SynthesisBMJ global health2019
Interventions to improve water supply and quality, sanitation and handwashing facilities in healthcare facilities, and their effect on healthcare-associated infections in low-income and middle-income countries: a systematic review and supplementary scoping review.
Synthesis in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 4 syntheses or guidelines pooled it, 56 citations in OpenAlex.
- Does WASH FIT Improve Water, Sanitation, and Hygiene and Related Health Impacts in Healthcare Facilities? A Systematic Review.International journal of environmental research and public health · 2025Pooled it
- Water supply emergency preparedness and response in health care facilities: A systematic review on international evidence.Frontiers in public health · 2022Pooled it
- Safety in fragile, conflict-affected, and vulnerable settings: An evidence scanning approach for identifying patient safety interventions.Journal of global health · 2022Pooled it
- Pooled it
- Evaluation of SaTo pans as a new latrine technology in Kisumu County healthcare facilities, Kenya.Tropical medicine & international health : TM & IH · 2023Trial
- Serious Bacterial Infections in Hospitalized Neonates in Eastern Ethiopia: Investigating the Emerging Pathogen Pantoea dispersa Compared With Klebsiella pneumoniae.Tropical medicine & international health : TM & IH · 2026Article
- Implementation and adaptation of WASH FIT in healthcare facilities: A systematic scoping review.World development sustainability · 2026Article
- Global capacity for implementing the eight practical steps to achieve universal access to water, sanitation, and hygiene in healthcare facilities: A qualitative study using implementation science.SSM - health systems · 2026Article
- Can improved handwashing infrastructure and soap change behavior? findings from a randomized control study in the Dadaab refugee camp in Kenya.Conflict and health · 2026Article
- Temporal and Regional Trends of Foodborne Diseases in Saudi Arabia (2015-2023): A Nationwide Retrospective Analysis.Journal of epidemiology and global health · 2026Article
- The perceived impacts of United States foreign development assistance reductions on health system building blocks at healthcare facilities in Zambia: A mixed-methods study.PLOS global public health · 2026Article
- Qualitative assessment of the water and sanitation for health facility improvement tool (WASH FIT) implementation in Zimbabwe.Discover public health · 2026Article
- Mapping the evidence on environmental health services in healthcare facilities in low- and middle-income countries: A systematic literature inventory of over 4,000 studies.medRxiv : the preprint server for health sciences · 2025Article
- Water (In)Accessibility, Healthcare Delivery, and Patients' Health Outcomes in Ghana: Perspectives from the Yendi Hospital.Nursing reports (Pavia, Italy) · 2025Article
- Global capacity for implementing the Eight Practical Steps to achieve universal access to water, sanitation, and hygiene in healthcare facilities: a qualitative study.medRxiv : the preprint server for health sciences · 2025Article
- Water, sanitation and infection control practices in rural health facilities of Jodhpur District, India: an intervention through supportive supervision.BMC health services research · 2025Article
- The effects of environmental health services on patient well-being and quality of care: A qualitative study in Malawi's public healthcare facilities.SSM - health systems · 2025Article
- With a new United Nations resolution on water, sanitation, hygiene, electricity, and waste in healthcare facilities, it is time for a logical framing and consistent vocabulary.PLOS sustainability and transformation · 2025Article
- Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda.Antimicrobial resistance and infection control · 2024Article
- Viral cardiovascular surgical diseases: global burdens, challenges and opportunities.Future cardiology · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 6 institutions in 11 countries.
Funding
Abstract
introductionHealthcare-associated infections (HCAIs) are the most frequent adverse event compromising patient safety globally. Patients in healthcare facilities (HCFs) in low-income and middle-income countries (LMICs) are most at risk. Although water, sanitation and hygiene (WASH) interventions are likely important for the prevention of HCAIs, there have been no systematic reviews to date.
methodsAs per our prepublished protocol, we systematically searched academic databases, trial registers, WHO databases, grey literature resources and conference abstracts to identify studies assessing the impact of HCF WASH services and practices on HCAIs in LMICs. In parallel, we undertook a supplementary scoping review including less rigorous study designs to develop a conceptual framework for how WASH can impact HCAIs and to identify key literature gaps.
resultsOnly three studies were included in the systematic review. All assessed hygiene interventions and included: a cluster-randomised controlled trial, a cohort study, and a matched case-control study. All reported a reduction in HCAIs, but all were considered at medium-high risk of bias. The additional 27 before-after studies included in our scoping review all focused on hygiene interventions, none assessed improvements to water quantity, quality or sanitation facilities. 26 of the studies reported a reduction in at least one HCAI. Our scoping review identified multiple mechanisms by which WASH can influence HCAI and highlighted a number of important research gaps.
conclusionsAlthough there is a dearth of evidence for the effect of WASH in HCFs, the studies of hygiene interventions were consistently protective against HCAIs in LMICs. Additional and higher quality research is urgently needed to fill this gap to understand how WASH services in HCFs can support broader efforts to reduce HCAIs in LMICs. PROSPERO REGISTRATION NUMBER: CRD42017080943.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.