# Averted HAI cases and deaths from delivering basic WASH services

High quality intervention studies that isolate the impact of WASH interventions on HAIs are rare, especially in an African context. Studies from SSA and from the rest of the world show variation in effectiveness of WASH interventions, from significant impact (above 50%), to marginal impact (below 40%), to no impact. The impact that improved WASH has on HAI numbers depends on the baseline HAI rates, main transmission pathways and patient risks, and the intensity of and compliance with the intervention. Table 3 presents a summary of selected key literature, in particular systematic reviews, supplemented with intervention studies from SSA. More than half of all cases of health care-associated sepsis are thought to be preventable through safe WASH services and appropriate IPC measures (WHO, 2020; Rudd et al, 2020). Shreiber et al (2018) suggest a sustained potential for the significant reduction of HAI rates in the range of 35%–55% associated with multifaceted interventions, irrespective of a country’s income level. Infection control measures during norovirus outbreaks are estimated to be associated with 0.6 (95% CI: 0.3–1.1) times smaller patient case counts (Adams et al, 2022).

**Table 3. Select studies presenting the impact of WASH interventions on HAIs**

|**Author (year)**|**Type of publication**|**Studies**<br>**included**|**HAI reduction achieved**|
|---|---|---|---|
|Watson et al|Systematic review|3 cohort studies|39% to 50%|
|(2019)||27 before-and-<br>after studies|Statistically significant reduction in at least one HAI in<br>26 studies (full details in article supplementary<br>materials)|
|Schreiber et al<br>(2018)|Systematic review|144 studies|The pooled incidence rate ratios associated with<br>multifaceted interventions were 0.543 for CAUTI, 0.459<br>for CLABSI, and 0.553 for VAP. The pooled rate ratio<br>was 0.461 for interventions aiming at SSI reduction, and<br>0.509 for VAP reduction initiatives.|
|Umscheid et al<br>(2011)|Systematic review|64 studies|65%–70% of cases of CABSI and CAUTI and 55% of cases<br>of VAP and SSI|
|Luangasanatip<br>et al (2015)|Systematic review|19 studies|The efficacy of the WHO 2005 campaign (WHO-5)<br>reported clinical outcomes in 19 studies. Impacts were<br>consistent with clinically important reductions in rates<br>of infection resulting from improved hand hygiene for<br>some important hospitalpathogens.|
|Adams et al<br>(2022)|Systematic review|102<br>papers<br>describing<br>162<br>norovirus<br>outbreaks|Control measures were implemented in 118 (73%)<br>outbreaks and were associated with 0.6 (95% CI: 0.3–<br>1.1) times smaller patient case counts and 0.7 (95% CI:<br>0.4,1.0)times shorter durations in hospitals.|
|Dramowski et<br>al (2022)|Intervention study|1<br>intervention<br>study<br>from<br>South SSA|Neonatal bloodstream infection rate declined follow-<br>ing implementation of the NeoCLEAN intervention,<br>from 6.7 to 3.9/1,000patient days(p= 0.166).|
|Aiken<br>et<br>al<br>(2012)|Intervention studies<br>on SSI prevention in<br>SSA|24 studies from<br>9 SSA countries|Several studies indicated that alcohol-based hand rubs<br>could provide a low-cost alternative to traditional<br>surgical hand-washingmethods.|
|Fenny et al<br>(2022)|Intervention study<br>of alcohol hand rub|1 study from<br>Ghana|Neonatal bloodstream infection-attributable deaths<br>decreased by 73% and extra length of hospital stay<br>(LOS) decreased by 50%. The post-intervention<br>assessment revealed the ABH program contributed to<br>16% decline in the incidence of neonatal bloodstream<br>infections at the NICU.|

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