The CDC Foundation is collaborating with the Centers for Disease Control and Prevention (CDC) to expand best practices for water, sanitation and hygiene (WASH) in healthcare facilities (HCFs) through implementation of targeted action research pilots in Uganda. These pilots involve developing and testing context-appropriate solutions for increasing uptake of WASH practices and sustained management of WASH services that meet the needs of patients and healthcare workers. Proposed action pilots will adapt promising interventions implemented in the United States and other healthcare settings to the context of Ugandan primary HCFs or identify new approaches where no interventions exist.

Pilot activities will include:

• Identifying the determinants of sustainability of WASH infrastructure in HCFs through review of policies and practices among HCFs with well and poorly managed infrastructure;
• Understanding patient and healthcare worker needs for drinking water and sanitation services, which remain understudied, and testing systems that meet their needs;
• Assessing the effectiveness and acceptability of formalizing management responsibilities of WASH infrastructure that is often neglected, such as water supply and sanitation facilities, through standard operating procedures and job aids;
• Identifying and testing culturally appropriate accountability systems for improving healthcare worker hand hygiene practices, including novel approaches that are suitable for small facilities.

There has been increased global focus in the past decade on the inadequate status of systems and WASH practices in HCFs and the importance of these systems for preserving the health and dignity of healthcare workers, patients and communities. Recent Ebola outbreaks and the COVID-19 pandemic have further highlighted the essential role of strong WASH systems in HCFs for infection prevention and control (IPC). However, despite advocacy and intervention efforts, global WASH in HCF stakeholder meetings in 2016 and 2019 continued to find significant gaps in sector knowledge. These include the need to identify effective approaches for sustainably managing WASH services and ensuring appropriate WASH practices are consistently adopted, particularly in aspects of patient and staff WASH needs that lie outside of IPC such as drinking water and sanitation.

As an increasing number of partners engage in WASH in HCF initiatives, evidence-based, field-tested best practices in these areas are needed to enable effective implementation and management by HCF leadership and supporting partners.