PURPOSEFUL DESIGN OF A SURVEY TOOL TO EVALUATE THE ADEQUACY OF HOSPITALS WATER SANITATION AND HYGIENE AND ALLOCATE RESPONSIBILITY FOR ACTION - FROM WASH FIT to WASH FAST
BackgroundPoor water sanitation and hygiene (WASH) in health care facilities increases hospital associated infections and results in greater use of second line antibiotics, which drives antimicrobial resistance. The existing assessment tool, Water and Sanitation for Health Facility Improvement Tool (WASH FIT), is designed for self-assessment in smaller primary facilities. A tool is needed for larger facilities with multiple inpatient units, that supports comparison of multiple facilities and identifies who is responsible for action at different levels of the health system.\n\nMethodsWe adapted the WASH FIT tool to: 1) create a simple numeric scoring approach to enable comparison of hospitals and facilitate tracking of WASH performance over time; (2) identify indicators that can be assessed and scored for each hospital ward to help identify variation within facilities and; (3) identify those responsible to effect positive change at different levels of the health system. We used a pilot, analysis of interview data and consultative stakeholder meetings to establish the feasibility and face validity of the WASH Facility Survey Tool (WASH FAST).\n\nResultsWASH FAST can be used to produce an aggregate percentage score at facility level to summarise hospitals overall WASH status and illustrate variation across hospitals. Thirty-four of the 65 indicators spanning four WASH domains can be assessed at ward level enabling between ward variations to be highlighted. Three levels of responsibility for WASH service monitoring and improvement were identified that were supported by qualitative data and multiple stakeholders: the county/regional level, hospital senior management and the infection prevention and control committee within the healthcare facility.\n\nConclusionWe propose WASH FAST can be used as a survey tool to assess, improve and monitor progress of WASH and IPC in hospitals in resource-limited settings, providing useful data for decision making and contributing to wider quality improvement efforts.