Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India.
Department of Otorhinolaryngology, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India.
J Hosp Infect. 2024 Sep;151:116-130. doi: 10.1016/j.jhin.2024.06.018. Epub 2024 Jul 18.
Despite global recognition, WHO reports reveal significant gaps, with one in four healthcare facilities lacking basic water services, affecting over 1.8 billion people, and 21% lacking sanitation services, impacting 1.5 billion people, especially prevalent in low- and middle-income countries. This study aimed to critically evaluate the current state of water, sanitation and hygiene (WASH) facilities across a diverse range of healthcare settings. This review included various databases such as PubMed, MEDLINE, EMBASE, CINAHL, Scopus and grey literature; eligible studies employing various designs were scrutinized for WASH infrastructure and practices. Methodological quality was rigorously evaluated using the QuADS checklist. Data analysis, performed with R software, involved deriving pooled estimates of WASH intervention effects. Sensitivity analyses were conducted, employing statistical methods such as funnel plots to ensure robustness and mitigate biases. Of the 13,250 articles screened, 18 were included in this review. Meta-analyses revealed significant effect sizes for WASH interventions across domains - water (67.38%), sanitation (53.93%), waste management (40.82%), environment (56.58%), hygiene (66.83%), and management (42.30%). Widespread disparities in WASH persist across healthcare facilities, with rural areas facing notable deficits. Challenges in water quality, sanitation and waste management demand comprehensive, multi-sectoral approaches for improvement.
尽管全球已经认识到这个问题，但世界卫生组织的报告显示，仍存在明显的差距，四分之一的医疗保健设施缺乏基本的供水服务，影响了超过 18 亿人，21%的设施缺乏卫生服务，影响了 15 亿人，这种情况在中低收入国家尤为普遍。本研究旨在批判性地评估不同医疗保健环境中当前的水、环境卫生和个人卫生（WASH）设施状况。本综述包括各种数据库，如 PubMed、MEDLINE、EMBASE、CINAHL、Scopus 和灰色文献；对采用各种设计的合格研究进行了 WASH 基础设施和实践的审查。使用 QuADS 清单对方法学质量进行了严格评估。使用 R 软件进行数据分析，得出了 WASH 干预效果的汇总估计值。进行了敏感性分析，使用漏斗图等统计方法确保稳健性并减轻偏差。在筛选出的 13250 篇文章中，有 18 篇被纳入本综述。荟萃分析显示，WASH 干预在各个领域都有显著的效果大小 - 水（67.38%）、卫生（53.93%）、废物管理（40.82%）、环境（56.58%）、卫生（66.83%）和管理（42.30%）。WASH 在医疗保健设施中仍然存在广泛的差距，农村地区面临着明显的不足。水质、卫生和废物管理方面的挑战需要全面的、多部门的方法来加以改善。
