Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review
Introduction Healthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are...
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BMJ Publishing Group
2019-07-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/4/e001632.full |
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| author | Benedetta Allegranzi Julie Watson Lauren D'Mello-Guyett Erin Flynn Jane Falconer Joanna Esteves-Mills Alain Prual Paul Hunter Maggie Montgomery Oliver Cumming |
| author_facet | Benedetta Allegranzi Julie Watson Lauren D'Mello-Guyett Erin Flynn Jane Falconer Joanna Esteves-Mills Alain Prual Paul Hunter Maggie Montgomery Oliver Cumming |
| author_sort | Benedetta Allegranzi |
| collection | DOAJ |
| description | Introduction Healthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, there have been no systematic reviews to date.Methods As per our prepublished protocol, we systematically searched academic databases, trial registers, WHO databases, grey literature resources and conference abstracts to identify studies assessing the impact of HCF WASH services and practices on HCAIs in LMICs. In parallel, we undertook a supplementary scoping review including less rigorous study designs to develop a conceptual framework for how WASH can impact HCAIs and to identify key literature gaps.Results Only three studies were included in the systematic review. All assessed hygiene interventions and included: a cluster-randomised controlled trial, a cohort study, and a matched case-control study. All reported a reduction in HCAIs, but all were considered at medium-high risk of bias. The additional 27 before-after studies included in our scoping review all focused on hygiene interventions, none assessed improvements to water quantity, quality or sanitation facilities. 26 of the studies reported a reduction in at least one HCAI. Our scoping review identified multiple mechanisms by which WASH can influence HCAI and highlighted a number of important research gaps.Conclusions Although there is a dearth of evidence for the effect of WASH in HCFs, the studies of hygiene interventions were consistently protective against HCAIs in LMICs. Additional and higher quality research is urgently needed to fill this gap to understand how WASH services in HCFs can support broader efforts to reduce HCAIs in LMICs.PROSPERO registration number CRD42017080943. |
| format | Article |
| id | doaj-art-b7bb6900147a4e98972c5fd3ea804b3b |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-b7bb6900147a4e98972c5fd3ea804b3b2025-08-20T01:56:38ZengBMJ Publishing GroupBMJ Global Health2059-79082019-07-014410.1136/bmjgh-2019-001632Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping reviewBenedetta Allegranzi0Julie Watson1Lauren D'Mello-Guyett2Erin Flynn3Jane Falconer4Joanna Esteves-Mills5Alain Prual6Paul Hunter7Maggie Montgomery8Oliver Cumming9World Health Organization, Geneva, SwitzerlandDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKLondon School of Hygiene & Tropical Medicine, London, UKInfection and Immunity, South Australian Health and Medical Research Institute, Adelaide, South Australia, AustraliaLibrary and Archives Service, London School of Hygiene and Tropical Medicine, London, UKDisease Control, London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, London, UKRegional Office for Western and Central Africa, UNICEF, Dakar, Senegal2 Sport Physiotherapy Canada, Ottawa, Ontario, CanadaWorld Health Organization, Geneva, SwitzerlandDepartment of Disease Control, London School of Hygiene & Tropical Medicine, London, UKIntroduction Healthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, there have been no systematic reviews to date.Methods As per our prepublished protocol, we systematically searched academic databases, trial registers, WHO databases, grey literature resources and conference abstracts to identify studies assessing the impact of HCF WASH services and practices on HCAIs in LMICs. In parallel, we undertook a supplementary scoping review including less rigorous study designs to develop a conceptual framework for how WASH can impact HCAIs and to identify key literature gaps.Results Only three studies were included in the systematic review. All assessed hygiene interventions and included: a cluster-randomised controlled trial, a cohort study, and a matched case-control study. All reported a reduction in HCAIs, but all were considered at medium-high risk of bias. The additional 27 before-after studies included in our scoping review all focused on hygiene interventions, none assessed improvements to water quantity, quality or sanitation facilities. 26 of the studies reported a reduction in at least one HCAI. Our scoping review identified multiple mechanisms by which WASH can influence HCAI and highlighted a number of important research gaps.Conclusions Although there is a dearth of evidence for the effect of WASH in HCFs, the studies of hygiene interventions were consistently protective against HCAIs in LMICs. Additional and higher quality research is urgently needed to fill this gap to understand how WASH services in HCFs can support broader efforts to reduce HCAIs in LMICs.PROSPERO registration number CRD42017080943.https://gh.bmj.com/content/4/4/e001632.full |
| spellingShingle | Benedetta Allegranzi Julie Watson Lauren D'Mello-Guyett Erin Flynn Jane Falconer Joanna Esteves-Mills Alain Prual Paul Hunter Maggie Montgomery Oliver Cumming Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review BMJ Global Health |
| title | Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review |
| title_full | Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review |
| title_fullStr | Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review |
| title_full_unstemmed | Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review |
| title_short | Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review |
| title_sort | interventions to improve water supply and quality sanitation and handwashing facilities in healthcare facilities and their effect on healthcare associated infections in low income and middle income countries a systematic review and supplementary scoping review |
| url | https://gh.bmj.com/content/4/4/e001632.full |
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