A new UN report showing that half of the world’s health care facilities fail to meet the basic standard for providing hygiene services like soap and water or an alcohol-based hand rub highlights the widespread global risk of disease spread and infections to patients and health care providers.

About two-thirds of all health care facilities provide these services at the points of care or toilets but not at both, which is the basic standard. Only 51% meet that standard by providing both, says a new report Tuesday from the World Health Organization (WHO) and UNICEF. 

The report, “Progress on WASH in health care facilities 2000-2021: Special focus on WASH and infection prevention and control (IPC)“, focuses on data from 2000 to 2021 and finds that the lack of basic hygiene puts around 3.85 billion people who use these facilities at greater risk of infection. That includes 688 million whose facilities offer no basic hygiene services at all.

Hygiene ‘non-negotiable’

Health officials say the situation likely will prolong the COVID-19 pandemic, monkeypox outbreak and other health crises.

“Hygiene facilities and practices in health care settings are non-negotiable,” said Dr Maria Neira, director of WHO’s Department of Environment, Climate Change and Health. 

“Their improvement is essential to pandemic recovery, prevention and preparedness,” she said, urging nations to spend more for “basic measures, which include safe water, clean toilets, and safely managed health care waste.”

That is in line with the 194-nation World Health Assembly’s commitment in 2019 to strengthen and monitor water, sanitation and hygiene services in health care facilities.

WHO and UNICEF operate a Joint Monitoring Program that provides regional, national and global estimates of progress on drinking water, hygiene and sanitation. The latest report on hygiene covers 35% of the world’s population and 40 nations, up from 21 nations in 2020.

Low-and-middle-income countries have made significantly less progress than high-income countries in implementing hand hygiene and infection prevention programmes that can stop deadly diseases, from diarrhoea to COVID-19, according to a recent WHO survey of 88 countries.

“If health care providers don’t have access to a hygiene service, patients don’t have a health care facility,” said Kelly Ann Naylor, UNICEF’s director of Water, Sanitation and Hygiene (WASH) and Climate, Environment, Energy, and Disaster Risk Reduction (CEED).

“Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns, and children,” she said. “Every year, around 670,000 newborns lose their lives to sepsis. This is a travesty — even more so as their deaths are preventable.”

In 2017, the World Health Assembly adopted a resolution to fight which is a life-threatening blood stream infection for which there is growing resistance.

The Assembly, which is WHO’s governing body, acknowledged that antimicrobial resistance is a growing health concern and underlined the urgent need for new accessible and affordable antibiotics.

The report finds the lack of basic hygiene is uneven across different regions and income groupings.

Facilities in sub-Saharan Africa are lagging; 73% in the region have alcohol-based hand rub or water and soap at points of care, but only 37% have handwashing facilities with water and soap at toilets. Among hospitals, 87% have hand hygiene facilities at points of care.

In the least developed countries, only 53% of health care facilities have access on-premises to a protected water source, the report says. That compares with 78% globally.

Many health care facilities also lack basic environmental cleaning and safe segregation and disposal of health care waste, it says.

Image Credits: WHO/UNICEF.