Episode #83 - Minimize infection at health-care facilities

VGS   What are the points at which patients are at risk of infection in health-care facilities? What is the status of water, sanitation and hygiene in health-care facilities? And what can health care providers and patients do to minimize the risk of infection?

Hello and welcome to Science in 5. I'm Vismita Gupta-Smith. Our expert today is Dr Richard Johnston.

Welcome, Rick. Let's start with the points at which a patient is most at risk of infection in a health-care facility.

RJ   Thanks so much Vismita.

Well, some of the highest risk places are in intensive locations like an operating theatre. But even in other locations, it is possible for patients to pick up an infection. Especially if health care workers are moving back and forth from higher risk settings to lower risk ones because they can actually transport bacteria and viruses on their hands.

And that's why one of the most important measures for infection prevention and control is for health care workers to practice proper hand hygiene. And that just means regularly cleaning their hands wherever they're interacting with patients.

Now, to do this, of course, they need to have access to plenty of water and soap. And also alcohol rubs can be very useful because they're quicker and easier for staff to use.

And hand hygiene, it is important to protect patients and their caregivers and visitors, but also health care workers themselves, because doctors, nurses and other staff in health-care facilities are very vulnerable to getting infections through all the contacts that they have with sick people.

VGS   Rick, talk to us about the latest WHO report which describes the status of health-care facilities when it comes to water, sanitation and hygiene.

RJ   Sure. Well, this report, jointly published by WHO and UNICEF, covers water, sanitation and hygiene, as well as waste management and environmental cleaning services in health-care facilities throughout the world.

And for me, the most shocking finding in the report was that only half of health-care facilities worldwide had basic hygiene services. And that just means having handwashing facilities where patients receive care as well as in bathrooms.

So besides health workers cleaning their hands regularly, it is also important for patients and visitors to be able to wash their hands when they use the bathroom. And that's just not possible in about half of the health-care facilities in the world today.

And as you might expect, the situation is even worse in the least developed countries, where only a third of health-care facilities have basic hygiene services. There was some better news in the report about water. We found that 78% of health-care facilities had a water supply available on premises.

But those data don't tell us if that water is actually clean and safe or if there's enough of it to meet all of the needs in the health care setting and all the different locations within the health centre.

We also found that two out of five hospitals globally didn't have basic waste management services. And that just means safe segregation, treatment and disposal of infectious wastes, as well as sharp materials like used needles. And we know that when there's inadequate water, sanitation and hand hygiene or poor waste management and infection prevention and control, that can lead to antimicrobial resistance, where the standard medicines that are used to treat infections become ineffective. And this is a really serious public health risk.

VGS   Rick, talk to us about what health care workers and patients can do to minimize their risk of infection.

RJ   Well, the first thing is to make sure that people take advantage of hand hygiene facilities where they're available.

So if you're in one of those half of all health-care facilities that do have water and soap or alcohol-based hand rub available, then use them and use them to clean your hands.

And this is something that health care workers can and should do every day as part of their job.

But it is also important for patients and their caregivers. There is something we call the multi-modal strategy, which supports cleaning hands, using the right techniques at the right times.

And this is a time proven approach to improving hand hygiene. And if the health care centre doesn't have water and soap or alcohol rub for cleaning hands, then you can complain.

It's not that expensive for hospitals and even smaller facilities to make sure that hand washing materials are available wherever patients receive care and also at toilets.

Also, health care administrators do have a lot of power over what happens in their facilities.

So health care managers can make sure that the resources that they do have and those are never enough to do everything they need to, but that those resources are used effectively for improving water and sanitation and hygiene and infection prevention and control.

And they can also advocate to have more resources where there are gaps. Over the past year, as we've seen in the COVID pandemic, as well as in Ebola outbreaks, that when health-care facilities don't have basic water, sanitation and hygiene services, they just can't provide safe health care.

So we need to make sure that health centres can provide quality care for all and that they're well-prepared for the next outbreak, whatever that may be, whenever it may come.

VGS   Thank you, Rick.

That was Science in 5 today. Until next time, then stay safe, stay healthy and stick with science.