**1. Introduction**

#### **1.1 Infection prevention and control (IPC)**

Infection prevention and control (IPC) is a scientific approach and practical solution designed to prevent harm caused by infection to patients and health workers. In health facilities, IPC cannot be met without water, sanitation, and hygiene (WASH) services that provide the basis for adequate IPC. In the context of COVID-19, poor or inadequate WASH and IPC services and practices lead to transmission of the infection from healthcare facilities to communities and exacerbate the outbreak and spread of infections. The World Health Organization (WHO) in collaboration with the United Nations Children's Fund (UNICEF) 2015 Report underlined the importance of adequate WASH in healthcare facilities for the prevention of infections and spread of disease and for protecting staff and patients' health, dignity, and privacy [1]. WASH services strengthen the resilience of healthcare systems to prevent disease outbreaks, allowing effective responses to emergencies (including natural disasters and outbreaks), and bringing emergencies under control when they occur.

IPC has an immense role in reducing disease transmission generally and in healthcare facilities specifically; this fact has been well established in many studies. Madge et al. (1992) concluded that several IPC measures significantly reduced the incidence of nosocomial respiratory syncytial virus in the sample groups they observed [2]. According to Ershova et al. (2018), in middle-income countries, the employment of the IPC programme was highly effective in preventing nosocomial infection and in reducing antibiotic resistance [3]. Conducting evaluation studies for IPC in healthcare facilities helps find gaps and mistakes that should be corrected for the IPC programme to be more efficient and effective. In Jordan, this type of evaluation is seldom carried out. A survey of nosocomial IPC capacity among radiographers in Jordan reported moderate knowledge of IPC practices and that future training and improvement are needed [4]. Another study was conducted among nurses from 9 different hospitals in Jordan regarding safe injection handling. The study recommended focused and effective infection control educational programmes in Jordanian hospitals [5].

#### **1.2 Water, sanitation, and hygiene (WASH)**

WASH is the acronym of Water, Sanitation, and Hygiene. It has a major impact on public health and its importance is recognized globally. In 2015 members of the United Nations agreed on 17 Sustainable Development Goals; these goals require urgent actions from all countries [6]. The first two targets in SDG 6 (Ensure availability and sustainable management of water and sanitation for all) are focused on the availability of clean affordable water and proper conditions of sanitation and hygiene [7].

Proper WASH conditions are essential for the protection of human health during all types of disease outbreaks including the ongoing COVID-19 pandemic. According to WHO, routinely applied WASH and waste management in homes, communities, schools, marketplaces, and healthcare facilities help to prevent the viral transmission that causes COVID-19 [8]. Prüss et al. (2002) have estimated the global disease burden from water, sanitation, and hygiene to be 4.0 per cent of all deaths and 5.7 per cent of the total disease burden (in DALYs) [9].

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

According to Khader (2017), despite the major advancement Jordan has made in IPC by providing access to drinking water and improving sanitation and health waste management, several areas are yet to be improved in the Jordanian healthcare setting. Also, it is advisable to establish and implement a WASH monitoring system for the healthcare system [10].

#### **1.3 Water**

Water is essential to humans, not only for nourishment but also for better sanitation and hygiene. Each year, about 3,000 children under the age of 5 years old die from diarrhoeal disease resulting from lack of safe drinking water, hygiene, and sanitation; it also causes death to more than 829,000 humans each year [11]. The availability and quality of water are very strong factors in public health. According to the UNICEF, 663 million people do not have access to clean drinking water and nearly 60 million people use untreated water from unsafe sources like rivers [12, 13]. Jordan is ranked as the world's-second most-water scarce country with 100 m<sup>3</sup> per person, 400 m<sup>3</sup> less than the severe water scarcity threshold, and more than 50 per cent receive water once every week [12]. Regarding COVID-19, clean water is very crucial in controlling the pandemic as about 1.8 billion people globally use fecal contaminated water; this water can serve as an alternative route of infection [14]. The Hospital Water Supply as a Source of Nosocomial Infections study by Anaissie et al. (2002) mentioned that an estimated number of 1,400 annual deaths in the United States due to waterborne nosocomial lung infections caused by Pseudomonas aeruginosa alone [15]. A recently published article in Infection Control and Hospital Epidemiology by Stuckey et al. (2020) reviewed the National Health care Safety Network annual reports from 4929 hospitals in the United States. They reported that 1 in 10 hospitals did not have a water management programme and some hospitals did not include some basic practices like water temperature and disinfectant monitoring [16]. Hospitals in Low- and middle-income countries suffer from water shortage. Chawla et al. (2016) reported in their study, a systematic review that included 22 hospital in the LMICs area providing surgical services, that more than one-third of the hospital did not have a reliable water source. They recommended that both governments and non-governmental organizations should direct more effort to enhance the water infrastructure of hospitals [17].

#### **1.4 Medical waste and sanitation facilities**

Medical waste is a dangerous pollutant that may contain viruses, bacteria, chemical substances, and even radioactive waste. It must not be taken for granted as it can act as a source of infection and limit the efforts in controlling an outbreak, not to mention its environmental impact. Since the beginning of COVID-19 pandemic medical waste has increased significantly and managing it became more difficult [18]. It is important to evaluate waste management for an accurate infection prevention assessment. In Jordan, less than 78 per cent of sanitation systems are managed safely and one-third of schools have basic sanitation services [12]. Several studies found that viral materials of the SARS-COV2 virus (RNA) can be found in human waste like blood and stool [19–21]. A recent study by Chen et al. (2020) tested human waste for SARS-COV2 viral shedding and found that fecal samples of COVID-19 patients remained positive for the virus after the pharyngeal swaps turned negative; this means that a patient that tests negative might excrete the virus by fecal route. The study also suggests that the fecal-oral transmission may be another way for this virus to be transmitted. Wastewater epidemiology is a relatively new discipline and it was mainly used to detect drugs in wastewater to

estimate drug use in a population. However, it is now applied to detect pathogens including SARS-COV2 as the first report of its detection in an Australian study by Ahmed et al. (2020) was followed by a number of studies that all recommended a safe wastewater management to help fighting the pandemic [22].
