**4. Results**

#### **4.1 Health centres' characteristics**

A total of 33 healthcare centres were assessed using WASH and IPC assessment tools. One-third of these centres (n = 11, 33.3 per cent) were primary healthcare centres and 22 (66.7 per cent) were comprehensive health centres. Of all assessed health centres, 39.4 per cent were in the North of Jordan, 33.3 per cent in the Middle and 27.3 per cent in the South of the country.

**Table 1** shows the characteristics and capacity of the 33 assessed health centres in Jordan. Primary healthcare centres were more consistent in the number of the medical staff they have than comprehensive healthcare centres; the median number of medical staff in each category was two for most specialties, while the median number of medical staff in the comprehensive healthcare centres ranged from two to six.

#### **4.2 The WASH and IPC indicators**

**Table 2** shows the mean percentage of WASH and IPC indicators over health centres that met the targets for each assessed area in both the primary and comprehensive healthcare centres. Each assessed area has a different number of indicators. The mean percentages of indicators that met the targets considerably varied among various WASH/IPC areas and type of health centres.

Almost 61.7 per cent of water indicators in all health centres (64.9 per cent in comprehensive health centres and 55.2 per cent in primary centres) met the targets. However, only half of the medical waste and sanitation indicators (49.1 per cent) met the target. Almost two-thirds of hand hygiene indicators (64.2 per cent) and


*Water, Sanitation, and Hygiene (WASH) and Infection Prevention and Control (IPC)… DOI: http://dx.doi.org/10.5772/intechopen.99523*

#### **Table 1.**

*The characteristics and capacity of the 33 assessed health centres in Jordan.*

environmental cleanliness and disinfection indicators (65.0 per cent) met the target. Only 41.8 per cent of management indicators (27.3 per cent in primary centres and 49.1 per cent in comprehensive centres) met the targets. While two-thirds of indicators pertaining to guidelines in IPC unit met the target, only 40.3 per cent of basic indicators of IPC programming, 38.4 per cent of indicators of the training and education for the Infection Prevention and Control Unit, and 43.4 per cent of the targets for healthcare-associated infection monitoring indicators were met. Moreover, 66.3 per cent of 'Monitoring/auditing of infection control practices and outcomes' indicators, 62.6 per cent of 'Personal protective equipment' indicators, 55.8 per cent of the 'Availability of hygiene materials' indicators, 44.7 per cent of the 'Training and education' indicators, 38.8 per cent of the 'Respiratory safety' indicators, and 48.5 per cent of the 'Environmental cleaning' indicators met the targets. The mean percentages of 'COVID-19 precautionary measures' indicators (49.7 per cent) that met the target were relatively low in both types of healthcare centres.

As expected, the mean percentages of indicators that had met the targets were higher for comprehensive healthcare centres than that for primary centres in all assessed WASH/IPC areas. For example, the mean percentage of 'respiratory safety' indicators in primary healthcare centres (14.5 per cent) was much lower than the mean percentage of 'respiratory safety' indicators in comprehensive healthcare centres (50.9 per cent).

#### **4.3 Water indicators**

The percentage of primary healthcare centres that met the target for most water indicators were lower than comprehensive care centres, except for a few indicators, as demonstrated in **Table 3**. The percentage of health centres that met water indicators varied between 21.2 per cent and 100 per cent. Improved drinking-water supply and the availability of hot water was weak in both primary and comprehensive healthcare centres. Less than two-thirds of centres had clean drinking-water available and accessible to all at all times and in all locations, had drinking-water safely stored in a clean bucket/tank with cover and tap, had water tanks cleaned annually, had an emergency water tank available, and had hot water available in the health centres. On the other hand, meeting the target for indicators related to the availability and functionality of water supply was high in both types of healthcare centres, and even higher in primary care centres, reaching 100 per cent.


#### **Table 2.**

*The mean percentage of indicators that met the targets in each assessed area.*

Fortunately, the percentage of healthcare centres that fully met the target was greater than the percentage of centres that partially met the target for almost all the indicators related to water.

#### **4.4 Medical waste and sanitation**

The targets for many indicators related to toilet provision were met by very few primary healthcare centres and relatively few comprehensive healthcare centres. In addition to the low percentage of centres that met targets for indicators pertaining to the number, functionality, and monitoring of toilets, there were few, if any, toilets that serve people with special needs, or toilets designed to meet menstrual hygiene needs. The difference in the percentage of centres that met the targets for

**Water Primary centres (N = 11) Comprehensive (N = 22) Total (N = 33) Partially meet target Meet target Partially meet target Meet target Partially meet target Meet target n % n% n %n% n % n%** 2 18.2 1 9.1 4 18.2 6 27.3 6 18.2 7 21.2 Water services available at all times and of sufficient quantity for all uses 2 18.2 5 45.5 2 9.1 17 77.3 4 12.1 22 66.7 A clean drinking-water is available and accessible for staff, patients and healthcare providers at all times and in all locations/wards 2 18.2 5 45.5 6 27.3 14 63.6 8 24.2 19 57.6 Drinking-water is safely stored in a clean bucket/tank with cover and tap 5 45.5 5 45.5 7 31.8 14 63.6 12 36.4 19 57.6 Water tanks are cleaned annually 0 0.0 4 36.4 0 0.0 10 45.5 0 0.0 14 42.4 Emergency water tank is available 0 0.0 2 18.2 0 0.0 13 59.1 0 0.0 15 45.5 All water end points (i.e., taps) in the health centre are connected to an available and functioning water supply 0 0.0 10 90.9 5 22.7 17 77.3 5 15.2 27 81.8 Water services are available throughout the year (i.e., not affected by seasonality, climate change-related extreme events or other constraints) 0 0.0 11 100 0 0.0 22 100 0 0.0 33 100 Water storage is sufficient to meet the needs of the health centre for two days 0 0.0 11 100 0 0.0 21 95.5 0 0.0 32 97.0 Water is treated and collected for drinking with standards that meet WHO performance standards 0 0.0 8 72.7 3 13.6 15 68.2 3 9.1 23 69.7 Drinking-water has appropriate chlorine residual (0.2 mg/L or 0.5 mg/L in emergencies) or 0 *E. coli*/100 ml and is not turbid 0 0.0 7 63.6 3 13.6 17 77.3 3 9.1 24 72.7 The health centre water supply is regulated according to national water quality standards 0 0.0 9 81.8 0 0.0 21 95.5 0 0.0 30 90.9 Hot water is available in the health centre 4 36.4 3 27.3 13 59.1 4 18.2 17 51.5 7 21.2 Water heating indicator is available 0 0.0 4 36.4 0 0.0 9 40.9 0 0.0 13 39.4

*Water, Sanitation, and Hygiene (WASH) and Infection Prevention and Control (IPC)… DOI: http://dx.doi.org/10.5772/intechopen.99523*

#### **Table 3.**

*Percentage of health centres that meet the target for each indicator of 'Water' according to the type of health Centre.*

indicators pertaining to toilets was obvious between comprehensive and primary healthcare centres (**Table 4**).

Some targets were met by most primary and comprehensive healthcare centres, such as wastewater management (72.7 per cent and 77.3 per cent, respectively), and disposal of domestic waste (90.9 per cent and 100 per cent, respectively). However, the percentage of primary centres that met the target for indicators like sorting of waste and the availability of a trained liaison officer for waste management were higher than comprehensive healthcare centres.
