Water, Sanitation, and Hygiene Services and Practices in Mobile Clinics and Emergency Healthcare Facilities in Mzuzu City, Malawi

Abstract

Inadequate provision of water, sanitation, and hygiene (WASH) services has compromised the implementation of infection prevention and control (IPC) globally. There was uncertainty regarding the safety of the environment in mobile and emergency healthcare facilities. The study aimed to establish WASH and IPC practices and investigate their effectiveness in reducing the transmission of healthcare-associated infections in the aforementioned facilities. The study took place in Mzuzu City, Malawi. It used a mixed method research design and data collection utilized WASHFIT, questionnaire, and laboratory experiment. Analyses were conducted using the Statistical Package for Social Sciences (SPSS), version 26, and Nvivo 14. The study participants (n = 100) were purposively selected and interviewed. They included the nurses, clinicians, and Environmental Health Officers. The results showed that provision of the WASH was poor at (40.9%) across all the facilities. The water domain performed poorly (34.8%) thereby having a huge impact on sanitation and hygiene including IPC. A few hand hygiene (39.5%) and cleaning and disinfection (27.4%) opportunities were converted into action. There was an insignificant negative association between frequent cleaning and disinfection and microbial decontamination (r = -0.27). Bloody agar medium grew a significant number of colony-forming units (879 cfu/100mls) from the samples complementing the visually contaminated surfaces. The catalase and coagulase tests confirmed the presence of Staphylococcus aureus. Thematic analysis identified several barriers to WASH and IPC services that include inadequate funding, and a lack of knowledge and resources. Generally, the study demonstrated poor WASH and IPC services in mobile and emergency healthcare facilities. The study, therefore, recommends regular monitoring of contamination, provision of enough resources and capacity building to the providers in the WASH and IPC.