Health Education Project Topics

Health Effects of Water and Sanitation on Patients in Hospitals

Health Effects of Water and Sanitation on Patients in Hospitals

Health Effects of Water and Sanitation on Patients in Hospitals

Chapter One

Objective of the study

The objective of the study are;

The primary objective of this study is to investigate and understand the health effects of water and sanitation conditions on patients in hospitals, with a focus on healthcare-associated infections (HAIs) and patient outcomes. To achieve this overarching goal, the study aims to accomplish the following specific objectives:

  • To evaluate the correlation between water quality in hospital settings and the incidence of healthcare-associated infections (HAIs) among patients.
  • To investigate the role of sanitation facilities, including toilets and waste disposal systems, in preventing the spread of infections within hospital environments.
  • To identify and examine patient groups with compromised immune systems or underlying health conditions that are particularly susceptible to the health effects of inadequate water and sanitation conditions.



The Relationship Between Water Quality and HAIs

The relationship between water quality and healthcare-associated infections (HAIs) is a topic of significant concern within hospital settings, where patients with compromised immune systems are at elevated risk of infections. Research has demonstrated a clear link between inadequate water quality and the increased incidence of HAIs. This section examines key studies that emphasize the importance of water quality in preventing HAIs.

The presence of waterborne pathogens, such as Legionella bacteria, can lead to serious infections among patients. A study by Stout et al. (1985) highlighted the role of contaminated water sources, including cooling towers and faucets, in the transmission of Legionnaires’ disease in a hospital. This study underscored the significance of effective water management and disinfection to prevent Legionella-associated HAIs.

Pseudomonas aeruginosa, a common opportunistic pathogen, can proliferate in water distribution systems and cause infections among hospitalized patients. A study by Exner et al. (2017) highlighted the importance of maintaining adequate disinfection measures to prevent the colonization of Pseudomonas aeruginosa in water systems and subsequently reduce the risk of HAIs.

Biofilms, which are complex microbial communities attached to surfaces, can form within water distribution systems and contribute to the persistence of pathogens. A study by LeChevallier et al. (1988) highlighted the potential for biofilms to act as reservoirs for Legionella bacteria, increasing the risk of waterborne infections in hospitals.

Outbreaks of HAIs linked to waterborne pathogens in hospitals have drawn attention to the need for robust water management. A review by Ciesielski et al. (2000) examined several outbreaks of Legionnaires’ disease and other waterborne infections in healthcare settings, emphasizing the necessity of strict water quality control measures to prevent such occurrences.

The World Health Organization (WHO) has emphasized the importance of implementing Water Safety Plans (WSPs) in healthcare facilities, including hospitals, to ensure safe water. A study by World Health Organization (2011) provided guidelines for developing WSPs tailored to healthcare settings, which can help minimize the risk of HAIs.

the Role of Sanitation Facilities in Infection Prevention

The role of sanitation facilities in infection prevention is paramount, especially within healthcare settings where vulnerable patients and healthcare workers interact. Proper sanitation facilities contribute significantly to maintaining hygiene, preventing cross-contamination, and ultimately reducing the risk of healthcare-associated infections (HAIs). Here are key studies that highlight the importance of sanitation facilities in infection prevention:

A study by World Health Organization (WHO) emphasizes that appropriate sanitation practices, including proper waste disposal and cleanliness of facilities, are essential components of infection prevention and control in healthcare settings. Adequate sanitation facilities help contain the spread of pathogens and minimize the risk of HAIs.

Hand hygiene is a critical aspect of sanitation in healthcare settings. A study by Pittet et al. (2003) highlights the impact of improved hand hygiene practices on reducing HAIs. Effective sanitation facilities, including easily accessible sinks and soap dispensers, play a vital role in promoting regular handwashing among healthcare workers.

A study by Weber et al. (2010) emphasizes the importance of environmental hygiene in preventing HAIs. Proper sanitation of surfaces and equipment within healthcare facilities is crucial for reducing the transmission of pathogens. Sanitation facilities that enable effective cleaning and disinfection contribute to maintaining a hygienic environment.

Proper sanitation facilities, including well-designed toilets and waste management systems, can contribute to reducing environmental contamination with pathogens. A study by Dancer et al. (2012) highlights the importance of minimizing environmental contamination to prevent the transmission of infections within healthcare settings.

Sanitation facilities also play a role in maintaining patient dignity and comfort, which can impact overall well-being. A study by Curtis et al. (2011) emphasizes that patient satisfaction with sanitation facilities can positively influence their perception of care quality, contributing to improved psychological well-being.

Historical Waterborne Outbreaks in Hospitals

Historical waterborne outbreaks in hospitals have served as crucial reminders of the potential risks posed by contaminated water sources within healthcare settings. These outbreaks have highlighted the importance of stringent water management practices and infection control measures to prevent the transmission of waterborne pathogens. The following studies discuss significant historical waterborne outbreaks in hospitals:

  1. Legionnaires’ Disease Outbreak: One of the most well-known historical waterborne outbreaks occurred in a hospital setting. A study by Kool et al. (2018) investigated a large outbreak of Legionnaires’ disease that originated from contaminated hospital water systems. The study emphasized the need for rigorous water management and monitoring to prevent Legionella-related outbreaks in healthcare facilities.
  2. Gastrointestinal Outbreaks: Waterborne outbreaks of gastrointestinal infections have also affected hospitals. A study by Senok et al. (2012) examined a gastroenteritis outbreak in a hospital that was linked to contaminated tap water. The study highlighted the potential for waterborne pathogens to cause widespread infections among hospitalized patients.
  3. Norovirus Outbreaks: Norovirus outbreaks have also been linked to contaminated water sources within healthcare facilities. A study by Han et al. (2009) investigated a norovirus outbreak in a hospital that was associated with the consumption of tap water. The study highlighted the potential for waterborne transmission of norovirus in healthcare settings.
  4. Cryptosporidiosis Outbreak: A study by Juranek et al. (1986) discussed a waterborne outbreak of cryptosporidiosis in a pediatric hospital. The study highlighted the challenges of controlling cryptosporidiosis in a healthcare setting due to the resistant nature of the parasite and the potential for widespread transmission through water.
  5. Outbreaks in Dialysis Units: Dialysis units within hospitals have also experienced waterborne outbreaks. A study by Campos et al. (2014) investigated a Pseudomonas aeruginosa outbreak in a dialysis unit that was linked to contaminated water used for dialysis. The study emphasized the need for strict water quality control in such healthcare settings.





In this chapter, we described the research procedure for this study. A research methodology is a research process adopted or employed to systematically and scientifically present the results of a study to the research audience viz. a vis, the study beneficiaries.


Research designs are perceived to be an overall strategy adopted by the researcher whereby different components of the study are integrated in a logical manner to effectively address a research problem. In this study, the researcher employed the survey research design. This is due to the nature of the study whereby the opinion and views of people are sampled. According to Singleton & Straits, (2009), Survey research can use quantitative research strategies (e.g., using questionnaires with numerically rated items), qualitative research strategies (e.g., using open-ended questions), or both strategies (i.e., mixed methods). As it is often used to describe and explore human behaviour, surveys are therefore frequently used in social and psychological research.


According to Udoyen (2019), a study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitutes of individuals or elements that are homogeneous in description.

This study was carried to examine Health effects of water and sanitation on patients in hospitals. Residents in Uyo forms the population of the study.




This chapter presents the analysis of data derived through the questionnaire and key informant interview administered on the respondents in the study area. The analysis and interpretation were derived from the findings of the study. The data analysis depicts the simple frequency and percentage of the respondents as well as interpretation of the information gathered. A total of eighty (80) questionnaires were administered to respondents of which only seventy-seven (77) were returned and validated. This was due to irregular, incomplete and inappropriate responses to some questionnaire. For this study a total of 77 was validated for the analysis.




It is important to ascertain that the objective of this study was to ascertain Health effects of water and sanitation on patients in hospitals. In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in addressing Health effects of water and sanitation on patients in hospitals.


This study was on Health effects of water and sanitation on patients in hospitals. Three objectives were raised which included; To evaluate the correlation between water quality in hospital settings and the incidence of healthcare-associated infections (HAIs) among patients, to investigate the role of sanitation facilities, including toilets and waste disposal systems, in preventing the spread of infections within hospital environments and to identify and examine patient groups with compromised immune systems or underlying health conditions that are particularly susceptible to the health effects of inadequate water and sanitation conditions. A total of 77 responses were received and validated from the enrolled participants where all respondents were drawn from residents in Uyo. Hypothesis was tested using Chi-Square statistical tool (SPSS).


In conclusion, this study underscores the critical importance of maintaining clean water sources, ensuring sanitation facilities’ functionality, and promoting proper hygiene practices within hospitals. By doing so, healthcare facilities can significantly contribute to reducing the incidence of HAIs, improving patient outcomes, and cultivating an environment of health and safety for all stakeholders involved. The knowledge gained from this study can guide future research, policy formulation, and practical interventions that will continue to elevate the standards of healthcare delivery and infection prevention within hospital settings.


Based on the comprehensive analysis of the health effects of water and sanitation conditions on patients in hospitals, several key recommendations emerge to enhance patient safety, prevent healthcare-associated infections (HAIs), and improve overall healthcare quality:

  1. Implement Water Safety Plans (WSPs): Hospitals should develop and implement tailored Water Safety Plans (WSPs) in accordance with guidelines provided by the World Health Organization (WHO). These plans should encompass risk assessment, monitoring, and management of water quality within the hospital’s distribution systems, ensuring the prevention of waterborne pathogens.
  2. Regular Monitoring and Testing: Establish a rigorous schedule for monitoring and testing water quality. Regularly check for the presence of pathogens such as Legionella, Pseudomonas aeruginosa, and other waterborne microorganisms. Implement responsive measures if any contamination is detected.
  3. Enhance Sanitation Infrastructure: Ensure sanitation facilities are well-designed, easily accessible, and properly maintained. Invest in adequate handwashing stations with soap dispensers and maintain a regular supply of clean water in washrooms for both patients and healthcare workers.
  4. Promote Hand Hygiene: Institute comprehensive hand hygiene programs that emphasize the importance of proper handwashing practices among healthcare workers, patients, and visitors. Display educational materials and provide training sessions to reinforce effective hand hygiene techniques.
  5. Hygiene Awareness Campaigns: Launch regular awareness campaigns to educate patients, visitors, and healthcare workers about the significance of proper hygiene practices, such as hand hygiene and proper utilization of sanitation facilities.
  6. Hygiene Compliance Monitoring: Implement mechanisms to monitor and ensure compliance with hygiene practices. Utilize observational audits and provide feedback to healthcare staff to encourage consistent adherence to infection control protocols.
  7. Vulnerable Patient Care: Tailor infection prevention measures to accommodate vulnerable patient populations with compromised immune systems. Implement specialized interventions to protect these patients from waterborne infections.
  8. Effective Waste Disposal: Ensure proper disposal of waste, especially medical waste, to prevent contamination of water sources and the environment. Implement waste management protocols that adhere to regulatory standards.


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  • World Health Organization. WASH in health care facilities: global baseline report 2019.
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  • Angrup A, Kanaujia R, Ray P, Biswal M. Healthcare facilities in low-and middle-income countries affected by COVID-19: Time to upgrade basic infection control and prevention practices. Indian Journal of Medical Microbiology. 2020 Apr 1;38(2):139–43. pmid:32883925
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