RT Journal Article SR Electronic T1 Implementing the Clean Clinic Approach Improves Water, Sanitation, and Hygiene Quality in Health Facilities in the Western Highlands of Guatemala JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP 256 OP 269 DO 10.9745/GHSP-D-19-00413 VO 8 IS 2 A1 Jason Lopez A1 Sergio Tumax Sierra A1 Ana MarĂ­a Rodas Cardona A1 Stephen Sara YR 2020 UL http://www.ghspjournal.org/content/8/2/256.abstract AB Key FindingsWater, sanitation, and hygiene (WASH) services and infection prevention supplies are suboptimal in Guatemalan health care facilities that provide labor and delivery services.The Clean Clinic Approach resulted in significant improvements across many WASH and infection prevention readiness indicators despite very little investment.Success and sustainment of the Clean Clinic Approach process relies on: Establishing clear, concise, ward-specific standards;Orienting staff to their responsibilities as they apply to the standards provided;Collecting detailed data collection at the ward level; andSharing survey results with health care facility staff, local governments, and the public.Key ImplicationsTo encourage future expansion of WASH in health care facilities, donors and implementing partners should: Collaborate with national ministries of health to review and update national guidelines for infection prevention and control in hospitals,Promote the intervention to hospital directors and regional ministry of health directorates,Partner with health care facility management to update the assessment tools according to level of care and type of service/ward with consideration for basic level of service, andExpand the intervention to include more health care facilities and share the results publicly.Background:Water, sanitation, and hygiene (WASH) services are cornerstones to providing safe health care services and improving patient satisfaction and care seeking. The Clean Clinic Approach (CCA) uses a 10-step process to support health care facilities (HCFs) in making incremental, effective cleanliness and infection prevention and control (IPC) improvements, without relying on external investments. We piloted the CCA in Guatemala and assessed the extent to which it contributed to quality improvements in WASH for IPC.Methods:After developing an assessment tool tailored to the Guatemalan context, we assessed 11 HCFs in 8 technical areas and scored the facilities on 79 criteria with a total of 100 points. We conducted a baseline assessment (September to October 2018), second assessment (January 2019), and final assessment (February to March 2019).Results:The 11 HCFs improved their average emergency/general ward scores from 41 points at baseline to 87 points at end line, based on a 100-point scale. For delivery wards, the scores increased from 50 to 91 points and for postnatal wards from 46 to 90 points.Conclusions:The CCA process and tools facilitated a systematic way for HCFs to identify, prioritize, make, and measure WASH quality of care improvements. Training facility staff was fundamental to improving quality standards, and involving medical and administration staff in joint analysis, coordination, and planning sessions was key to integration and teamwork. Further work is needed to increase involvement of local government and community members and to further adapt the process and tools.