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

Julie Watson, Lauren D'Mello-Guyett, Erin Flynn, Jane Falconer, Joanna Esteves-Mills, Alain Prual, Paul Hunter, Benedetta Allegranzi, Maggie Montgomery, Oliver Cumming

Research output: Contribution to journalReview article

Abstract

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.

LanguageEnglish
Article numbere001632
JournalBMJ Global Health
Volume4
Issue number4
DOIs
Publication statusPublished - 1 Jul 2019

Keywords

  • health education and promotion
  • hygiene
  • prevention strategies
  • public health
  • systematic review

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Watson, Julie ; D'Mello-Guyett, Lauren ; Flynn, Erin ; Falconer, Jane ; Esteves-Mills, Joanna ; Prual, Alain ; Hunter, Paul ; Allegranzi, Benedetta ; Montgomery, Maggie ; Cumming, Oliver. / 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. In: BMJ Global Health. 2019 ; Vol. 4, No. 4.
@article{14cc065954434ede9c233ffb318f9745,
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",
abstract = "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.",
keywords = "health education and promotion, hygiene, prevention strategies, public health, systematic review",
author = "Julie Watson and Lauren D'Mello-Guyett and Erin Flynn and Jane Falconer and Joanna Esteves-Mills and Alain Prual and Paul Hunter and Benedetta Allegranzi and Maggie Montgomery and Oliver Cumming",
year = "2019",
month = "7",
day = "1",
doi = "10.1136/bmjgh-2019-001632",
language = "English",
volume = "4",
journal = "BMJ Global Health",
issn = "2059-7908",
publisher = "BMJ Publishing Group",
number = "4",

}

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. / Watson, Julie; D'Mello-Guyett, Lauren; Flynn, Erin; Falconer, Jane; Esteves-Mills, Joanna; Prual, Alain; Hunter, Paul; Allegranzi, Benedetta; Montgomery, Maggie; Cumming, Oliver.

In: BMJ Global Health, Vol. 4, No. 4, e001632, 01.07.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - 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

T2 - BMJ Global Health

AU - Watson, Julie

AU - D'Mello-Guyett, Lauren

AU - Flynn, Erin

AU - Falconer, Jane

AU - Esteves-Mills, Joanna

AU - Prual, Alain

AU - Hunter, Paul

AU - Allegranzi, Benedetta

AU - Montgomery, Maggie

AU - Cumming, Oliver

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

KW - health education and promotion

KW - hygiene

KW - prevention strategies

KW - public health

KW - systematic review

UR - http://www.scopus.com/inward/record.url?scp=85068823703&partnerID=8YFLogxK

U2 - 10.1136/bmjgh-2019-001632

DO - 10.1136/bmjgh-2019-001632

M3 - Review article

VL - 4

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

IS - 4

M1 - e001632

ER -