in HCFs in LMICs and understand the ‘drivers’ of improvement in their service levels. WASH service levels in 14 LMICs were descriptively analysed, and potential drivers of service-level differences were explored using univariable and multivariable mixed-model logistic regression analyses. Descriptive analysis showed a lack of adequate water quality, sanitation, hand, and environmental hygiene, and waste disposal. We found that the presence of infection prevention and control protocols (IPCPs), having an IPC/WASH focal person at the facility, and conducting WASH training for staff were associated with higher levels of WASH services. This study demonstrates a lack of basic WASH services in HCF in LMICs. We show that there are potential interventions, such as implementing IPCPs, identifying WASH leaders in HCF, and conducting training that may lead to service improvements.
Highlights
An estimated 10–25% of neonatal and maternal deaths are estimated to be related to healthcare-associated infection (HAI), of which the majority are recorded in low- and middle-income countries (LMICs) (Zaidi et al 2005; Allegranzi et al 2011; Kassebaum et al 2014; Say et al 2014)
Of the healthcare facilities (HCF) surveyed, 90% reported having access to their own sanitation facilities, with numbers ranging from 68% of facilities in Niger to 100% of facilities in Rwanda and Uganda. 20% of facilities stated that open defecation was present on their premises. 22% of facilities were observed to have functional hand hygiene stations near the sanitation facilities
The multivariable analysis indicated that the presence of an infection prevention and control protocols (IPCPs) (OR: 1.594) as well as offering WASH training (WT) to staff (OR: 1.665) resulted in a higher likelihood of facilities having at least basic hand hygiene service levels. Summary These multivariable analyses indicate that the presence of an IPCP as well as a designated infection prevention and control (IPC)/WASH focal person (FP) was associated with the most service-level improvements
Summary
An estimated 10–25% of neonatal and maternal deaths are estimated to be related to healthcare-associated infection (HAI), of which the majority are recorded in low- and middle-income countries (LMICs) (Zaidi et al 2005; Allegranzi et al 2011; Kassebaum et al 2014; Say et al 2014). Basic measures to ensure patient safety and to prevent transmission of HAI, such as clean drinking water, waste management, hand hygiene, personal protective equipment, and clean and safe sanitation facilities, all of which are components of ‘WASH in HCF’, are frequently missing (Zaidi et al 2005; Buxton et al 2019) This could be due to a lack of physical infrastructure, staff capacity, funding gaps, competing interests, and limited data collection and evaluation measures (Zaidi et al 2005; Bouzid et al 2018; Buxton et al 2019). This could be due to a lack of physical infrastructure, staff capacity, funding gaps, competing interests, and limited data collection and evaluation measures (Zaidi et al 2005; Bouzid et al 2018; Buxton et al 2019). The 2020 WHO report ‘Progress report on water, sanitation and hygiene in health care facilities’ highlights the major gaps in WASH services globally: 25% of all HCFs have
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