WASH in health care facilities: Global baseline report 2019

April 2, 2019

No one goes to a health care facility to get sick. People go to get better, to deliver babies, to get vaccinated. Yet, hundreds of millions of people face an increased risk of infection by seeking care in health facilities that lack basic necessities, including water, sanitation, hygiene (WASH) and health care waste services. The WHO/UNICEF JMP report, WASH in Health Care Facilities, is the first comprehensive global assessment of water, sanitation and hygiene (WASH) in health care facilities. It finds that 1 in 8 health care facilities has no water service and 1 in 5 has no sanitation service – impacting close to 900 million and more than 1.5 billion people, respectively. The report also reveals that many health centres lack basic facilities for hand hygiene and safe segregation and disposal of health care waste.  These services are crucial to preventing infections, reducing the spread of antimicrobial resistance and providing quality care, particularly for safe childbirth.


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The availability of clean water in health facilities is critical to providing quality health care

Workers in health care facilities need sufficient quantities of safe water to provide health care services. Drinking and cooking, hand hygiene, showering and bathing, and a variety of general and specialized medical uses all require safe and reliable supplies of water. Water is also essential for cleaning rooms, beds, floors, toilets, sheets and laundry. It is central to patient experiences of health care, as it enables them to remain hydrated, to clean themselves, and to reduce the risk of infections. Without water, a health care facility isn’t a health care facility. Yet, around  1 in 4 health care facilities do not have basic water services, which impacts around 2 billion people while 1 in 8 health care facilities have no water service at all, which impacts around 894 million people.

Health facilities without proper sanitation, including toilets and waste disposal can spread disease instead of preventing them

Sanitation is a human right. Sanitation services in health care facilities are essential to deliver high-quality care that improves the health, welfare and dignity of patients and staff and improve health outcomes. Health facilities without proper toilets and waste disposal can spread disease instead of preventing them. Sanitary management of excreta in health care is particularly important to ensure faecal pathogens do not contaminate the health care facility environment or surrounding areas. Yet,  around 1 in 5 health care facilities lack a sanitation service. That means, 1.5 billion people are going to health centers no toilets at all.

When soap and water are absent, the risk of infection is great

Effective hand hygiene in health care facilities has been the cornerstone of infection prevention and control and, and is today considered the primary measure for preventing health care associated infections and the spread of antimicrobial resistance. Health care workers are the principal target of efforts to improve hand hygiene, since they care for multiple patients and may come into contact with blood and other bodily fluids. However, visitors to health care facilities can also spread pathogens on their hands, and it is important that health care facilities provide handwashing facilities with soap and water at toilets used by patients as well as other visitors who may be tending to patients’ needs. Globally 1 out of 6 health care facilities have no hygiene service, meaning they lack hand hygiene facilities where patients receive care, as well as soap and water at toilets.

Infectious and hazardous waste in health care facilities often isn’t managed appropriately to prevent unsafe exposure

Most waste produced in health care facilities – about 85% – is not hazardous and can be disposed of along with general solid waste. The remaining 15% is either infectious, chemically hazardous or radioactive, and must be managed appropriately to prevent unsafe exposure to health care workers, patients, visitors, waste handlers and the public. Used needles and other sharp materials are generally considered the most hazardous category of health care waste because they can easily cause needle stick injuries and subsequent infection.



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