Evaluating the foundations that help avert antimicrobial resistance: Performance of essential water sanitation and hygiene functions in hospitals and requirements for action in Kenya

Autoři: Michuki Maina aff001;  Olga Tosas-Auguet aff003;  Jacob McKnight aff003;  Mathias Zosi aff001;  Grace Kimemia aff001;  Paul Mwaniki aff001;  Constance Schultsz aff002;  Mike English aff001
Působiště autorů: Health Services Research Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya aff001;  Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands aff002;  Nuffield Department of Medicine, University of Oxford—Oxford, United Kingdom aff003;  Amsterdam Institute for Global Health and Development- Amsterdam, The Netherlands aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222922



Water Sanitation and Hygiene (WASH) in healthcare facilities is critical in the provision of safe and quality care. Poor WASH increases hospital-associated infections and contributes to the rise of antimicrobial resistance (AMR). It is therefore essential for governments and hospital managers to know the state of WASH in these facilities to set priorities and allocate resources.


Using a recently developed survey tool and scoring approach, we assessed WASH across four domains in 14 public hospitals in Kenya (65 indicators) with specific assessments of individual wards (34 indicators). Aggregate scores were generated for whole facilities and individual wards and used to illustrate performance variation and link findings to specific levels of health system accountability. To help interpret and contextualise these scores, we used data from key informant interviews with hospital managers and health workers.


Aggregate hospital performance ranged between 47 and 71% with five of the 14 hospitals scoring below 60%. A total of 116 wards were assessed within these facilities. Linked to specific domains, ward scores varied within and across hospitals and ranged between 20% and 80%. At ward level, some critical indicators, which affect AMR like proper waste segregation and hand hygiene compliance activities had pooled aggregate scores of 45 and 35% respectively. From 31 interviews conducted, the main themes that explained this heterogenous performance across facilities and wards included differences in the built environment, resource availability, leadership and the degree to which local managers used innovative approaches to cope with shortages.


Significant differences and challenges exist in the state of WASH within and across hospitals. Whereas the senior hospital management can make some improvements, input and support from the national and regional governments are essential to improve WASH as a basic foundation for averting nosocomial infections and the spread of AMR as part of safe, quality hospital care in Kenya.

Klíčová slova:

Antimicrobial resistance – Health care facilities – Hygiene – Kenya – Nosocomial infections – Nurses – Pediatrics – Sanitation


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2019 Číslo 10
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