Safe water, sanitation, hygiene (including cleaning and waste handling) or WASH and energy supply in healthcare facitilies (HCFs) are critical for equitable, quality care, efficient infection prevention and control, safety and dignity of patients and healthcare workers. Recognising this, the World Health Assembly adopted Resolution 72.7 in 2019, calling on countries to assess and improve WASH in HCFs.
As a first step in meeting the goals of the resolution, Hungary with the coordination of the National Public Health Centre and the support the WHO Regional Office for Europe conducted a situation assessment on WASH in HCFs, covering legislative aspect, review of evidence and data collection.
Most healthcare facilities in Hungary, like in other developed countries, are connected to centralised water supply and wastewater system and have a strict regulation on infectious waste handling and many other fields of WASH (5). Despite to the universal access to the safe water and sanitation in healthcare facilities, there are still areas for improvement. The reduction of antibiotic resistance, the presence of opportunistic pathogens (such as Legionella and Pseudomonas) in water networks, or the prevention of environmental risk related to hospital wastewater are prevailing challenges. Accessibility of toilets and constant supply of hand hygiene consumables were identified as the main obstacles for achieving 100% coverage for the JMP indicators for basic services. Based on the collated evidence, national advanced indicators will be defined and action plan will be developed in order to achieve them.
Colonisation of plumbing systems by Legionella or other pathogens is the most prevalent water-related risk in HCFs. Compliance monitoring of drinking water quality based on fecal indicators, such as E. coli is not suitable for indicating the presence of Legionella. Hungary issued a decree on environmental risk assessment and management of Legionella in 2015 (6). Implementation of the legislation is assisted by a detailed methodological guideline of NPHC (4). Other NPHC guidelines on various aspects of WASH in HCFs are also publicly available, e.g. on hand hygiene in healthcare, infection prevention and control in specific settings (for example in dialysis centres, dentistries) or prevention of device associated infections (7-10).
Hungary is committed to foster advancing WASH in healthcare facilities internationally. The UN Group of Friends on WASH in HCFs is a high-level political cooperation, co-lead by Hungary and the Philippines, aiming to raise awareness to the role of WASH in quality care globally (1). The Protocol on Water and Health is a unique instrument of the European Region, coordinated by the WHO Regional Office for Europe and the UN Economic Commission for Europe (2). Within the framework of the Protocol, Hungary co-leads a programme area on WASH in institutions (HCFs and schools) and public places. A recent development in this programme area is the development of a practical tool to assess WASH in HCFs (3).
Further information:
- UN Group of friends for WASH in HCF: https://www.washinhcf.org/resource/concept-note-un-group-of-friends-in-support-of-wash-in-hcf
- Protocol on Water and Health: https://www.who.int/europe/initiatives/protocol-on-water-and-health
- Water, sanitation and hygiene in health-care facilities: a practical tool for situation assessment and improvement planning: https://apps.who.int/iris/handle/10665/363511
- Legionella risk assessment and risk management guideline: https://www.nnk.gov.hu/index.php/kozegeszsegugyi-laboratoriumi-foosztaly/kornyezetegeszsegugyi-laboratoriumi-osztaly/vizhigienes-laboratorium/legionarius-betegseg/1378-a-legionella-kockazatbecsles-modszertani-utmutato
http://www.oek.hu/oekfile.pl?fid=6873
- JMP indicators in Hungarian HCFs: https://washdata.org/data/healthcare#!/hun
- Legionella legislation: http://www.kozlonyok.hu/nkonline/MKPDF/hiteles/MK15167.pdf
- Hand hygiene in HCFs: http://www.oek.hu/oekfile.pl?fid=3279
- Infection control in dialysis centres: http://www.oek.hu/oekfile.pl?fid=6672
- Infection control in dentistries: http://www.oek.hu/oekfile.pl?fid=7309
- Prevention of device associated infections https://www.antsz.hu/data/cms90553/A_gepi_lelegeztetessel_osszefuggo_pneumonia_megelozesere.pdf
https://www.antsz.hu/data/cms89838/Modszertani_level_a_holyagkateterrel_osszefuggo_hugyuti_fertozes_megelozesere.pdf
https://www.antsz.hu/data/cms89792/Modszertani_level_az_erkateterrel_osszefuggo_veraramfertozesek_megelozesere.pdf