A mother sits with her 3-month old baby at Sarkin Noma Primary Health Center (PHC) in Nigeria. The 19-year old new mom is getting advise from the head community health officer. The health officer is placing her hand near the baby’s head and smiling. The new mom is smiling as well.

Evidence

There is robust evidence linking improvements in hygiene at healthcare facilities with improved patient outcomes. Research has documented that proper hand hygiene reduces infection risks by 50% and proper disinfection is associated with risk reductions of 40-80%. Routine cleaning has been associated with a 33% reduction in microbial contamination and 27% infection reduction.

Overviews
WASH in Health Care Facilities: Global Baseline Report 2019WHOUNICEF, April 2019. This first Joint Monitoring Program (JMP) report on WASH in health care facilities introduces new service ladders for basic services and establishes national, regional, and global baseline estimates that contribute toward global monitoring of Sustainable Development Goal (SDG) targets 6.1 and 6.2—universal access to WASH.

WASH in Health Care Facilities: Practical Steps to Achieve Universal Access to Quality CareWHOUNICEF, April 2019. The purpose of this document is to present practical actions that can be taken at the national and subnational level to improve WASH in health care facilities. This document is a companion to the WHO and UNICEF global baseline report 2019 for WASH in health care facilities (see above), which provides the first national, regional, and global baseline estimates for monitoring SDG 6 in health care facilities.

Environmental Conditions in Health Care Facilities in Low- and Middle-Income Countries: Coverage and InequalitiesInternational Journal of Hygiene and Environmental Health, April 2018. A study of nationally representative data from 78 countries found that 50 percent of HCFs lacked piped water, 33 percent lacked improved sanitation, 39 percent lacked soap for handwashing, and 39 percent lacked adequate infectious waste disposal.

Water, Sanitation, and Hygiene at the Health CenterSave the Children and the USAID Maternal and Child Survival Program (MCSP), February 2017. This two-page brief outlines the challenges facing WASH in maternal and perinatal health settings and proposes actions to address them, including through improved WASH in HCFs.

Safe Management of Wastes from Health-Care Activities: A SummaryWHO, 2017. This document highlights the key aspects of safe health care waste management to guide policymakers, practitioners, and facility managers to improve waste management services in HCFs.

Transforming Health Systems: The Vital Role of Water, Sanitation and HygieneWaterAid, May 2018. Released at the 2018 World Health Assembly, this report is a manifesto of change for governments and donors to ensure that all health centers around the world have safe, reliable, accessible, and inclusive WASH by 2030, as part of the drive to achieve universal health coverage.

What Is the Impact of Water Sanitation and Hygiene in Healthcare Facilities on Care Seeking Behaviour and Patient Satisfaction? A Systematic Review of the Evidence from Low-Income and Middle-Income CountriesBMJ Global Health, March 2018. A systematic review of maternal health services found that poor WASH provision often prompted women to choose home delivery. However, providers’ attitudes and interpersonal behaviors were the main drivers of patient dissatisfaction with maternal health services

Handwashing/Hygiene
The State of Handwashing in 2017: Annual Research SummaryGlobal Handwashing Partnership, 2018. This literature review provides a comprehensive summary of recent articles on hand hygiene, including a particular focus on health care settings.

An Invisible Workforce: The Neglected Role of Cleaners in Patient Safety on Maternity Units. Global Health Action, February 2019. A study of HCFs in Bangladesh, India, The Gambia, and Zanzibar argues that the low status of cleaners within facilities—with their wider societal marginalization, lack of training, and poor pay and working conditions contributes to the lack of prioritization placed on HCF environmental hygiene.

Toolkits/Training Materials
Clean Clinic Approach BriefSave the Children and USAID Maternal and Child Survival Program (MCSP), October 2016. This two-page brief explains MCSP’s Clean Clinic Approach, a programmatic tool that encourages health facilities to establish WASH goals and make incremental improvements toward the end goal of achieving “Clean Clinic” status, as defined by national ministries of health.

Developing a Participatory Management Tool for User-Friendly Water Sanitation and Hygiene in Healthcare FacilitiesWaterAid, March 2018. This report synthesizes key learning on making WASH in HCFs more user-friendly, accessible, and inclusive. It captures the participatory, inclusive, collaborative, and rigorous approach taken to develop a "Participatory Management Tool” to support progress toward user-friendly WASH in HCFs in Cambodia and beyond.

The Teach Clean PackageThe Soapbox Collaborative, November 2018. This resource is designed to address the training of HCF cleaning staff in low- and middle-income countries. The package is tailored toward use with low-literate cleaning staff but can be applied to wider facility staff.

Improving Management Systems for Better Water, Sanitation, Hygiene, and Infection Prevention for Mothers and Newborns: Trainer’s GuideSave the Children and USAID MCSP, July 2018. This training guide aims to strengthen systems that support WASH and infection prevention and control, both within HCFs and in the broader health system.

Websites
WASH in Health Care Facilities: A Toolbox for Improving Quality of Care– USAID’s MCSP created this microsite to host resources as well as perspectives and insights from MCSP’s experience integrating WASH in support of quality of care improvements that lead to improved health outcomes.

WASH in Health Care Facilities – This updated WHO and UNICEF knowledge portal is for all involved in this issue to exchange the latest standards, tools, approaches, achievements and learnings. It is also for making and tracking commitments.

Globalwaters.org – The USAID Water Office supports Globalwaters.org to foster knowledge sharing and collaboration for sustainable WASH access for all, and provide water practitioners with the latest news, learnings, and resources from USAID and its partners. A search on health care facilities retrieves guidance, tools, and other resources.

Global Handwashing Partnership (GHP) – GHP is a coalition of international stakeholders working to promote handwashing with soap and advocate for hygiene as a pillar of international development and public health. The website includes case studies, blogs, publications, and other outreach materials to support handwashing programs.

Hand Hygiene in Healthcare Settings – This website from the Centers for Disease Control and Prevention includes a summary of the agency’s resources on hand hygiene.

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