Antimicrobial resistance (AMR) presents a significant TACKLING threat to human health. World leaders have agreed that ANTIMICROBIAL tackling AMR will require addressing both health and agriculture concerns with a focus on prevention. Improving RESISTANCE: infection prevention and control (IPC) and water, Supporting national measures to address sanitation, and hygiene (WASH) is one of the five infection prevention objectives in the World Health Organization’s (WHO) AMR and control and water, Global Action Plan. Nowhere is reducing infection more sanitation and hygiene in important than in health care facilities. Joint, immediate health care settings action to address IPC and WASH is essential.

THE CURRENT SITUATION IN HEALTH CARE FACILITIES IN LOW- AND MIDDLE- INCOME COUNTRIES WASH IPC AMR 38% of health care In Africa, up to 20% of Prophylactic use of facilities do not have ANY women get a wound antibiotics is standard in water source infection after a caesarean over 80% of maternity units section in several counties 19% do not have improved toilets Hospital-born babies in low- Patients with resistant income settings are at a Staphylococcus Aureus 35% do not have water higher risk of being affected are 50% more likely to die and soap or alcohol-based by neonatal sepsis, with than those with a non- hand rub for hand washing infection rates 3 to 20 times resistant infection higher than in high-income Up to 90% of health settings Each year hundreds workers do not adhere of millions of cases of to recommended hand On average 15% of patients diarrhoea are treated hygiene practices will acquire at least one with antibiotics. Universal infection in acute care access to WASH could hospitals reduce this by 60%

THE CONSEQUENCES OF POOR WASH AND COMPROMISED IPC

Overreliance on preventive Lack of 1 Increased risk of healthcare- use of antibiotics WASH in associated infections (HAI) health care facilities 2 Increased risk of spread of HAI High health care costs and poor health outcomes 3 Increased burden of expensive, hard-to-treat and life-threatening resistant infections Increased use of antibiotics to Compromised treat preventable infections IPC practices 4 Decrease in patient confidence in health care Increased resistance

Addressing these challenges will require accelerating joint efforts to improve WASH, IPC and AMR in health care settings. Goals and objectives

Global Action Plan on AMR’s objective three: Reduce the incidence of infection TAKING through effective sanitation, hygiene and infection prevention measures. WASH and IPC efforts aim to support objective three through joint efforts to ensure ACTION every health facility, in every setting, has safely managed water, sanitation, hygiene and waste management facilities and implements effective, evidence- based IPC programs and practices to protect the lives of health workers, patients and all facilities users.

Priority joint AMR, IPC and WASH actions

GLOBAL NATIONAL LOCAL Joint advocacy National action plans Health care facilities Raise awareness of the threat Support the development and Support the implementation of AMR and the critical need to implementation of guidelines and of WASH standards and prioritise prevention, particularly National Action Plans for AMR improvement and the IPC Core in health care facilities, but also which prioritise IPC1 and WASH Components Guidelines. in the wider community through activities and support access to universal WASH access. and rational antibiotic use. Drive efforts to improve and sustain hand hygiene Ensure WASH in HCF and IPC Develop systems to strengthen infrastructure and practices and are prioritised in all AMR global disease surveillance, guidelines efforts to support adequate, plans, accountability frameworks, on antibiotics use, and laboratory routine cleaning practices, policies, and financing capacity to better diagnose and sterilization and safe health care mechanisms. track HCAIs. waste management.

Support global and national Align prevention efforts with Improve the evidence-base of leaders to advocate for WASH existing health plans and locally relevant interventions to and IPC in HCF to reduce AMR. prevention activities, particularly reduce HAI, improve WASH and quality universal health coverage IPC and support rational use of Achieve universal access to and maternal, newborn and antibiotics. and use of adequate toilets child health. and safe drinking water supplies in communities to reduce unnecessary antibiotic use and hospital admissions. 1 New WHO Guidelines on Core Components of IPC and implementation tools.

Key WHO tools and guidance to support WASH, IPC and AMR progress • WHO Essential Environmental Standards in Health Care • New WHO Guidelines on Core Components of IPC and implementation tools • Hand hygiene and AMR policy briefing note • JMP Core Indicators for WASH in HCF • WHO Hand Hygiene guidelines and implementation tools • WHO Sanitation Safety Planning Manual • Water and Sanitation for Health Facility Improvement Tool Can be found at: http://www.who.int/gpsc/en/ and http://www.who.int/water_sanitation_health/facilities/en/ ACTION in WASH and IPC

Reduce cost Reduce overall Reduce Reduce spread of expensive Reduce the Drive people- Increase care antibiotic opportunity for of resistant and treatment of risk of all health centred quality seeking and demand, use resistant strains non-resistant resistant care associated health care staff morale and and misuse to emerge infections infections infections productivity

And therefore help reduce antimicrobial resistance.

WASHinHEALTH CARE FACILITIES for better health care services