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6.3.2 & 6.3.5
Hygiene and sanitation
Hygiene
WHO EMT TECHNICAL INFORMATION
EMTs should ensure that staff and patients can practice hand hygiene throughout the facility by promoting access to culturally appropriate materials and places for handwashing, as well as adequate access to showers, safe spaces and materials for personal and menstrual hygiene.
Effective hand hygiene in health-care facilities has been the cornerstone of infection prevention and control and is the primary measure for preventing health-care associated infections and the spread of antimicrobial resistance. It is essential for EMTs to provide handwashing facilities with soap and water in clinical areas and toilets.79 Staff and patients need access to showers and water points for personal hygiene in gender-segregated areas. Women and girls must have culturally adequate access to safe spaces with adequate washing facilities and products to perform menstrual hygiene management (MHM). EMT staff should understand the practices, norms and beliefs associated with MHM in local communities.
WHO EMT MINIMUM TECHNICAL STANDARD
Hand Hygiene
- Provision of handwashing stations80 in clinical areas, including each ward, OT, emergency room, delivery room, isolation units, outpatient clinics and other clinical, laboratory and similar health-care and other services areas.
- Provision of hand hygiene stations with hand disinfectant/alcohol handrub solution in any clinical area.
- Provision of handwashing stations within 5 meters of the toilets, at food preparation and food consumption areas, and between clinical and staff rest area transition points.
- There should be at least two hand hygiene stations in a ward with more than 20 beds.
- Clearly visible and understandable hand hygiene information, education and communication (IEC) promotion materials to be placed at key locations.
Personal
- Set up adequate and separate showers (for men and women) for inpatients and staff in an accessible and safe area.
- Provide hygiene materials to patients for their use in the health facility with special consideration for those with reduced mobility, special conditions due to their disease or cultural concerns.
- Display posters on best practices in personal hygiene and respiratory etiquette.
- Provision of suitable spaces within inpatient facilities for women and girls to carry out menstrual hygiene practices, including washing facilities within toilet areas.
Guidance Notes
- WHO recommends handrub formulas for local production, all alcohol-based with ingredients easily accessible.
- Food preparation facilities should be carefully kept clean and respect the Five Keys to Safer Food.
Sanitation
WHO EMT TECHNICAL INFORMATION
EMTs must ensure that patients, staff and caregivers have accessible, appropriate, safe and sufficient facilities and well-documented procedures in place for management of excreta and grey and storm water to limit disease transmission.
EMTs should have accessible, safe, clean and culturally appropriate toilet facilities for patients waiting for and undergoing treatment. Sanitation in health-care facilities should ensure the hygienic separation of excreta from human contact. Sanitation facilities are also important for dignity and human rights and have an important gender element, as toilets should ensure privacy and safety for the needs of women and girls. Grey and black water waste management, possibly supplemented by a sewage treatment plant on site, meaning a septic tank with subsequent drainage pit, provisional retention system, or safe sewage disposal directly into a functioning sewer system are the top priority of EMT sanitation policies.
WHO EMT MINIMUM TECHNICAL STANDARD
- Provide adequate and sustainable sanitation facilities for all team members and locally engaged staff, as well as sanitation facilities for outpatient and inpatient care adapted to children.
- Toilets and sinks for staff and patients should be clearly separated and marked.
- Calculate the proportion of toilets per user type (inpatient, outpatient, staff) following recommended ratio (toilet/per person) considering gender ratio, people with disabilities, children and isolation patients.
- Outpatients 1 : 50
- Inpatients 1 : 20
- Team members 1 : 20
- Isolation patients 1 : 20 (for cohorted isolation)
- Isolation patients 1 : 1 (for individual isolation)
At least one gender-neutral toilet must be accessible to users with reduced mobility, in line with standards.
- Availability of sanitation systems that can be adapted to different local soil conditions (soft/hard) and ground water levels as well as adapted to local cultural behaviours.99
- Plan for the accessibility component for management and maintenance of sewage tanks, drainage/sewer shafts.
- Ensure adequate lighting and locking mechanisms within toilets and showers which should be clearly marked and located close enough to wards and patient areas to provide safe access in a way that reduces the risk of violence, especially sexual and gender-based violence (SGBV).100
- Plan alternatives for safe faecal sludge and grey water management through containment and on-site treatment in case local structures are inaccessible.
WHO EMT RECOMMENDATIONS FOR OPTIMAL PATIENT CARE
- Faecal sludge should be emptied and transported in a way that protects service providers, families, communities and the environment.
- Plan the deployment of basic first-phase sanitation solutions to be used during the setup of the facility.
Guidance Notes
- Solutions to adopt during the first phase of the response include portable toilet with plastic bag and absorbent granules, packet latrines, bucket latrines, commode latrine and chemical toilets.
- Particular attention needs to be paid to infectious grey water produced in sterilization or in isolation wards.