Half of healthcare facilities worldwide lack basic hygiene services with water and soap or alcohol-based hand rub where patients receive care and at toilets in these facilities, according to the latest Joint Monitoring Programme (JMP) report by the World Health Organization (WHO) and UNICEF. Around 3.85 billion people use these facilities, putting them at greater risk of infection, including 688 million people who receive care at facilities with no hygiene services at all.

Hygiene improvement essential

“Hygiene facilities and practices in healthcare settings are non-negotiable. 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 health care waste,” said Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health. “I encourage Member States to step up their efforts to implement their 2019 World Health Assembly commitment to strengthen water, sanitation and hygiene (WASH) services in health care facilities, and to monitor these efforts.”

The latest report, Progress on WASH in healthcare facilities 2000-2021: special focus on WASH and infection prevention and control, has for the first time established this global baseline on hygiene services – which assessed access at points of care as well as toilets – as more countries than ever report on critical elements of WASH services in their hospitals and other health centres. For hygiene, data are now available for 40 countries, representing 35 per cent of the world’s population, up from 21 countries in 2020 and 14 in 2019.

The newly established global estimate reveals a clearer and more alarming picture of the state of hygiene in healthcare facilities. Though 68 per cent of healthcare facilities had hygiene facilities at points of care, and 65 per cent had handwashing facilities with water and soap at toilets, only 51 per cent had both and therefore met the criteria for basic hygiene services. Furthermore, one in 11 (nine per cent) of healthcare facilities globally have neither.

Preventable deaths will occur without basic hygiene

“If healthcare providers don’t have access to a hygiene service, patients don’t have a healthcare facility,” said Kelly Ann Naylor, UNICEF Director of WASH and Climate, Environment, Energy, and Disaster Risk Reduction (CEED). “Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns, and children. Every year, around 670 000 newborns lose their lives to sepsis. This is a travesty – even more so as their deaths are preventable.”

The report notes that contaminated hands and environments play a significant role in pathogen transmission in healthcare facilities and the spread of antimicrobial resistance. Interventions to increase access to handwashing with water and soap and environmental cleaning form the cornerstone of infection prevention and control programmes and are crucial to providing quality care, particularly for safe childbirth.

Coverage of WASH facilities is still uneven across different regions and income groupings: facilities in sub-Saharan Africa are lagging on hygiene services. While three-quarters (73 per cent) of healthcare facilities in the region overall have alcohol-based hand rub or water and soap at points of care, only one-third (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 68pe cent of other healthcare facilities.

In the Least Developed Countries, only 53 per cent of healthcare facilities have access on-premises to a protected water source. To compare, the global figure is 78 per cent with hospitals (88 per cent) doing better than smaller healthcare facilities (77 per cent), and the figure for eastern and south-eastern Asia is 90 pe cent. Globally, around three per cent of healthcare facilities in urban areas and 11 per cent in rural areas had no water service.

Of the countries with available data, one in 10 healthcare facilities globally had no sanitation service. The proportion of healthcare facilities with no sanitation services ranged 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, just one in five (21 per cent) had basic sanitation services in healthcare facilities.

The data further reveals that many healthcare facilities lack basic environmental cleaning and safe segregation and disposal of healthcare waste.