Safe Water, Basic Sanitation And Waste Management In Health-Care Settings

The month of October every year is observed as the sanitation month by the government of Bangladesh. The ministry of LGRD and Cooperatives along with the Department of Public Health Engineering, UNICEF and WHO undertakes a number of programmes to review the progress of works concerning safe water supply, arsenic mitigation, waste management and installation of sanitary latrines throughout the country in order to reach the target of sanitation for all by 2010

Health-Care Facilities Require:

Access to safe water; low risks to health from microorganisms like Legionella and Pseudomonas that grow in the environment; and physically clean surfaces and tools. Safe disposal of wastes generated ranges from the excreta of patients, staff and visitors to high risk health-care wastes and especially needle-syringes or blood.

These apply across a range of facilities from the reference hospital to the village health posts; residential care accommodation, dental facilities and so on to include home based care.

What Actions are Most Urgent in Relation to Water, Sanitation and Health?

The three top priorities are the provision of sufficient quantities of safe water, basic sanitation arrangements and promotion of good hygiene behaviours.

The first priority is to provide an adequate quantity of water, even if its safety cannot be guaranteed, and to protect water sources from contamination. A minimum of 15 litres per person per day should be provided as soon as possible, though in the immediate post-impact period, it may be necessary to limit treated water to a minimum of 7.5 litres per day per person. During emergencies, people may use an untreated water source for laundry, bathing, etc. Water-quality improvements can be made over succeeding days or weeks.

Major health risks due to inadequate excreta disposal arise after disasters. Where normal sanitation structures have been damaged or destroyed it is essential to provide toilet facilities immediately. Emergency facilities are usually provisional and need to be progressively improved or replaced as the situation develops.

Following damage to existing systems, or when parts of a city receive large numbers of displaced or homeless people, so putting increased pressure on facilities that may already be under strain, a rapid assessment of damage and needs is required to decide what emergency actions to take.

Designated defecation fields or areas can be used where enough space is available. These work best in hot, dry climates and should be clearly marked, fenced (if possible), and protected against flooding. They should be located downwind and away from living areas, avoid water courses, and at a reasonable distance (minimum 50m) from water points. Shovels should be provided to families so that they can dig small holes to defecate into and cover their faeces with soil. Collective trench latrines may also be an option. In longer term situations or after the initial emergency period has subsided, it may be more practical to build simple pit latrines, ventilated improved pit (VIP) latrines, or poor-flush latrines. In situations where the soil is rocky or the ground water is very close to the surface, elevated platforms may be constructed. Latrines of all types need to be properly cleaned and maintained. Responsibilities for cleaning and maintaining latrines should be clearly spelled out. For collective latrines it may be necessary to hire someone to take care of them.

The immediate response may also include establishing or reinforcing sewage evacuation services, to bypass blocked sewers or to carry out intensive septic tank or latrine emptying in periurban areas. Every effort should be made to allow people to use their existing toilets, through temporary repairs to broken sewers and sewage treatment works.

In all cases, good hygiene practices are very important for preventing disease transmission. Water should be provided in sufficient quantities to enable proper hygiene. Hands should be washed immediately after defecation, after handling babies’ faeces, before preparing food and before eating.

Other environmental health interventions might be crucial as indicated in the subsequent questions and answers.

Support to The Overall Achievement of The MDGs

Safe drinking water and basic sanitation is of direct relevance to Goal 5 on maternal health with an estimated 529 000 maternal deaths per year and supportive of other Millennium Development Goals, especially those on major diseases and infant mortality.
Hospital-associated infections contribute to morbidity and mortality and to loss of health sector resources worldwide. Five to 30 per cent of patients a year develop one or more infections during a stay in hospital, a significant percentage which could be avoided. In crisis or precarious situations the number of infections worsens and in some circumstances people may choose not to seek care because the nearest facilities are not functioning or because they know that treatment is uncertain due to shortages of water, electricity or supplies.

Unsafe health care settings contribute a significant proportion of some diseases. Legionellosis is a well-established risk associated with health care facility with an average proportion of nosocomial infections close to 10 per cent.

Sharps waste, although produced in small quantities, is highly infectious. Contaminated needles and syringes represent a particular threat because they are sometimes scavenged from waste areas and dump sites and then reused. Poorly managed, they expose health-care workers, waste handlers and the community to infections. WHO estimates that, in 2000, injections with contaminated syringes caused: 21 million hepatitis B virus (HBV) infections (32 per cent of all new infections); two million hepatitis C virus (HCV) infections (40 per cent of all new infections); and 260 000 HIV infections (5 per cent of all new infections).

In 2002, the results of a WHO assessment conducted in 22 developing countries showed that the proportion of health-care facilities that do not use proper waste disposal ranges from 18 per cent to 64 per cent. The development and implementation of national policies, guidelines on safe practices, training and promotion of effective messages in a context of healthy medical facility will decrease the number of health-care settings associated infections. This will also impact on visitors and will be reflected in communities through good practices in safe water, sanitation and hygiene.

The burden of disease can be pulled down massively and with a very favorable cost benefit ratio. In 1999 in England alone hospital acquired infections cost the health service 1 billion Pounds a year and that 15 per cent of them were potentially avoidable. The underlying driving forces suggest that this problem is getting worse. World-wide there is increasing provision of health care, increasing complexity of that health care, an increasing proportion of the population that is immunocompromised (and therefore more susceptible to health care related infection) and without effective action the situation is therefore likely to deteriorate.

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