**4.5 Hygiene**

### *4.5.1 Hand hygiene*

Hand hygiene indicators were generally good at both the primary and the comprehensive healthcare centres; there were more centres that fully met the target than centres that partially met the target (**Table 5**). Over 70 per cent of healthcare centres were reported to have functioning and adequately available hand-hygiene stations that were supplied with water and soap. However, almost half of the centres had clearly displayed sign boards for hand hygiene (posters), had functioning hand-hygiene stations in waste disposal areas, and had regular hand-hygiene compliance activities.

#### *4.5.2 Environmental cleanliness and disinfection*

The target for many indicators for cleanliness and disinfection were met by most healthcare centres (**Table 6**). The percentage of primary healthcare centres that met the target was close to the percentage for comprehensive healthcare centres, but were quite different for centres that partially met the target. Two indicators —'record of cleaning' and 'laundry facilities'—were met by few centres only, and one-third of healthcare centres provide at least two pairs of gloves, apron, and boots for each cleaning and waste disposal staff member.

#### **4.6 Management**

Less than half of healthcare centres met the target for indicators related to the management of WASH, except for the availability of 'a dedicated WASH or IPC coordinator' and 'a written job description that is clear and legible for all staff' which were achieved by 57.6 per cent of centres. An annual planned budget for the centre that includes WASH infrastructure and service was available at 15.2 per cent of centres only, with none of the primary healthcare centres having completely met the target. However, there was a higher percentage of healthcare centres that completely met the target than those that partially met the target, except for few indicators in the primary healthcare centres like the availability of an annual budget, a protocol for operation and maintenance, and the availability of cleaners and WASH maintenance staff (**Table 7**).

#### **4.7 Infection prevention and control programme**

#### *4.7.1 Basic indicators*

One-third of primary healthcare centres (36.4 per cent) and two-thirds of comprehensive healthcare centres (63.6 per cent) have an IPC programme. Nonetheless, an IPC team or focal person was not available at most healthcare centres (**Table 8**). IPC objectives were clearly defined in 42.4 per cent of the health centres. Although the leadership in most healthcare centres shows full commitment to support the IPC programme in the centre, most centres lack the ability to support an appropriate


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


#### **Table 4.**

*Percentage of health centres that meet the target for each indicator of "medical waste and sanitation" according to the type of health Centre.*


#### **Table 5.**

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

IPC system, such as a microbiological laboratory (33.3 per cent) or an early-detection system (15.2 per cent).

#### *4.7.2 Guidelines in IPC unit*

A higher percentage of comprehensive healthcare centres met the targets compared to primary healthcare centres for all indicators of the IPC guideline (**Table 9**). Almost 48.5 per cent of health centres have policies and procedures for disease

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


#### **Table 6.**

*Percentage of health centres that meet the target for each indicator of 'environmental cleanliness and disinfection in the health Centre' according to the type of health Centre.*

outbreak management and a preparedness system, 45.5 per cent have policies and procedures for antibiotic usage, 48.5 per cent of health centres had trained healthcare workers on the new or updated IPC guidelines, and 57.6 per cent of


#### **Table 7.**

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

health centres regularly monitor the implementation of at least some of the IPC guidelines in the health centre.

Further, there was a large difference between the percentage of primary healthcare centre and comprehensive healthcare centres that met the target for the following indicators: the availability of policies and procedures for transmissionbased precautions (45.5 per cent versus 86.4 per cent), policies and procedures for prevention of infection during treatment (36.4 per cent versus 77.3 per cent), and


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

#### **Table 8.**

*Percentage of health centres that meet the target for each indicator of 'infection prevention and control programme: Basic indicators' according to the type of health Centre.*

monitoring the implementation of at least some of the IPC guidelines (27.3 per cent versus 72.7 per cent).

#### *4.7.3 Training and education for the infection prevention and control unit*

Although 60.6 per cent of health centres have an employee who leads the IPC training, healthcare workers, cleaners or other workers receiving training in IPC is reported by few centres (27.3 per cent); primary (18.2 per cent) or comprehensive (31.8 per cent). However, some centres were reported to have partially met the target; about one-third of centres met the target for receiving training regarding IPC for healthcare workers (39.4 per cent) and cleaners (33.3 per cent) (**Table 10**).

#### *4.7.4 Healthcare-associated infection monitoring*

Surveillance was mainly conducted for epidemic-prone infections, as indicated by almost two-thirds of healthcare centres (60.6 per cent). Furthermore, surveillance for colonization or infections caused by multidrug-resistant pathogens was conducted by about one-fifth of healthcare centres (21.2 per cent), and about a half of them (48.5 per cent) conducted surveillance for infections that may affect healthcare workers in clinical, laboratory, or other settings, like the hepatitis virus (**Table 11**).


#### **Table 9.**

*Percentage of health centres that meet the target for each indicator of 'guidelines in IPC unit' according to the type of health Centre.*

#### *4.7.5 Monitoring/auditing of infection control practices and outcomes*

The targets for some infection control practices were well met by most comprehensive healthcare centres. For instance, monitoring of cleaning and disinfection was performed in 100 per cent of comprehensive healthcare centres and monitoring alcohol-based hand rub was performed in 95.5 per cent of them. In contrast, a low percentage of primary healthcare centres met the target for any indicator, except for disinfection and alcohol-based hand rub monitoring indicators, which were at 81.8 per cent each (**Table 12**).

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


#### **Table 10.**

*Percentage of health centres that meet the target for each indicator of 'training and education for the infection prevention and control unit' according to the type of health Centre.*


#### **Table 11.**

*Percentage of health centres that meet the target for each indicator of 'healthcare-associated infection monitoring' according to the type of health Centre.*

Monitoring of transmission-based precautions to prevent the spread of multidrugresistant organisms (MDRO) was conducted by about one-quarter of primary healthcare centres (27.3 per cent) and one-fifth of comprehensive healthcare centres (22.7 per cent).

#### *4.7.6 Personal protective equipment*

There was a considerable wide range of difference for PPE indicators in the percentage of healthcare centres that met the target. Some indicators such as 'HCP


#### **Table 12.**

*Percentage of health centres that meet the target for each indicator of 'monitoring/auditing of infection control practices and outcomes' according to the type of health Centre.*

do not wear the same gown for the care of more than one patient' and 'wearing protection for the mouth, nose, and eyes during procedures that are likely to generate splashes or sprays of blood or other body fluids' were met by 36.4 per cent and 39.4 per cent of centres, respectively. Comparatively, other indicators, such as 'wearing gloves' and 'replacing gloves after each patient' were met by 90.9 per cent and 81.8 per cent of centres, respectively, as illustrated in **Table 13**. A higher percentage of comprehensive healthcare centres met the target compared to primary healthcare centres for all indicators.
