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Measuring Infection Prevention & Control for Mothers and Newborns:
A WASH in HCF Approach
Presented by Lindsay DennyCenter for Global Safe WASH at Emory University
With support from Arabella Hayter (WHO WASH)
Infection Prevention & Control + WASH in HCF
1. Hand Hygiene2. Environmental Cleanliness3. Medical Equipment Processing4. Healthcare Waste Management
IPC
WASH Key Behaviors include:
WASH/IPC resources required for the behaviors listed affect the conditions of HCF, affecting the safety, efficiency and effectiveness of care.
• In Jan 2018, UNC published an article on 21 WASH and IPC indicators in 78 countries, including more than 120,000 HCF.
• Data were drawn from large-scale facility assessments like the SPA and the SARA
• Limited data available, not all countries had all 21 indicators
Environmental Conditions in HCF in Low- and Middle-Income Countries
Table 4Coverage of environmental conditions and availability of standard precaution items in health care facilities based on data from 78 low- and middle-income countries.
Indicator Estimatedcoverage
Number ofcountries in theestimate
Number offacilities in theestimate
Coverage in low-income countries
Number of lowincome countries
Coverage in lowermiddle-incomecountries
Number of lowermiddle-incomecountries
Coverage in uppermiddle-incomecountries
Number of uppermiddle incomecountries
Improved water source within 500m 70.7% 71 129,557 65.2% 33 70.4% 26 81.0% 29Piped water source on premises 50.3% 26 52,689 45.7% 11 48.3% 7 100.0% 13Reliable electricity 41.2% 46 121,381 39.9% 27 40.4% 21 41.6% 17Client toilet 67.4% 49 123,695 64.6% 27 67.9% 20 75.6% 19Soap 60.8% 34 85,742 54.1% 14 60.9% 12 74.6% 14Running water 54.3% 11 69,746 57.4% 7 54.3% 5 57.6% 6Soap and running water 44.1% 10 66,355 43.2% 6 44.1% 5 50.6% 5Alcohol-based hand disinfectant 29.5% 9 66,257 28.1% 6 29.5% 5 – 4Soap and running water or alcohol-
based hand disinfectant62.2% 17 94,676 60.3% 13 62.2% 12 70.2% 5
Sterilization equipment 26.8% 25 71,048 27.7% 11 26.4% 9 22.7% 7Equipment for high level disinfection 46.1% 6 54,349 – 4 – 4 – 2Appropriate storage of infectious
waste39.3% 15 85,116 43.2% 12 39.6% 11 – 3
Appropriate disposal of infectiouswaste
60.9% 14 82,915 54.3% 12 63.7% 11 – 3
Disinfectant (e.g. chlorine solutionfor decontamination)
63.6% 35 108,022 63.1% 18 63.7% 16 66.4% 11
Latex gloves 76.5% 41 114,086 81.1% 22 76.7% 16 70.2% 15Appropriate storage of sharps waste
(e.g. sharps boxes)74.7% 39 113,628 76.3% 22 74.7% 16 73.3% 16
Safe disposal of sharps 63.6% 17 91,382 58.7% 14 68.4% 11 80.2% 6Disposable syringe 85.2% 30 96,218 86.9% 16 85.1% 12 80.6% 9Guidelines for standard precautions 26.2% 19 95,708 28.6% 16 26.3% 12 22.5% 6Gowns 43.7% 19 57,989 52.8% 6 44.2% 5 – 3Eye protection 6.7% 9 55,613 5.3% 5 6.7% 5 – 2
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Source: Cronk, R., 2018. “Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities.” Int. J. Hyg. Environ. Health.
Indicator Weighted Coverage
Number of Facilities
Number of Countries
Access to piped water 50% 52,689 26
Access to improved sanitation facilities 67% 123,695 49
Access to soap for hand washing 61% 85,742 34Availability of latex gloves 77% 114,086 41Safe disposal of sharps 64% 91,382 17
Appropriate disposal of infectious waste 61% 82,915 14
Adequate sterilization equipment for medical equipment 27% 71,048 25
Source: Cronk, R., 2018. “Environmental conditions in health care facilities in low- and middle-income countries: Coverage and inequalities.” Int. J. Hyg. Environ. Health.
Global Data from 2018 Cronk Article
Basic serviceWater from an improved source on site is available at time of survey
No serviceNo improved water source
Basic serviceImproved facilities, separated for patients and staff, for men and women, and useable by those with limited mobility
No serviceNo improved toilets or latrines
Basic serviceHand hygiene facilities are available at points of care and toilets
Limited serviceHand hygiene stations at some, but not all, points of care and latrines
No serviceNo hand hygiene stations with soap and water or alcohol based handrub
Water Sanitation Hygiene
Limited serviceThere is an improved source, but off premises or not available at time of survey
Limited serviceThere are improved facilities, but not usable or do not meet the needs of specific groups
Advanced service
(to be defined at national level)
Advanced service
(to be defined at national level)
Advanced service
(to be defined at national level)
SDG
Targ
et Basic serviceWaste is segregated into bins, and sharps and infectious wastes are safely treated and disposed. Limited serviceWaste is segregated but not disposed of safely, or bins are in place but not used effectively
No serviceWaste is not segregated or safely treated and disposed
Health Care WasteAdvanced service
(to be defined at national level)
JMP Service Ladder for WASH in HCF
WASH in HCF Indicators for Birthing Settings
• Developed by the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP)
• To be used in tandem with the JMP core indicators for the general facility
• Tailored to birthing settings, with a focus on the delivery room
• For the JMP, the data is either “reported” or “observed”
• Still in draft format; Emory and other partners have tested indicators in the field
WASH in HCF Indicators in Birthing Settings
WATERWATER
The proportion of facilities with basic water supply in the delivery room
The proportion of facilities in which delivery rooms have running water (piped, or storage container with tap) at the time of the survey (D-W1).
WATER
SANITATION
The proportion of facilities with basic sanitation available for women during and after labour and childbirth
The proportion of facilities which have a functional improved toilet or latrine (D-S1), accessible to women during and after labour and childbirth (D-S2), and which provides privacy (D-S3).
SANITATION
HYGIENE
The proportion of facilities with basic hygiene provisions in the delivery room
The proportion of facilities in which delivery rooms have at least one functional handwashing station with water and soap available (D-H1), access to a shower or bathing area for women to use during and after labour and childbirth (D-H2) and basic sterile equipment is available (D-H3).
HYGIENE
WASTE MANAGEMENT
The proportion of facilities with basic healthcare waste management in the delivery room
The proportion of facilities in which waste is safely segregated in the delivery room (D-WM1) and placentas are treated and disposed of safely (D-WM2).
WASTE MANAGEMENT
ENVIRONMENTAL CLEANING PRACTICES
The proportion of facilities with basic environmental cleaning practices in the delivery room
The proportion of facilities in which delivery rooms have written protocols for cleaning (D-C1), and cleaning staff and healthcare providers have received training on cleaning procedures (D-C2).
*The core indicator for environmental cleaning practice has not been finalized.
ENVIRONMENTAL CLEANING PRACTICES*
WHO’s Six ‘Cleans’ for Delivery: 1. Clean hands of the attendant 2. Clean surface3. Clean blade4. Clean cord tie 5. Clean towels to dry the baby and then wrap the baby 6. Clean cloth to wrap the mother
Additional Questions Beyond JMP Monitoring
• Quality and Quantity• i.e. assessing quality of the previous indicators, such as latrines
• Laundry
• Management• IPC Committee/Focal Point• Frequency of IPC/WASH training (orientation and annual) • Supply chain for IPC/WASH materials
• Control Access Points• Who, where, when and how
• Behaviors• Hand hygiene practices, sterilization, cleaning techniques, etc.
Additional Questions Beyond JMP Monitoring
Your Feedback is Welcome!
• The JMP indicators are still being refined
• Much discussion has been held around the definition of a “birthing setting” (delivery room, pre/postnatal care rooms, etc.) as well as what can/should be monitored
• Email Arabella Hayter ([email protected]) with comments on the indicators
