Safely managed sanitation systems will reduce pathogen loads and help prevent the spread of AMR pathogens; but millions of healthcare facilities lack such systems
Photo: iStock. The importance of preventing infections has become more crucial, with the existing antibiotics becoming increasingly ineffective due to the growing burden of antimicrobial resistance (AMR) and the thin and dry drugs in the pipeline.
Prevention refers to practices that can limit or avert the emergence and spread of infections, such that antimicrobial use can be reduced. AMR occurs when bacteria, viruses, fungi and parasites develop resistance against the antimicrobial drugs and no longer be inactivated or killed by the drug.
The culprits are not just the misuse and overuse of antimicrobials in humans, animals and the food production sector. The environment also accelerate the emergence and spread of AMR. In 2019, about five million deaths worldwide were estimated to be associated with antibiotic resistance. About 1.3 million deaths were directly attributed to it.
Water, sanitation and hygiene (WASH) in healthcare facilities, households and communities, and food-animal production systems play a fundamental role in AMR prevention and containment. Universal access to clean drinking water, better sanitation and hygiene can control the development and spread of infections and subsequent antibiotic use.
Also read: Unregulated use of antibiotics a threat to public health, say experts
A recent report by the World Health Organization and UNICEF has reaffirmed this. Water, Sanitation, Hygiene, Waste and Electricity Services in Health Care Facilities: 2023 Global Progress Report, released on June 13, assessed global and national efforts and progress towards improving WASH, cleanliness and waste management, particularly in health care facilities.
Healthcare-associated infections that occur while receiving care for another condition are a major threat; they call for the use of antibiotics.
Moreover, waste (mostly sewage and effluents) from such settings can also be a source of AMR-causing determinants such as resistant bacteria, resistant genes or antibiotic residues.
Improper disposal of healthcare-associated waste such as gloves, syringes and vials also adds to the environmental dimension of AMR spread. The concentration of antibiotics in the waste stream of healthcare facilities is more than that in the waste stream of communities, noted the report.
“Safely managed sanitation systems, even simple ones using well-maintained septic tanks, will reduce pathogen loads and help prevent the spread of antimicrobial-resistant pathogens (and other pathogens) in wastewater. Sadly, millions of healthcare facilities lack such systems”, it added.
These facilities often serve communities that lack safe WASH services and good stewardship of antibiotics, thus exacerbating the cycle of infections, antibiotic use and the spread of AMR.
The report indicated a lot needs to be done to improve the global status of WASH, waste management and cleanliness in healthcare facilities. For example, one in five healthcare facilities (22 per cent) lack basic water services.
About 857 million people globally depend on healthcare facilities with no water at all. Hygiene services also remain limited, as almost half of the healthcare facilities lack basic services that include water and soap or alcohol-based hand rub.
Nearly 688 million people rely on facilities without any hygiene services. One in 10 healthcare facilities has no toilets, and one in four does not practise waste segregation.
The status of least developed countries (LDC) —low-income countries confronting severe structural impediments to sustainable development — is even more grim. Only 21 per cent of healthcare facilities have basic sanitation services, whereas basic hygiene services are available in just a third (32 per cent) of healthcare facilities in these countries.
When it comes to the integration of WASH and waste management services with health, only 14 per cent of countries monitored WASH in health systems in 2022. In terms of health budgets, only 12 per cent of countries have more than 75 per cent of the funds needed to reach WASH targets.
Universal access to WASH in healthcare facilities will cost $0.60 per person per year for LDCs — equivalent to 6 per cent of their current annual health spending.
“Safe WASH services enable life-saving infection prevention and control practices, curb the spread of antimicrobial resistance and help in delivering quality primary health care services to all,” read a WHO press release.
WHO and UNICEF emphasised the need for improving investments, integration into health planning, building the right set of health workforce and strengthening the review and monitoring process to deliver and maintain better WASH, waste and electricity services.
We have come a long way from the initial days of the COVID-19 Pandemic, when we were startled by the pandemic, albeit with a lot of learnings.
The world today has the opportunity to better prepare for the next pandemic. Ensuring a sustainable and clean water supply, sanitation and hygiene in healthcare facilities will be crucial in responding to future pandemic threats, which could be the silent pandemic of AMR.
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