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

2. 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.

3. 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.

4. 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

5. 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

6. The outside of a facility is also important

7. 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

8. Keep pests & animals out

9. 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

10. 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

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

12. 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.

13. 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

14. Water leakages and overflows must be immediately reported and repaired

15. 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.

16. 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.

17. 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

18. Prevent spills and proper storage of fuel and used oil

19. 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

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

21. 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

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

23. 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) Beds have insecticide treated nets to protect patients from mosquito-borne diseases 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.

24. WASH FIT indicators (2)
3.17 Kitchen stores and prepared food is protected from flies, other insects or rats 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.

25. References
WHO. (2008). Essential environmental health standards in health care.
WHO/World Bank (2014). Access to modern energy services for health facilities in resource- constrained settings.
WHO. (2011). Technical notes on drinking water, sanitation and hygiene in emergencies. Retrieved from df
WHO/UNICEF (2015). Water, sanitation and hygiene in healthcare facilities: Status in low-and middle-income countries. health-care-facilities/en/

26. World Health Organization
21 February, 2018
Questions?