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    A matter of health

    Aqilah Rahman

    Only half of healthcare facilities worldwide have a basic hand hygiene service, with water and soap and/or alcohol-based handrub at both points of care and toilets.

    This means 3.85 billion people do not have access to basic hygiene services at their healthcare facilities, including 688 million with no hygiene services, according to a joint report by the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF).

    In comparison, about two-thirds of healthcare facilities have hygiene facilities at points of care or toilets. One in 11 of healthcare facilities worldwide have neither, highlights the report titled Progress on WASH in Health Care Facilities 2000–2021.

    “Hygiene facilities and practices in healthcare settings are non-negotiable,” said Director of the Department of Environment, Climate Change and Health at WHO Dr Maria Neira in a joint press release.

    “Their improvement is essential to pandemic recovery, prevention and preparedness.

    “Hygiene in healthcare facilities cannot be secured without increasing investments in basic measures, which include safe water, clean toilets, and safely managed healthcare waste.”

    Since 1990, WHO and UNICEF have been producing regular updates on water, sanitation and hygiene (WASH). The 2022 update presents national, regional and global estimates for WASH in healthcare facilities up to the year 2021, with a special focus on the linkages between WASH and infection prevention and control (IPC).

    Inadequate WASH and IPC contribute to healthcare associated infections (HAI), which are a major public health concern globally. In high income countries, seven per cent of patients in acute-care hospitals develop HAI, and the rate is more than twice as high (15 per cent) in low and middle income countries. Up to almost a third of patients in intensive care can be affected by HAI, with an incidence two to 20 times higher in low and middle income countries than in high income countries, in particularly among newborns.

    The report noted that studies have shown contaminated hands of healthcare workers and patients play a significant role in pathogen transmission. Increasing access to hand hygiene services is one of the most effective ways to reduce HAI, forming the cornerstone of IPC programmes to ensure the safety and quality of healthcare services.

    Aside from the transmission of infections, inadequate WASH also contributes to the spread of antimicrobial-resistant (AMR) pathogens in healthcare, making infections harder to treat.

    Evidence also suggests that poor WASH in healthcare facilities leads to increased prophylactic use of antibiotics before birth, which may be linked to AMR.

    Every year, about 670,000 newborn die due to sepsis – the body’s extreme response to an infection – and about a third may be attributable to resistant pathogens. In addition, unsafe disposal of wastewater from healthcare facilities can contribute to the spread of AMR in the environment.

    “If healthcare providers don’t have access to a hygiene service, patients don’t have a healthcare facility,” said Director of WASH and Climate, Environment, Energy, and Disaster Risk Reduction (CEED) at UNICEF Kelly Ann Naylor. “Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns, and children.”

    Globally, the proportion of women who give birth at healthcare facilities has increased from 51 per cent in 2000 to 80 per cent last year.

    It is estimated that over 16 million women in least developed countries give birth in healthcare facilities with inadequate water, sanitation and hygiene services, putting pregnant women and newborns at higher risk of infection.

    The report also highlighted the uneven coverage of WASH facilities across different regions and income groupings. In sub-Saharan Africa, hygiene services are fairly common at healthcare facilities, of which 73 per cent have alcohol-based hand rub or water and soap at point of care. However, only 37 per cent have handwashing facilities with water and soap at toilets.

    The vast majority (87 per cent) of hospitals have hand hygiene facilities at points of care, compared to 68 per cent of other healthcare facilities.

    Access to water service is the lowest in the least developed countries – only 53 per cent of healthcare facilities have access on-premises to a protected water source compared to the global figure (78 per cent).

    Regional coverage ranges from 52 per cent in sub-Saharan Africa to 90 per cent in Eastern and South-Eastern Asia.

    Among the countries with data, one in 10 healthcare facilities do not have sanitation service, meaning they have unimproved toilets or no toilets at all. The proportion ranges from three per cent in Latin America and the Caribbean and in Eastern and South-Eastern Asia to 22 per cent in sub-Saharan Africa. In the least developed countries, only one in five have basic sanitation services in healthcare facilities.

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