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

Autoři: Michuki Maina aff001;  Olga Tosas-Auguet aff003;  Jacob McKnight aff003;  Mathias Zosi aff001;  Grace Kimemia aff001;  Paul Mwaniki aff001;  Arabella Hayter aff004;  Margaret Montgomery aff004;  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;  Water Sanitation and Hygiene Department, World Health Organization, Geneva, Switzerland aff004;  Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226548



Poor 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.


We 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.


We 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.


We 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.

Klíčová slova:

Budgets – Data visualization – Global health – Health care facilities – Hygiene – Inpatients – Outpatients – Sanitation


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Článek vyšel v časopise


2019 Číslo 12