WASH in Healthcare Facilities

Improving water, sanitation, and hygiene conditions in health facilities to prevent healthcare-associated infections and improve patient outcomes.

Key Questions

  • What are the barriers to adequate WASH in healthcare settings?
  • How can healthcare workers be supported to practice hand hygiene?
  • What role can patients play in promoting hand hygiene?
  • How can WASH improvements be sustained in resource-limited settings?

Our Approach

PROMISE deploys the WASH FIT (WASH in Healthcare Facilities Improvement Tool) developed by WHO-UNICEF for continuous quality improvement. The tool guides facilities through structured risk assessments, participatory improvement planning, and regular monitoring to strengthen WASH infrastructure, infection prevention practices, and patient safety.

Active Projects

  1. WASH FIT Implementation in healthcare facilities across Amuru, Nwoya, Mukono, and Kagadi districts (process evaluation completed; policy integration achieved)
  2. Hand Hygiene Patient Empowerment Study exploring patient role in promoting healthcare worker hand hygiene (data analysis phase)
  1. WASH FIT in healthcare facilities in Diamaguène-Sicap Mbao (assessments complete; improvement plans developed)

Case Study: From Research to Routine Practice in Uganda

Challenge: Healthcare facilities struggled with inadequate WASH infrastructure, contributing to healthcare-associated infections. Hand hygiene compliance among healthcare workers was low despite knowledge of risks.

  • Deployed WASH FIT in health facilities across four districts.
  • Conducted process evaluation to understand implementation barriers and enablers.
  • Researched patient empowerment strategies for promoting hand hygiene.
  • Engaged Ministry of Health and district health teams throughout.
  • Structured risk assessments and stakeholder participation improved facility performance.
  • Heavy workloads and limited technical capacity hindered sustained uptake.
  • Tailoring WASH FIT to local contexts and strengthening leadership structures were critical.
  • Patients could be empowered to promote hand hygiene when supported appropriately.
  • WASH FIT integrated into national health facility guidelines.
  • Over 100 healthcare workers trained.
  • Measurable improvements in hand hygiene infrastructure and practice.
  • Model for scale-up to additional facilities nationwide.

Uganda’s institutionalization of WASH FIT ensures continued investment in healthcare WASH beyond the PROMISE project timeline.

“WASH FIT gave us a practical framework for continuous improvement. Now it’s part of how we operate.” – Health Facility Administrator, Mukono District

  1. Mugambe RK, Wanyenze RK, Ssekamatte T, et al. (2025). Infection prevention and control and WASH status of healthcare facilities in Greater Kampala during COVID-19. PLOS Water.
  2. Ssekamatte T, Mugambe RK, Isunju JB, et al. (2024). Application of behaviour-centred design to understand hand hygiene facilitators and deterrents. BMC Health Services Research.
  3. Buregyeya E, Atusingwize E, Nuwematsiko R, et al. (2024). Stakeholders’ perceptions towards patients’ participation in promoting hand hygiene. PLoS