Strengthening support for world nurses requires basic WASH services in health care facilities

Date: 15th April 2020

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By Philip Son and Technical experts, WSSCC

Geneva – Last week — on World Health Day — the World Health Organization (WHO) released an Executive Summary on the state of the world’s nursing, highlighting the crucial role that nurses play in reaching the Sustainable Development Goals and the support that the workforce needs over the coming decade. This report on nurses is important and timely; facing the devasting impacts of COVID-19, we have seen just how much we depend on these frontline workers.

The report places an emphasis on strengthening nurse education, job creation and relevant policy development. Given WSSCC’s concern with sanitation and hygiene in health centres, we would like to add more: today the lack of adequate water, sanitation, and hygiene (WASH) services in health care facilities (HCFs) means that many nurses are unable to properly carry out their work and to protect their well-being.

As a joint WHO/UNICEF report from 2019 notes, globally, 26% of health care facilities lack basic water services and 21%, sanitation service; 43% have no hand hygiene facilities at points of care and  16%, no hygiene service at all. Put simply, 1 in 5 health care facilities have no basic toilets and handwashing facilities, directly impacting more than 1.5 billion people. One out of three hospitals lack basic waste management services to properly dispose of medical equipment, such as needles. Proper environmental maintenance, too, is often a luxury, as routine cleaning may be much less frequent than once per day and cleaning with hot water and detergent, even less frequent.

In such environments, nurses cannot properly carry out their work and may even be exposing patients and themselves to harm. Research has shown how the lack of basic sanitation and hygiene in health facilities contributes to sepsis and anti-microbial resistance (AMR)—big health threats “endanger[ing] achievement of the Sustainable Development Goals.”

The current COVID-19 crisis further makes the importance of WASH services clear: according to the latest guidance on virus prevention in health facilities, infection prevention and control “cannot be met without WASH services,” which are vital for preventing transmission through respiratory droplets and contact (UNICEF; WHO).

Indeed, the joint WHO/UNICEF guidance lists the following as “key practices”: hand hygiene; availability of safe water and sanitation services at all times; environmental cleanliness; personal protective equipment and WASH equipment disinfection; infectious and hazardous waste management—all services that are unavailable in many health facilities around the world, as highlighted above.

If we follow Princeton University researchers’ assertion that COVID-19 is more dangerous in higher doses (i.e. frequent/longer exposure), the importance of hygiene in health facilities becomes, “only greater, since these practices not only decrease infectious spread but also tend to decrease dose and thus the lethalness of infections that do occur.”

It is no wonder, then, that WHO considers improving WASH services in health care facilities one of the top thirteen urgent challenges for the next decade.

To be sure, job creation, education, and policy development are all important measures to promote and support nursing.

However, creating “an enabling environment for nursing practice to improve attraction, deployment, retention and motivation of the nursing workforce” per WHO recommendations requires digging deeper—it necessitates taking concerted action to improve WASH services, the key to the comfort and well-being of health care workers and patients as well as a vital step toward solving global inequalities. It is time to take action.

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