World Health Organization 21 February, 2018 Module 8 Environmental Management including Energy WASH FIT

Overview NB: Environmental management is part of Domain 3: Hygiene. What makes a health care facility safe What does environmental management mean Required interventions towards a safer health care facility environment Energy efficiency practices Resources required to ensure environmental management NB: Environmental management is part of Domain 3: Hygiene.

What is a safe healthcare facility environment? A safe healthcare facility environment is free from: Vectors (including mosquitoes, rats, etc) and other animals that transmit disease and pose a risk to humans Smoke, dust or other types of air pollution Inappropriate chemical use and disposal Unsafely managed wastewater and storm water Accumulated garbage or inappropriate disposed of health care waste A safe healthcare facility should have sufficient power to ensure adequate lighting and operation of water pumps, refrigeration and sterilization equipment. In addition, there should be enough fuel/energy to support treatment of healthcare waste.

Environmental management – a key part of WASH FIT Ensure environmental management by implementing the following: Assign a member of the WASH FIT team to oversee environmental management Conduct regular assessments and implement pollution prevention and control measures Ensure environmental compliance Ensure training and awareness among health workers Incorporate environmental planning and decision-making into facility plans Keep records and documentation of measures Continual program evaluation and improvement Involvement of patients, their families, and community in environmental management

Key environmental management interventions Ensure proper functioning & maintenance of incinerators to reduce air pollution from black smoke and toxic materials (Dioxins and furans/POPs) Ensure proper collection, storage and disposal of used oil resulting from generator maintenance to prevent water and soil contamination by hydrocarbons Ensure proper fueling of various equipment to prevent fuel spills Prevent soil erosion by planting grass (vegetation cover) Ensure safe disposal of laboratory reagents and chemical waste

The outside of a facility is also important

Maintain a clean, green environment throughout the facility grounds Remove rubbish and litter Ensure there is a sealed fence around the facility that does not let animals through Plant plants to make the grounds more appealing Paint buildings, add murals and decorations

Keep pests & animals out

Integrated pest & vector control management Use a combination of approaches for excluding and reducing vector numbers: Keep health care facility environment clean and free from feces, wastewater and stagnant water Improving food hygiene standards by safely storing and disposing of food Removing pests manually by using hands, setting traps Habitat manipulation, cultural control or pest/animal proofing including mosquito nets, solid fence, window screens, close fitting doors, etc. Using biological control products

Spacing and ventilation Beds should be adequately spaced, separated by 2.5m from each other. Ensure sufficient natural ventilation and where the climate allows, large opening windows, skylights and other vents to optimize natural ventilation. Overcrowded facility, India. Credit EAWAG/SANDEC

Are these stored correctly? World Health Organization Are these stored correctly? 21 February, 2018 Ask how this picture could be improved?

How could this room be improved? World Health Organization How could this room be improved? 21 February, 2018 Materials should be tidied up, put in a cupboard.

Store supplies appropriately Keep stores locked Reduce sun exposure Prevent water damage Control the temperature Keep free of pests Clean, tidy and organised Store supplies on shelves, in a systematic way Supplies with upcoming expiry dates at front Label supplies clearly

Water leakages and overflows must be immediately reported and repaired

Energy & its importance Energy is necessary to ensures adequate lighting for safe provision of healthcare, use of toilets and safe waiting areas including at night. Energy is critical for treatment of health care waste, sterilization of equipment, water pumping, refrigeration, machine-laundry activities, etc. Efficient use of green energy in healthcare facilities mitigates climate change effects.

Petroleum, Oil and Lubricants (POL) products Examples of POL products: Oil Gasoline Hydraulic fluids Kerosene Diesel, etc. MUST be disposed of in environmental friendly way to avoid ground water contamination.

Effects of POL contamination Pollution of water sources: percolates easily to reach ground water sources Air pollution Health effects in human beings Affects ecosystem Can be persistent

Prevent spills and proper storage of fuel and used oil

Management of Spills Take steps to prevent spills from the generator Keep clean-up materials such as rags, saw dust and oil sponge readily available. Stop the oil from flowing at the source to reduce contamination. If a leak from a container/tank or generator cannot be stopped, catch the oil in another holding container. Contain spilled oil by isolating the contaminated area, closing the effluent, or spread oil sponge or other clean-up materials over the oil and surrounding area. Implement bioremediation of POL contaminated sites

Renewable energy Renewable energy is the energy generated from resources which are naturally replenished such as sunlight, wind, rain, tides, waves, and geothermal heat.

Energy efficient practices Only turn on air conditioners when required and establish a minimum temperature (24°C=75°F). Turn off lights, computers and other equipment at the end of the day. Unplug equipment that uses energy even when they are not in use. Use solar power for lighting, pumping water supply, refrigeration, etc. Use energy efficient bulbs

Examples of solar energy use Use solar power for pumping and heating water supply, refrigeration, light etc.

World Health Organization WASH FIT Indicators 21 February, 2018 3.6 The exterior of the facility is well-fenced, kept generally clean (free from solid waste, stagnant water, no animal and human faeces in or around the facility premises, etc.). 3.7 General lighting sufficiently powered and adequate to ensure safe provision of health care including at night (mark if not applicable). 3.12 Beds have insecticide treated nets to protect patients from mosquito-borne diseases. 3.16 The facility has sufficient natural ventilation and where the climate allows, large opening windows, skylights and other vents to optimize natural ventilation The other missing indicators are covered in hand hygiene and in cleaning and disinfection.

WASH FIT indicators (2) 3.17 Kitchen stores and prepared food is protected from flies, other insects or rats. 3.18 Beds for patients should be separated by a distance of 2.5 metres from the centre of one bed to the other and each bed has only one patient. Note: the “missing” indicators are covered in the hand hygiene and cleaning and disinfection modules.

References WHO. (2008). Essential environmental health standards in health care. http://www.who.int/water_sanitation_health/hygiene/settings/ehs_hc/en/ WHO/World Bank (2014). Access to modern energy services for health facilities in resource- constrained settings. http://apps.who.int/iris/bitstream/10665/156847/1/9789241507646_eng.pdf WHO. (2011). Technical notes on drinking water, sanitation and hygiene in emergencies. Retrieved from http://www.who.int/water_sanitation_health/publications/2011/tn9_how_much_water_en.p df WHO/UNICEF (2015). Water, sanitation and hygiene in healthcare facilities: Status in low-and middle-income countries. http://www.who.int/water_sanitation_health/publications/wash- health-care-facilities/en/

World Health Organization 21 February, 2018 Questions?