Water Sanitation Health

Clean care is safer care - Clean environment

Address by Dr Jamie Bartram, Coordinator, Water, Sanitation and Health Programme, Protection of the Human Environment Department for The World Alliance for Patient Safety, May 2005

Dear colleagues

I would like to thank the organizers for the opportunity to be here and speak this evening, for all of those who have chosen to spend time here and also the Health System Policies and Operations Department / Evidence and Information for Policy cluster for the initiative of pushing forward the World Alliance for Patient Safety. The initiative provides an excellent opportunity to deliver added value by bringing together the actions of different parts of WHO with outside partners in a concerted initiative.

"Clean Environment" somehow sounds a little vague and maybe a little remote from the hard edged concerns of delivering an effective health service and I would like to reflect on why it is at the heart rather than at the periphery of health services and outlining what we are doing to both try to make it a reality and to try to ensure that the real and massive gains for health that are achievable are also achieved.

What do we mean by 'clean environment'? We mean both:

  • the clean environment that health-care facilities require - access to safe water, low risks to health from microorganisms like Legionella and Pseudomonas proliferating in the environment as well as the physical cleanliness of the surfaces and tools used
  • safe disposal of wastes generated - ranging from the excreta of patients staff and visitors to high risk health care wastes and especially needle-syringes or blood.

And we mean these across a wide range of facilities from the reference hospital to the village health post; residential care accommodation, dental facilities and so on to include home based care.

There are four reasons why this issue is ripe for increased attention

  • firstly the known burden of disease is high. Safe drinking water and basic sanitation is of direct relevance to (the goal on) maternal health with an estimated 529 000 maternal deaths per year and supportive of the Millennium Development Goals, especially those on major diseases and infant mortality. Legionellosis is a well-established risk associated with health care facility with an average proportion of nosocomial cases close to 10%.
  • secondly that burden of disease can be pulled down massively and with a very favorable cost benefit ratio (In 1999 in England alone Hospital Acquired Infections cost the health service 1 billion Pounds a year and 15 per cent of them are potentially avoidable).
  • thirdly because the underlying driving forces suggest that this problem is getting worse. World-wide we see increasing provision of health care, increasing complexity of that health care, an increasing proportion of the population that is immunocompromised (and therefore more susceptible to health care related infection) from a variety of causes including especially HIV/AIDS; an increasing ageing population.
  • and finally because the international policy environment now calls for attention to this. The outcome of the recent 13th session of the Commission on Sustainable Development noted that investments in water and sanitation contribute to better health and must be focused on areas of greatest needs and greatest impact notably health centers while the United Nations Secretary General and Millennium Project have both highlighted the importance of rapidly addressing 'quick wins' - identifying specifically provision to health-care facilities.

And we see three major areas of benefit from such increased attention:

  • firstly a direct reduction in disease risk
  • secondly that reduced risk translates directly into reduced costs to both the health sector and to the affected population
  • thirdly the health care facility serves as an educational and example environment that contributes to better 'clean environment' also at home, at work and in other settings, multiplying the potential benefits over again

So finally what are we doing within PHE/WSH at WHO HQ to contribute to taking this forward? Some specific examples that reflect the core functions of WHO:

  • in setting, validating and monitoring norms and standard we have published "Guidelines for Waste Management in Health Care Settings" and will finalize later this year "Water and Sanitation Minimum Standards in Health Care Settings and Schools"
  • in developing tools and guidelines for disease control and risk reduction we will publish this year guides on "Legionella and the prevention of Legionellosis" and "Management of Wastes from Blood Transfusion Activities" And next year, guidance on "Water Safety in Public Buildings" including health care facilities
  • In support of developing ethical and evidence based policy we have produced a series of policy papers for example on "safe health care waste management"
  • in stimulating research and development and testing new technologies we have worked with practitioners and academic institutions in testing and verifying health care management options for resource poor settings

But the principal focus of action is at country level:

  • all six regional offices of the Organization have Health Care Waste and Water Sanitation and Health in Health Care Facilities activities in hand
  • we are presently concluding arrangements with the GEF or Global Environment Facility for a major implementation project in 7 countries: Argentina, India, Latvia, Lebanon, the Philippines, Senegal and Vietnam.

Ladies and gentlemen

Our failure to adequately manage the environment contributes enormously to the burden of health care related infections; a burden of disease that we know can be substantially reduced to the benefit of both the affected persons and the health care system itself. The driving forces suggest that the problem will grow but also that the potential benefits of doing things better will grow in parallel.

The Global Patient Safety Initiative provides an opportunity to ensure that the benefits of a safe environment to health are at the heart of health service actions and we are pleased to both be here and to be able to contribute to that initiative. Thank you