Study title

Kenya

Other

The WASH assessment was carried out at ward level and at facility level in a sample of 16 public hospitals in Kenya. The selection of these hospitals was purposeful and based on links developed from ongoing work to improve clinical information as part of a collaboration between the Kenya Medical Research Institute -Wellcome Trust Research Programme and the Ministry of Health. The data collection tool was the Water Sanitation and Hygiene Facility Improvement tool (WASH FIT) developed by the World Health Organization. The assessment included inpatient wards in the paediatric, medical, surgical and neonatal departments but excluded units not present in all hospitals (i.e. critical care, Ear Nose and Throat (ENT), eye, renal and psychiatric units). In each eligible ward, ward assessment forms were completed. Once these ward level inspections were complete, there was an inspection of the entire facility, including the laundry, kitchen, outpatient areas and the external environment. At facility level, there were a total of 65 WASH indicators to be assessed spread across 4 domains. Each indicator was assessed by direct observation and the score determined by team consensus on a three-point scale (meets = 2, partially meets = 1, or does not meet = 0 the required standard).At ward level, 34 of the 65 indicators were assessed and scored with the same three point system. Through a process of stakeholder engagement, each of the 65 indicators was assigned toone of three persons/groups who would be responsible to improve these indicators. These are the county government, Hospital Management or the hospital infection prevention and control committee.Antibiotics StewardshipPatient-Level Data collection At the patient level, data were collected on the patients' age, sex, weight, hospital department,  date of admission or of surgery in the case of surgical patients, date of survey and diagnoses. For the diagnosis, there were a total of 46 possible options provided, 45 of these were categorised by the anatomical system involved. Data are provided on the antimicrobial type, posology, start and stop dates among others. Microbiology, antibiotic susceptibility and biomarker (C-reactive protein; procalcitonin or other) test results used to inform the diagnosis and treatment choice, were also collected for each patient where available.