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
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
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有目的地设计调查工具，以评估医院水环境卫生和个人卫生的充足性，并分配行动责任 - 从“Fash FIT”到“Wash Fast”
DOI：
10.1101/622449
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Maina M
中科院分区：
文献类型：
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作者：
Maina M
背景医疗机构中不良的水环境卫生和个人卫生 (WASH) 会增加医院相关感染，并导致更多地使用二线抗生素，从而导致抗菌素耐药性。现有的评估工具“卫生设施供水和卫生设施改进工具”(WASH FIT) 专为小型初级设施的自我评估而设计。拥有多个住院病房的大型设施需要一种工具，该工具支持对多个设施进行比较，并确定谁负责卫生系统不同级别的行动。方法我们对 WASH FIT 工具进行了改造，以：1) 创建一个简单的数字评分方法，以便对医院进行比较并方便跟踪随时间推移的 WASH 表现； (2) 确定可对每个医院病房进行评估和评分的指标，以帮助识别设施内的差异； (3) 确定负责在卫生系统不同层面实现积极变革的人员。我们通过试点、访谈数据分析和利益相关者协商会议来确定 WASH 设施调查工具 (WASH FAST) 的可行性和表面有效性。结果WASH FAST 可用于生成设施级别的总百分比分数，以总结医院的整体 WASH 状态并说明医院之间的差异。跨越四个 WASH 领域的 65 项指标中的 34 项可以在病区级别进行评估，从而突出病区之间的差异。确定了 WASH 服务监测和改进的三个级别的责任，并得到定性数据和多个利益相关者的支持：县/地区级、医院高级管理层和医疗机构内的感染预防和控制委员会。结论我们建议 WASH FAST 可用作评估、改进和监测资源有限环境中医院 WASH 和 IPC 进展的调查工具，为决策提供有用的数据，并为更广泛的质量改进工作做出贡献。
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.MethodsWe 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).ResultsWASH 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.ConclusionWe 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.