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Hygiene in Healthcare Facilities

Sustained hygiene within healthcare facilities (HCFs) depends on a complex system – of which handwashing stations are only a small part.

Strong leadership by the director and staff is a powerful factor.

Why? Because no matter what kind of infrastructure, the hygiene system requires human inputs at multiple levels.

HappyTap’s products and services are meant to bolster the system that underpins consistent hygienic behaviour. Indeed, actually having a handwashing station is necessary to wash hands. But beyond the hardware, our support services are designed to foster a sense of ownership and commitment that can improve long-term outcomes.

Our vision is that every HCF worker, patient, and patient’s family members, is enabled to use handwashing points in accordance with WHO guidance.

While the timescale for such a lofty aspiration is normally set on the horizon, we believe it should be now.

Key considerations for handwashing stations in the healthcare setting

How big should the water tank be?

Because there’s no one size that fits all, tanks should be readily expandable.

  • Installing multiple units is the simplest way to expand capacity
  • Offering multiple handwashing points offers additional benefits:
    • increases convenience and encourages greater compliance, especially for staff who need to wash their hands between patient contacts;
    • creates more visual stimuli – or cues – to wash for staff and patients;
    • reduces clustering and queuing, and increases physical distancing;

 

To increase the number of uses per refill, a low-flow tap is essential.

The tank should be small enough to be placed throughout the inside of an HCF (see ‘Location’ tab).

Some HCF administrators prefer separate facilities for staff and patients, in order to ensure that staff have ready access to priority sinks and don’t need to queue behind visitors.

Is a mass-produced solution appropriate?

Unfortunately, millions of handwashing stations need to be deployed and installed in healthcare facilities.

They should be producible quickly and cheaply, easy to ship in large quantities, and very simple & quickly to install (i.e. without special skills or tools).

Such mass-produced solutions not only offer advantages, they likely represent the only credible near-term solutions.

The JMP’s current database on WASH in health care facilities drew on assessments of 560,000 HCFs globally, of which only 43% had handwashing at the point of care.

 

Location location location!

Little is more important than location when it comes to ensuring that handwashing points in a healthcare facility are consistently used.

  • Low-cost, portable devices can make multiple points available in every ward.
  • No more walking outside to the toilet, nor even walking down the hall to wash hands — wash where it’s convenient: where you are.

 

Handwashing stations need to be inside the HCF, in the places where handwashing is needed most.

This is critical to enabling handwashing compliance; every additional meter that a healthcare worker must walk to reach a sink may decrease the likelihood of hand washing by approximately 10%. (Deyneko, A. et al. 2016

 

Can healthcare facilities simply build their own sinks if given design ideas?

Most HCFs in low-income countries are unlikely to connect to piped water and to install plumbing everywhere sinks are required in the near term.

Many organizations have devised low-cost, large-capacity group handwashing stations that clinics and hospitals can build for themselves.

Unfortunately this approach is not easy to scale up. It’s manual building/welding done onsite with limited materials, tools, and expertise.

As a result such stations typically:

  • require construction & welding expertise as well as tools and materials – that HCFs often do not have
  • are situated outside – they cannot easily be placed throughout the inside of wards, between beds, etc.
  • are visually unattractive – they do not serve as a positive visual cue to wash
  • are too expensive to place in the many location points needed

Isn’t refilling inconvenient?

Any station—save a piped basin—requires refilling. That means without plumbing, handwashing stations need to be manually refilled.

The key consideration to reduce maintenance is to increase the number of washes per a given amount of water (which depends on tap flow rate, user behaviour, type of soap, etc.)

Does having a larger tank mean less refilling work?

Not necessarily. Filling one 60L tank, or four 15L tanks, may require similar effort.

Why? Because without plumbing, workers have to manually refill the amount of water that is used for washing, no matter the tank capacity.

  • where refill water must be carried or wheeled, a 15L tank fits the carrying capacity of most caretakers (15kg). Bigger tanks just require more trips.
  • where refill water is available through a hose, multiple handwashing points can be easily refilled;
  • where plumbing and permanent basins can be installed throughout, then that should be done—cost and time permitting.

 

Until hospitals have access to piped water and permanent sinks in critical locations, particularly the point of care, and are kept operable with on-going maintenance, our experience in Cambodia demonstrates that portable handwashing stations may be one acceptable, cost-effective way to help close the global gap in the hand hygiene crisis within healthcare facilities. (Innovations in Hygiene: Healthcare Facilities, May 2019)