Clean care is safer care - Clean environment

I would like to thank the organizers for the opportunity to be here and speak this evening, for all of those who have chosen to spend time here and also the Health System Policies and Operations Department / Evidence and Information for Policy cluster for the initiative of pushing forward the World Alliance for Patient Safety. The initiative provides an excellent opportunity to deliver added value by bringing together the actions of different parts of WHO with outside partners in a concerted initiative.
"Clean Environment" somehow sounds a little vague and maybe a little remote from the hard edged concerns of delivering an effective health service and I would like to reflect on why it is at the heart rather than at the periphery of health services and outlining what we are doing to both try to make it a reality and to try to ensure that the real and massive gains for health that are achievable are also achieved.

• firstly the known burden of disease is high. Safe drinking water and basic sanitation is of direct relevance to (the goal on) maternal health with an estimated 529 000 maternal deaths per year and supportive of the Millennium Development Goals, especially those on major diseases and infant mortality. Legionellosis is a well-established risk associated with health care facility with an average proportion of nosocomial cases close to 10%.
• secondly that burden of disease can be pulled down massively and with a very favorable cost benefit ratio (In 1999 in England alone Hospital Acquired Infections cost the health service 1 billion Pounds a year and 15 per cent of them are potentially avoidable).
• thirdly because the underlying driving forces suggest that this problem is getting worse. World-wide we see increasing provision of health care, increasing complexity of that health care, an increasing proportion of the population that is immunocompromised (and therefore more susceptible to health care related infection) from a variety of causes including especially HIV/AIDS; an increasing ageing population.
• and finally because the international policy environment now calls for attention to this. The outcome of the recent 13th session of the Commission on Sustainable Development noted that investments in water and sanitation contribute to better health and must be focused on areas of greatest needs and greatest impact notably health centers while the United Nations Secretary General and Millennium Project have both highlighted the importance of rapidly addressing 'quick wins' - identifying specifically provision to health-care facilities.