Water, sanitation and hygiene (WASH)

and Infection Prevention and Control in

COVID-19 referral hospitals in
Indonesia: Evidence from Indonesia

Sri Irianti, Andre Yunianto, Ika Dharmayanti,

Zahra, Basuki Rahmat, Tities Puspita, Athena
Anwar

National Research and Innovation Agency

Background
1. Nosocomial infection or healthcare-acquired infections (HAIs) still found
in many health facilities in developing countries
2. In an emergency situation (an outbreak or epidemic of an infectious
disease such as COVID-19), the hospital must meet the standard
WASH requirements to control infection
3. The problem of handling COVID-19 in hospitals is closely related to
the readiness of hospitals in providing safe and adequate WASH
4. Benefits of fulfilling WASH services at health facilities: Maternal and
newborn health, reducing the burden on the public health system, and
helping to prevent excessive use of antimicrobial drugs
 Objectives

• To determine the existing conditions of WASH services

and assess the readiness of such services during the
COVID-19 pandemic
 Method
Study design: descriptive and cross-sectional

Population : 132 COVID-19 referral hospitals, based on Minister of Health Regulation

no 196/2020 ‘Penetapan RS Rujukan Penanggulangan Penyakit Infeksi Emerging
Tertentu’
Sample : 106 hospitals (80,3%) fill in online structured questionnaire

Collection data: May - August 2020

Online survey with structured questionnaire using WASH core questions monitoring
(WHO-UNICEF/JMP 2018) and IPCAF questionnaire core component 8 ‘Build
environment, materials and equipment for IPC at the facility level’.
 Indicators

WHO, 2018. Infection Prevention and Control Assessment

Framework at The Facility Level,

WHO/UNICEF, 2018. Core questions and indicators for monitoring WASH in

health care facilities in the Sustainable Development Goals
 Result
Percentage of COVID-19 referral hospitals by class
1.9 These 106 hospitals spread in 33
province. Provinces with the largest
22.6 20.8 number of referral hospitals namely
Central Java (13 hospitals), East
Java (10 hospitals), West Java (8
hospitals) and DKI Jakarta (7
54.7
hospitals).
N=106
A B C D
 Main findings in WASH services
WASH services before COVID-19 pandemic WASH services during COVID-19 pandemic
2.8% 0.0% 0.0% 0.0% 0.0%
2.8% 0.0% 0.0% 0.0% 0.0%
4.7% 2.8%
2.8% 3.8% 1.9%
1.9%
23.6%
23.6%
41.5%
39.6%

95.3% 95.3% 97.2%

97.2% 76.4%
95.3% 96.2%
58.5%
76.4%

60.4%

si
ir

an
e

ba
n
A

ie

ng
it

m
ig
n

ku
Li
Sa

ng
Li
n
Air Sanitasi Higiene Limbah Pembersihan

a
ih
Lingkungan

rs
be
m
Basic Limited No Service

Pe
Basic Limited No Service
 WASH management problems
a) Water unavailable as needed by quantity, not all the time (<5 days in a week) and availability
of water doesn’t comply for every points
b) Available latrines are less than ratio requirements, but it functioned, or available latrines
comply with ratio requirements but not functioned.
c) Hand-washing facility such as soap not available.
d) Solid waste storage available but not closed or the volume more than 3/4 parts, or only two
storages (at least 3 storages) for general solid waste, not sharp waste and sharp waste.
e) Temporary solid waste storage with barrier of wall not available, or it’s available with
overload capacity.
f) Environment cleaning equipment available but not properly maintained
 Indicator of Room by Availibility and Utility- Core Component 8 - IPCAF
8% 10%
Level
25% 25% 25%
33% 33%

50% 50% 50%

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
100% 100% 100% 92% 90% 100% 100% 100% 100% 100%
75% 75% 75%
67% 67%

50% 50% 50%

l l I i l l
c eh mut bar iau se kulu ung be iau K bar eng I Y tim ten Bal T B T T lbar eng lse ltim tara ulut eng lse ltra talo lbar luku alut bar pua
A Su um R m p a R D a t D a n N Ka al t a l S ul t u Su ron Su Ma Pa Pa
S Su eng am p. B ep. J Ja J Ba N
K K Ka Ka S S M
B L Ke K Go
Advanced Intermediate

Indikator Ruangan diambil dari pertanyaan FF1, FF2, dan GG1 mengenai kebutuhan listrik, fungsi ventilasi ruangan, dan
ketersediaan kamar tunggal / khusus untuk penyakit infeksi
 Indicator of IPC Core Component 8 - IPCAF Level
8% 10%

25% 25%

50% 50% 50% 50% 50%

67%

100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
92% 90%
100% 100% 100% 100% 100% 100% 100% 100%
75% 75%

50% 50% 50% 50% 50%

33%

l l I i l l
c eh mut bar iau se kulu ung be iau K bar eng I Y tim ten Bal T B T T lbar eng lse ltim tara ulut eng lse ltra talo lbar luku alut bar pua
A Su um R um g a R D Ja at D Ja an N Ka alt Ka Ka l S ult Su Su ron Su Pa Pa
S S e n amp p. B ep. J B N
K Ka S M
a M
B L Ke K G o
Advanced Intermediate Basic
Indikator PPI diambil dari pertanyaan EE1, EE2, GG2, HH1, HH2, HH3. IPC Level Basic hanya ada di Prov Sulbar dan Maluku
 Discussion

WASH services in COVID-19 referral hospitals using JMP 2018 indicators

• Study result: no hospitals were found to meet all the five basic WASH indicators, either before
and during pandemic
• Inequality exists among hospitals classes, ownership and location
• Global indicators have not been implemented in national surveys

IPC infrastructure base on IPCAF indicators : core components 8 Build

Environment, Materials and Equipment for IPC at Facility Level

The findings can be used to inform policy making in COVID-19 management and other upcoming
diseases pandemic.
.

Conclusion

• There is a need to improve basic WASH services (especially

sanitation and environmental cleaning) and fulfillment of PPI
facilities which must be carried out immediately so as not to
increase the risk of transmitting infectious diseases to the hospital
community during a pandemic.
• Although the results of this study were only in referral hospitals,
the findings of this study can be used as a basis for improving the
conditions of other hospitals, considering that the hospitals selected
as referrals still do not meet basic standards