Evidence provides an important catalyst for advocacy as well as for driving investments. One of the first tasks is to review the evidence base, determine where there is sufficient evidence to make further estimates, especially regarding burden of disease associated with WASH in health care facilities, and to identify the priority evidence gaps, and how they can be best addressed in tandem with health colleagues.

In addition, operational research on how to improve WASH services and practices in health care facilities most effectively is needed to inform effective implementation and further understand what drives and sustains change at the facility level and the other benefits of improving WASH such as increase uptake of services and greater patient satisfaction and confidence in care. 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 behaviour change in facilities and among patients, and
  • optimizing WASH hardware that is easy to use, environmentally friendly, and appropriate to the setting.

The interactions between WASH and IPC are many and includes issues such as personal washing, hand hygiene, cleaning of medical and surgical apparatus and equipment, general ward cleanliness, provision of sanitation, drinking water and washing water safety, health care waste and wastewater disposal. These distinct interactions may be classified into one of three broad areas:

  • WASH to reduce Cross-infection – e.g. handwashing in preventing the spread of Methicillin Resistant Staphylococcus aureus.
  • WASH as a source of infection – e.g. contaminated wash water leading to pseudomonas wound infections
  • WASH as a pathway for spread of hospital infections into the community – e.g. typhoid or antimicrobial resistance organisms spreading into the community through inadequately treated sewage.

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

[2] Nejad, S. B., Allegranzi, B., Syed, S. B., Ellis, B., & Pittet, D. (2011). Health-care-associated infection in Africa: a systematic review. Bulletin of the World Health Organization, 89 (10), 757-765.