Evidence & Research

Operational research is needed for informing effective implementation of WASH in health care facilities and further understanding the links between WASH services, infection prevention and control practices, and health outcomes. Such research is also important for informing the broader work of quality Universal Health Coverage and improved WASH services contribute to cost efficiencies, increased uptake and greater patient satisfaction and experience of care.

Health care-associated infections (HCAI) are a major burden on health care systems world-wide. The prevalence of HCAI varies considerably among facilities and countries. A 2011 global systematic review of HCAI in developing countries found that an estimated 15% (95% confidence interval (CI 12.6-18.9) of patients develop one or more infections during a  stay in a health care facility. This figure is substantially higher than HCAI rates in developed countries, especially for intensive care units (1). For example, in a recent point prevalence study in England 6.4% (CI 4.7 – 8.7%) of in-patients had a diagnosable HCAI (2). HCAI are very diverse and include: diarrhoeal disease, wound infections, urinary tract infections and chest infections amongst others. What these surveys will not have reported are infections occurring in the general community outside of health care facilities and spread from contaminated health care waste and wastewater.

It seems obvious that the provision of safe water and sanitation is essential to any health care system and indeed advanced surgery would be impossible without such provision. Nevertheless, the fact remains that many health care settings in low income and middle countries are not adequately provisioned. The aim of this theme within the global action plan will be to generate and synthesize evidence of the value of WASH in health care settings in order to enable the other task teams better undertake their responsibilities, including providing evidence to convince policy-makers for greater investments in this area.

Specific areas requiring further study include: assessing costs and benefits of investments, understanding the most effective measures for implementing facility-based risk management plans, drivers of hygiene behavior change in facilities and among patients, and optimizing WASH hardware that is easy to use, environmentally friendly, and appropriate to the setting.


[1] English National Point Prevalence Survey on Healthcare-associated Infections and Antimicrobial Use, 2011

[2] Allegranzi, B., Nejad SB, Combesure C, Graafmas W, Attar H, Donaldson L et al (2011). Burden of health-care-associated infection in developing countries: a systematic review and meta-analysis. The Lancet, 377: (228-41).