Water and Sanitation hygiene (WASH) is a prerequisite and very important factor for the safe management of healthcare facilities. WASH in healthcare facilities plays a vital role to lower the risk of infection not only among patients but also among the visitors and healthcare workers.

World Health Organization (WHO) targets to secure at least basic WASH services in 60% of all health care facilities globally by 2022, 80% basic WASH services by 2025, and 100% basic WASH services by 2030 for which WHO has published practical steps and believes will improve WASH in health care facilities.

One of the steps states that, all the workers engaged in the healthcare system, from doctors, to nurses, midwives, and cleaners should have access to up-to-date information on WASH and infection prevention and control practices during pre-service training and as part of regular professional development.

Although, doctors and nurses have knowledge and practice WASH, most of the lower level staffs including cleaners and midwives are not totally familiar with the concept.

For instance, Pita Musifal, an office helper in Bhaktapur Hospital, when asked about how she implements WASH in her daily work, she couldn’t answer it because she was clueless about the term WASH.

Later, after explaining that WASH at healthcare facilities refers to the provision of water, sanitation, healthcare waste management, hygiene and environmental cleaning infrastructure, and services across all parts of a facility – she explained that even though she was responsible for cleaning wards, patients’ transfer, disposing of waste – she was not provided with any kind of formal training to do so.

In term of waste management, she explained that the hospital had three different bins labelled: Disposable, Non-Disposable and Sharp Needles. However, the waste is later thrown into the same garbage truck, rendering the segregation of waste at the hospital meaningless.

It is an irony how a person whose responsibility is to keep the hospital clean and hygienic, has not been briefed and trained about the importance of WASH. In addition, the failure to address WASH in healthcare facilities compromises the most important aspect of health care – quality of care.

A ward cleaner of Civil Hospital, Iswori Pariyar, said, “I haven’t received any training related to WASH but we are told to be more attentive and precise ever since the emergence of the coronavirus pandemic.”

“Earlier we used cleaning chemicals for floors but now we also add ‘Dettol’ in the cleaning process. We are told to ‘clean door handles too’ which we wouldn’t do prior to the pandemic. We are provided with PPE that includes a gown, mask, gloves and boots.” she said.

Approximately, 80% of the 78 countries that participated in WHO-led Global Analysis and Assessment of Sanitation and Water (GLAAS) a 2017 survey reported that they had a policy for WASH or infection prevention and control, but fewer than 25% of these policies were fully funded and implemented.

The lack of funding for WASH leads to Health care–associated infections (HAIs) linked to the spread of antimicrobial-resistant infections, placing patients and staff at risk of serious infections that are hard to treat.

In 2011, an estimated 721,800 HAIs occurred in the United States, leading to 75,000 deaths. In 2010, unsafe injections were responsible for as many as 33,800 new HIV infections, 1.7 million hepatitis B infections, and 315,000 hepatitis C infections.