The Impact of Water Sanitation and Hygiene (WASH) Improvements on Hand Hygiene at Two Liberian Hospitals during the Recovery Phase of an Ebola Epidemic

Udhayashankar Kanagasabai, Kayla Enriquez, Richard Gelting, Paul Malpiedi, Celina Zayzay, James Kendor, Shirley Fahnbulleh, Catherine Cooper, Williamatta Gibson, Rose Brown, Nadoris Nador, Desmond E. Williams, David Chiriboga and Michelle Niescierenko
Additional contact information
Udhayashankar Kanagasabai: John F. Kennedy Medical Centre, 1000 Monrovia, Liberia
Kayla Enriquez: Emergency Medicine, School of Medicine, University of California, San Francisco, CA 94110, USA
Richard Gelting: Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Paul Malpiedi: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Celina Zayzay: Ministry of Health, 1000 Monrovia, Liberia
James Kendor: Academic Consortium Combatting Ebola in Liberia, 1000 Monrovia, Liberia
Shirley Fahnbulleh: Academic Consortium Combatting Ebola in Liberia, 1000 Monrovia, Liberia
Catherine Cooper: Ministry of Health, 1000 Monrovia, Liberia
Williamatta Gibson: Liberian Government Hospital, 2000 Tubmanburg, Liberia
Rose Brown: Liberian Government Hospital, 2000 Tubmanburg, Liberia
Nadoris Nador: Centers for Disease Control and Prevention, 1000 Monrovia, Liberia
Desmond E. Williams: Centers for Disease Control and Prevention, 1000 Monrovia, Liberia
David Chiriboga: Academic Consortium Combatting Ebola in Liberia, 1000 Monrovia, Liberia
Michelle Niescierenko: Harvard Medical School, Boston, MA 02115, USA

IJERPH, 2021, vol. 18, issue 7, 1-13

Abstract: Fourteen years of civil war left Liberia with crumbling infrastructure and one of the weakest health systems in the world. The 2014–2015 Ebola virus disease (EVD) outbreak exposed the vulnerabilities of the Liberian health system. Findings from the EVD outbreak highlighted the lack of infection prevention and control (IPC) practices, exacerbated by a lack of essential services such as water, sanitation, and hygiene (WASH) in healthcare facilities. The objective of this intervention was to improve IPC practice through comprehensive WASH renovations conducted at two hospitals in Liberia, prioritized by the Ministry of Health (MOH). The completion of renovations was tracked along with the impact of improvements on hand hygiene (HH) practice audits of healthcare workers pre- and post-intervention. An occurrence of overall HH practice was defined as the healthcare worker practicing compliant HH before and after the care for a single patient encounter. Liberia Government Hospital Bomi (LGH Bomi) and St. Timothy Government Hospital (St. Timothy) achieved World Health Organization (WHO) minimum global standards for environmental health in healthcare facilities as well as Liberian national standards. Healthcare worker (HCW) overall hand hygiene compliance improved from 36% (2016) to 89% (2018) at LGH Bomi hospital and from 86% (2016) to 88% (2018) at St. Timothy hospital. Improved WASH services and IPC practices in resource-limited healthcare settings are possible if significant holistic WASH infrastructure investments are made in these settings.

Keywords: water sanitation and hygiene (WASH); infection prevention and control (IPC); Ebola; low-resource setting (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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