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Health through safe health care: safe water, basic sanitation and waste management in health-care settings

Goal 4, target 5 of the Millennium Development goals aims at reducing by two-thirds the death rate for children under five while goal 5, target 6 aims at reducing maternal mortality by three-quarters.

What does safe water, basic sanitation & waste management in health-care settings mean?

It combines the safe environment needed for health care with the responsibility of health care providers not to make the environment more dangerous from the waste generated.

  • Health-care facilities require: access to safe water; low risks to health from microorganisms like Legionella and Pseudomonas that grow in the environment; and physically clean surfaces and tools.
  • Safe disposal of wastes generated ranges from the excreta of patients, staff and visitors to high risk health-care wastes and especially needle-syringes or blood.

These apply across a range of facilities from the reference hospital to the village health posts; residential care accommodation, dental facilities and so on to include home based care.

Support to the overall achievement of the MDGs

Safe drinking water and basic sanitation is of direct relevance to Goal 5 on maternal health with an estimated 529 000 maternal deaths per year and supportive of other Millennium Development Goals, especially those on major diseases and infant mortality.

Safety through safe water, basic sanitation and waste management

Hospital-associated infections contribute to morbidity and mortality and to loss of health sector resources worldwide. Five to 30 per cent of patients a year develop one or more infections during a stay in hospital, a significant percentage which could be avoided. In crisis or precarious situations the number of infections worsens and in some circumstances people may choose not to seek care because the nearest facilities are not functioning or because they know that treatment is uncertain due to shortages of water, electricity or supplies.

  • Unsafe health care settings contribute a significant proportion of some diseases. Legionellosis is a well-established risk associated with health care facility with an average proportion of nosocomial infections close to 10%.
  • Sharps waste, although produced in small quantities, is highly infectious. Contaminated needles and syringes represent a particular threat because they are sometimes scavenged from waste areas and dump sites and then reused. Poorly managed, they expose health-care workers, waste handlers and the community to infections. WHO estimates that, in 2000, injections with contaminated syringes caused: 21 million hepatitis B virus (HBV) infections (32% of all new infections); two million hepatitis C virus (HCV) infections (40% of all new infections); and 260 000 HIV infections (5% of all new infections).

What is needed to reach the target?

In 2002, the results of a WHO assessment conducted in 22 developing countries showed that the proportion of health-care facilities that do not use proper waste disposal ranges from 18% to 64%. The development and implementation of national policies, guidelines on safe practices, training and promotion of effective messages in a context of healthy medical facility will decrease the number of health-care settings associated infections. This will also impact on visitors and will be reflected in communities through good practices in safe water, sanitation and hygiene

Health significance of reaching the goals

The burden of disease can be pulled down massively and with a very favorable cost benefit ratio. In 1999 in England alone hospital acquired infections cost the health service 1 billion Pounds a year and that 15 per cent of them were potentially avoidable. The underlying driving forces suggest that this problem is getting worse. World-wide there is increasing provision of health care, increasing complexity of that health care, an increasing proportion of the population that is immunocompromised (and therefore more susceptible to health care related infection) and without effective action the situation is therefore likely to deteriorate.

WHO efforts

  • setting, validating and monitoring norms and standard through "Guidelines for Waste Management in Health Care Settings" and "Water and Sanitation Minimum Standards in Health Care Settings and Schools"
  • developing tools and guidelines for disease control and risk reduction. WHO "Legionella and the prevention of Legionellosis"; "Management of Wastes from Blood Transfusion Activities" and "Water Safety in Public Buildings"
  • support of developing ethical and evidence based policy through a series of policy papers for example on "safe health care waste management"
  • stimulating research and development and testing new technologies such as working with practitioners and academic institutions in testing and verifying health care waste management options for resource poor settings
  • Assessment, status and trends. In close collaboration with national authorities, WHO is involved in country assessments leading to national plans
  • provides support for sustainable capacity building on water, sanitation and waste management in health-care settings.

World Health Organization efforts on safe water, basic sanitation and waste management in health-care settings are undertaken in HQ, regional and country offices and include:

WHO is also involved in the Global Environment Facility implementation project in 7 countries: Argentina, India, Latvia, Lebanon, the Philippines, Senegal and Viet Nam and actively contribute to the World Patient Safety initiative through clean environment for clean care is safer care.

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