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For COVID-19, Focus on the Basics: WASH in Healthcare Facilities

Thomas Boynton and John Oldfield, Global Water 2020
21 Apr 2020

When it comes to stopping a pandemic – be it COVID-19 or infectious Disease X sometime in the future – we are only as strong as the weakest link. And there is a clear weak link that few recognize and appreciate: the lack of water, sanitation, and hygiene (WASH) in healthcare facilities across the developing world.

Pandemics specialize in beating efforts to control them, especially at critical sites. Perhaps no place is more critical than any given healthcare facility where there is the greatest density of pathogens and the greatest volume of sick people. The unappreciated reality is that at a time when we are bombarded with the message to “wash your hands,” healthcare workers and patients in healthcare facilities often cannot perform that simple act. WASH is the foundation of healthcare. However, one in four healthcare facilities lacks basic water, one in five lacks sanitation, and two in five lack hand hygiene materials at points of care. That leaves a massive “catchment area” of two billion people who must rely on these inadequate facilities for their healthcare. This situation is always deeply troubling and especially problematic during a pandemic. 

People visit healthcare facilities to get better, but instead, they can and often do get sicker because of lack of WASH within these facilities. And it’s not just the patients or even the wider global public at increased risk during this pandemic. These conditions seriously impact healthcare staff – the people on the frontlines.

Healthcare workers’ access to WASH in healthcare facilities is clearly crucial. Handwashing is directly linked to significantly decreasing viral respiratory infections, the type of infection presented by COVID-19. According to the World Health Organization, proper hand hygiene is the primary measure proven to be effective in preventing healthcare-acquired infections; improving hand hygiene practices may reduce infectious disease transmission in healthcare by 50%. 

There are already worrying signs that healthcare facilities are hotbeds of COVID-19 transmission. A study in a health center in Wuhan, China suggested that 41% of 138 confirmed cases were contracted during the patients’ stay at a healthcare facility, and 29% of those infected were healthcare workers. According to China’s National Health Commission, nearly 3,400 healthcare workers across China have been diagnosed with the virus. Given the nature of the crisis and the problem of countries not testing and reporting accurate data, the current number of infections occurring at healthcare facilities, and the exact role of inadequate water and hygiene services at these facilities, are not fully known. But evidence from previous outbreaks clearly indicates that leaders must take the healthcare setting far more seriously.

For those of us whose healthcare facilities have water and sanitation services, this WASH problem may seem “over there.” But in a global pandemic, there is no “over there.” Two hundred and thirteen countries, territories and areas have reported coronavirus cases as of this writing. We are in this together. 

What steps can we take now to tackle this challenge, especially in developing countries where COVID-19 appears to be accelerating? This resource compiled by Global Water 2020’s Health Advisor Lindsay Denny is ten steps in the right direction. These are immediately actionable, in many cases inexpensive, steps that each and every healthcare facility across the globe can take today to ensure safe, affordable WASH access on the premises. To start with, set up simple handwashing facilities in appropriate locations, institutionalize daily cleaning protocols, appoint and celebrate staff dedicated to facility cleanliness, and work closely with Infection Prevention and Control teams.  

Access to the fundamental necessity of WASH is now even more important for the heroic and exhausted workers in the coming days as they care for the critically ill, work tirelessly to prevent the further spread of COVID-19, and try to keep themselves safe. During a pandemic, the fact that millions of healthcare facility staff — from doctors and nurses to aides and cleaners — do not have water, soap and proper waste disposal is inexcusable and deadly. This is a serious challenge, but it is absolutely solvable. It is critical that water, soap and basic sanitation, the foundation of infection prevention and control, be made available in every healthcare facility, and this could well be key to stopping the spread of COVID-19. 


About the authors:

  • John Oldfield is a Principal at Global Water 2020
  • Thomas Boynton is a research assistant at Global Water 2020. He holds a master’s degree in Water Science, Policy and Management from the University of Oxford.