Gnanasekaran Sridevi, Gupta Manoj Kumar, Goel Akhil Dhanesh, Bhardwaj Pankaj, Srinivasan Srikanth, Jain Vidhi, Rajendran Vinoth, Raghav Pankaja
Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Gorakhpur, Uttar Pradesh, India.
Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
BMC Health Serv Res. 2025 Sep 1;25(1):1171. doi: 10.1186/s12913-025-12689-7.
Inadequate water, sanitation, and hygiene (WASH) infrastructure in rural healthcare facilities in India, poses significant challenges to effective infection control, contributing to the prevalence of healthcare-associated infections (HAIs) and poor patient outcomes. Despite ongoing global efforts to enhance WASH standards, these facilities often lack the necessary resources and management systems to sustain improvements. Supportive supervision has emerged as a potential strategy to address these gaps. This study aimed to improve the water, sanitation, and infection control practices in Rural health facilities of Jodhpur District through supportive supervision.
This study presents the findings of an intervention study conducted in Luni Block of the Jodhpur district. All the healthcare facilities (6 PHCs and 5 CHCs) in that block were included and baseline assessment was done. The intervention was provided through supportive supervision covering various domains of Water and Sanitation for Health Facility Improvement Tool (WASH FIT). After three months, a follow-up assessment was done in all the Health Care Facilities (HCFs). Endline assessment was done after three months of the follow-up assessment using the same tool. Water and swab samples from the labour room were collected from the facilities for microbiological surveillance during the baseline and endline assessments.
During the baseline, none of the facilities included in this study had a more than 60% bed occupancy rate. Average OPD attendance in CHCs was 57, and in PHCs it was 22. None of the facilities had adequate human resources as per IPHS 2012. The significant issues in water-related practices were quality, accessibility, safe storage, periodic testing of chlorine residue, and sanitation inspection risk score. Unable to meet menstrual hygiene-related needs, improper cleaning records, and inadequate usage of PPE for waste disposal were significant gaps in sanitation-related practices. The unavailability of functional hand hygiene stations, non-adherence to hand hygiene compliance activities, and inadequate knowledge regarding the correct concentration of cleaning solution were identified as potential lacunae related to hygiene. All the facilities had shown statistically significant improvement in WASH FIT scores across all four domains post-intervention.
Practices related to water, sanitation, hygiene, and infection control in health care facilities of rural Jodhpur were not satisfactory. There were specific gaps in all these domains. The intervention in the form of capacity building of healthcare workers, formation of an Infection Control Committee, and continuous supportive supervision was found effective.
印度农村医疗机构的水、环境卫生和个人卫生（WASH）基础设施不足，给有效的感染控制带来了重大挑战，导致医疗相关感染（HAIs）的流行和患者预后不良。尽管全球一直在努力提高WASH标准，但这些设施往往缺乏维持改善所需的资源和管理系统。支持性监督已成为解决这些差距的潜在策略。本研究旨在通过支持性监督改善焦特布尔地区农村卫生设施的水、环境卫生和感染控制实践。
本研究展示了在焦特布尔地区卢尼街区进行的一项干预研究的结果。该街区的所有医疗机构（6个初级卫生保健中心和5个社区卫生中心）均被纳入，并进行了基线评估。通过涵盖卫生设施改善工具（WASH FIT）水和环境卫生各个领域的支持性监督提供干预措施。三个月后，对所有医疗机构（HCFs）进行了随访评估。在随访评估三个月后，使用相同工具进行了终线评估。在基线和终线评估期间，从这些设施的产房采集水和拭子样本进行微生物监测。
在基线期间，本研究纳入的设施中没有一个床位占用率超过60%。社区卫生中心的平均门诊人次为57，初级卫生保健中心为22。根据2012年《印度公共卫生标准》，没有一个设施拥有足够的人力资源。与水相关实践中的重大问题包括水质、可及性、安全储存、氯残留定期检测以及卫生检查风险评分。无法满足与经期卫生相关的需求、清洁记录不当以及个人防护装备在废物处理中的使用不足是与环境卫生相关实践中的重大差距。功能性手部卫生设施不可用、不遵守手部卫生合规活动以及对清洁溶液正确浓度的知识不足被确定为与卫生相关的潜在缺陷。所有设施在干预后在WASH FIT四个领域的得分均有统计学显著改善。
焦特布尔农村地区医疗机构中与水、环境卫生、个人卫生和感染控制相关的实践并不令人满意。所有这些领域都存在特定差距。以医护人员能力建设、成立感染控制委员会和持续支持性监督形式的干预措施被证明是有效的。
