Water Currents: Hand Hygiene and Sepsis Prevention

Centers for Disease Control and Prevention Global Infection Control Supervisor Simone Loua (left) reinforces proper handwashing techniques during a field supervision visit to a clinic in Guinea. Photo credit: Lindsey Horton

Water Currents is produced biweekly by USAID’s E3 Water Office. Each issue contains recent news and articles on water sector issues, partner and donor updates, latest sector research, and a special focus on one topic. Please provide your feedback and suggestions by contacting the waterteam@usaid.gov.

May 5, 2018 marked World Hand Hygiene Day, an annual awareness day and call to action for promoting hand hygiene in health care. This year’s theme was “It’s in your hands—prevent sepsis in health care.” Sepsis—when the body’s response to infection causes injury to its own tissues and organs—affects more than 30 million patients every year worldwide and leads to an estimated 6 million deaths. Proper hand hygiene is a critical step to preventing sepsis and providing quality health care.
This issue contains recently published studies on hand hygiene, as well as studies on water and sanitation conditions in health care facilities (HCFs). We would like to thank the Global Handwashing Partnership (GHP) for contributing to this issue. GHP is a coalition of international stakeholders working to promote handwashing with soap as a pillar of international development and public health. USAID is a founding member of the Partnership and has contributed funding annually to the coalition since 2001.

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Water Currents - In Focus

GHP Resources

Infographic: Hygiene in Health FacilitiesGHP, April 2018. May 5 marks two important global advocacy days: World Hand Hygiene Day and International Day of the Midwife. This infographic introduces key data on hand hygiene and sepsis, and shares what you can do to support health workers and prevent sepsis.
Advocacy Toolkit: Clean Hands for AllGHP, February 2018. Handwashing with soap is critical to health and development. This toolkit provides resources to help hygiene advocates promote and facilitate handwashing and engage others to do the same.
Fact Sheet: Hand Hygiene in Healthcare FacilitiesGHP, August 2017. This fact sheet explores the health care-related risks of poor hygiene and the critical elements of hand hygiene needed to improve quality of care and reduce negative outcomes of poor compliance (e.g., infections and antimicrobial resistance) in HCFs. It also provides recommendations for improving hygiene in health.

Reports/Blog Posts

Every Newborn Deserves Caring, Clean HandsGHP, May 2018. In this blog post, Dr. Pavani K. Ram from the University at Buffalo discusses the importance of hand hygiene, summarizes findings from recent hand hygiene research, and gives a call to action for understanding and responding to the key barriers to hand hygiene among health workers caring for mothers and newborns.
Opinion: Clean Water Is HealthDevex, May 2018. Toyin Ojora-Saraki, founder of the Wellbeing Foundation Africa, states that the global health and development communities can no longer stand by in silence while mothers and newborns die from preventable and unnecessary complications, simply because the most basic of WASH services are not available.
WASH in Healthcare Facilities: Recommendations for DonorsImprove International, February 2018. It is widely acknowledged that access to quality essential health care services cannot be achieved without access to basic WASH services. This blog post provides recommendations to donors for funding WASH in HCFs.
Water and Sanitation for Health Facility Improvement Tool (WASH FIT): A Practical Guide for Improving Quality of Care through Water, Sanitation and Hygiene in Health Care FacilitiesWorld Health Organization (WHO)UNICEF, 2018. WASH FIT is a risk-based, continuous improvement framework with a set of tools for undertaking water, sanitation, and hygiene (WASH) improvements as part of a wider set of improvements in HCFs.
Water, Sanitation, and Hygiene at the Health CenterUSAID Maternal and Child Survival Program (MCSP), February 2017. This two-page brief outlines challenges facing WASH in maternal and perinatal health and proposes actions to address them via improved WASH in HCFs, greater leadership for ministries of health, increased coordination with other sectors, and better accountability.
WASH for Neonatal and Maternal Sepsis Reduction Study: Phase 1 ReportUSAID MCSP, May 2017. The USAID-funded MCSP commissioned this study to investigate the current hygiene practices of health care staff, mothers, and other caregivers from the onset of labor through the first two days of life.
Achieving Quality Universal Health Coverage through Better Water, Sanitation and Hygiene Services in Health Care Facilities: A Focus on Cambodia and EthiopiaWHO, 2017. The situation analyses outlined in this report capture mechanisms that jointly support WASH in HCFs and quality of care improvements. They also identify barriers and challenges to implementing and sustaining these improvements.

National Guidelines for Water, Sanitation and Hygiene in Healthcare Facilities in TanzaniaMinistry of Health, Community Development, Gender, Elderly and Children, October 2017. This guide provides a standardized approach to the provision of WASH services in public and private HCFs throughout Tanzania. It offers guidance for planning and budgeting, as well as technical designing and construction of recommended WASH facilities, operation and maintenance, and monitoring of the performance of services.
Guide to Infection Control in the Hospital: Hand HygieneInternational Society of Infectious Diseases, February 2018. The Guide to Infection Control includes this chapter on hand disinfection methods, the WHO Multimodal Hand Hygiene Strategy, and other topics.

Journal Articles

2018 WHO Hand Hygiene Campaign: Preventing Sepsis in Health Care and the Path to Universal Health CoverageLancet Infectious Diseases, May 2018. Infection and control measures are essential for preventing avoidable infections that can lead to sepsis. Hand hygiene is both the cornerstone and entry point for infection prevention and control. (This article is open access, but a login is required to view/download the full article.)

Environmental Conditions in Health Care Facilities in Low- and Middle-Income Countries: Coverage and InequalitiesInternational Journal of Hygiene and Environmental Health, April 2018. In this report, researchers identify important, previously undocumented inequalities and environmental health challenges faced by HCFs. The information and analyses provided can be used to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources to improve HCF conditions.
Barriers to and Motivators of Handwashing Behavior Among Mothers of Neonates in Rural BangladeshBMC Public Health, April 2018. This thematic analysis explains some of the determinants of maternal handwashing behaviors. Factors adversely impacting handwashing behavior include lack of family support, social norms, perceptions of frequent contact with water as a health threat, and a mother’s restricted movement during the first 40 days of a neonate’s life.
Water Treatment and Handwashing Practices in Rural Kenyan Health Care Facilities and Households Six Years after the Installation of Portable Water Stations and Hygiene TrainingJournal of Water and Health, January 2018. Many HCFs and households in low- and middle- income countries have inadequate access to water for hygiene and consumption. In 2005, handwashing and drinking water stations were installed in 53 HCFs in Kenya, in conjunction with hygiene education for health workers and clinic clients. This study analyzes results six years after the intervention to assess longevity of impact.

An Educational Intervention to Improve Hand Hygiene Compliance in VietnamBMC Infectious Diseases, February 2018. A simple educational model implemented in a Vietnamese hospital was shown to improve hand hygiene compliance for an extended period of time.
Unpacking the Enabling Factors for Hand, Cord and Birth-Surface Hygiene in Zanzibar Maternity UnitsHealth Policy and Planning, July 2017. Maternity units in Zanzibar have substantial gaps in infection prevention practices essential at the time of birth. This study describes areas for further improvement such as knowledge and training and infrastructure, which are becoming increasingly important as more women in Tanzania opt to deliver in HCFs.

Water, Sanitation and Hygiene Infrastructure and Quality in Rural Healthcare Facilities in RwandaBMC Health Services Research, August 2017. In this survey of 17 rural HCFs in Rwanda, 60 percent of water access points were observed to be functional, 32 percent of handwashing locations had water and soap, and 44 percent of sanitary facilities were in hygienic condition and accessible to patients. Regular maintenance of WASH infrastructure consisted of cleaning, while no HCF had on-site capacity for performing repairs.

Impact of Adding Handwashing and Water Disinfection Promotion to Oral Cholera Vaccination on Diarrhoea-Associated Hospitalization in Dhaka, Bangladesh: Evidence from a Cluster Randomized Control TrialInternational Journal of Epidemiology, December 2017. Neither cholera vaccination alone nor cholera vaccination combined with behavior change intervention efforts measurably reduced diarrhea-associated hospitalization in this highly mobile population. Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating feces from the environment, food and water, and with minimal behavioral demands on impoverished communities remain an important area for research.
Approaches to Hand Hygiene Monitoring: From Low to High Technology ApproachesInternational Journal for Infectious Diseases. December 2017. Approaches to monitoring hand hygiene compliance vary from simple methods such as direct observation and product usage to more advanced methods such as automated electronic monitoring systems. Current literature supports a multimodal approach, supplemented by education, to enhance hand hygiene performance.
Awareness of Hand Hygiene Among Health Care Workers of Chitwan, NepalSage Open, October–December 2017. A study was carried out in three hospitals to identify the knowledge and practice of hand hygiene. The results showed that half of the health care workers were lacking in knowledge and practice regarding important components of hand hygiene.


WASH in Health Care Facilities: A Toolbox for Improving Quality of Care. This USAID MCSP microsite includes a toolbox of resources, as well as perspectives and an emerging approach from MCSPs’ experience integrating WASH in support of quality of care improvements that lead to improved health outcomes.

Global Handwashing Partnership (GHP). The GHP is a coalition of international stakeholders working to promote handwashing with soap and advocate for hygiene as a pillar of international development and public health. Their website includes materials, case studies, and publications to support handwashing programs.

Save Lives: Clean Your Hands. This WHO site contains reports and other promotional materials for the annual WHO-led Clean Your Hands campaign.

WASH in Health Care Facilities. WHO provides reports and others resources on this site for users to learn about and improve WASH in HCFs.

WASH FIT Digital. WASH FIT Digital is a free, open-access digital tool, based on the WASH FIT guide developed by WHO and UNICEF. It is designed to help HCFs improve quality of care through improved WASH and includes a set of forms for implementing a risk-based management approach.

If you would like to feature your organization's materials or suggest other content for upcoming issues of Water Currents, please send them to Dan Campbell, Knowledge Creation/WASH Specialist, at dcampbell@waterckm.com.



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