Extending the use of the World Health Organisations’  water sanitation and hygiene assessment tool for surveys in hospitals – from WASH-FIT to WASH-FAST

Abstract

BackgroundPoor water sanitation and hygiene (WASH) in health care facilities increases hospital-associated infections, and the resulting greater use of second-line antibiotics drives antimicrobial resistance. Recognising the existing gaps, the World Health Organisations’ Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) was designed for self-assessment. The tool was designed for small primary care facilities mainly providing outpatient and limited inpatient care and was not designed to compare hospital performance. Together with technical experts, we worked to adapt the tool for use in larger facilities with multiple inpatient units (wards), allowing for comparison between facilities and prompt action at different levels of the health system.MethodsWe adapted the existing facility improvement tool (WASH-FIT) to create a simple numeric scoring approach. This is to illustrate the variation across hospitals and to facilitate monitoring of progress over time and to group indicators that can be used to identify this variation. Working with stakeholders, we identified those responsible for action to improve WASH at different levels of the health system and used piloting, analysis of interview data to establish the feasibility and potential value of the WASH Facility Survey Tool (WASH-FAST) to demonstrate such variability.ResultsWe present an aggregate percentage score based on 65 indicators at the facility level to summarise hospitals’ overall WASH status and how this varies. Thirty-four of the 65 indicators spanning four WASH domains can be assessed at ward level enabling within hospital variations to be highlighted. Three levels of responsibility for WASH service monitoring and improvement were identified with stakeholders: the county/regional level, senior hospital management and hospital infection prevention and control committees.ConclusionWe propose WASH-FAST can be used as a survey tool to assess, measure and monitor the progress of WASH in hospitals in resource-limited settings, providing useful data for decision making and tracking improvements over time.

When It Is Not Measured, How Then Will It Be Planned for? WaSH a Critical Indicator for Universal Health Coverage in Kenya

“…Similarly, researchers have contextualized some monitoring tools in WaSH in HCF research. Maina et al [ 40 ] adapted and contextualized the WaSHFIT tool and developed WaSHFAST for the assessment of WaSH indicator performance in facilities beyond primary healthcare level. The authors developed a total of 65 WaSH in healthcare indicators relevant to monitoring WaSH in hospitals in limited resource areas.…”

“…The frame was guided by the logic framework (input, activities, output and impact), heuristic framework (agenda setting, formulation, implementation and evaluation) [ 37 ] and policy triangle (grounded in a political economy perspective and considers actors, context, process and content shape policymaking) [ 38 ]. The authors adapted the WaSHFIT conceptual framework [ 39 , 40 ]. It is a framework designed to help implementers identify risks in healthcare facilities and it provides practical tools and templates for managing WaSH and facilities.…”

Potential secondary transmission of SARS-CoV-2 via wastewater

“…Effective waste management of health care facilities is an often-neglected problem ( Harhay et al, 2009 ; Maina et al, 2019 ). There are major differences in healthcare waste and wastewater management around the world.…”

COVID-19: an opportunity to improve infection prevention and control in LMICs

“…Additionally, there were scarce resources available to install new hand hygiene and waste disposal structures, especially in locations where they were absent. 3 …”

“… 4 Our prepandemic survey suggested that these committees were inactive and poorly constituted. 3 The low status and awareness of infection prevention and control in the hospitals contributed to these committees being largely dormant. 4 However, from our interviews with health-care workers done during the COVID-19 pandemic in April, 2020, we found that these infection prevention and control committees are playing a crucial role in training medical staff on personal protective equipment use and infection prevention and control procedures (Maina M, unpublished).…”