New Survey Tools Improve Healthcare on the Frontlines of the Pandemic

Rod Beadle, P.E., M.ASCE, is the senior WASH and response advisor for Food for the Hungry, an international relief and development organization graduating communities from extreme poverty in over 20 countries worldwide. He has been an active member of ASCE for over 35 years.

In today’s Member Voices article, he shares how his team has adapted its work on the fly to meet the new challenges presented by COVID-19.

When COVID-19 turned into a global tsunami, engineers on the frontlines knew that the ability to aggressively improve hygiene practices and facilities in the place where germs gather in greatest concentrations – healthcare facilities – would be foundational to keeping healthcare workers, patients and their families safe. They also knew it would be a huge challenge.

Most of us know that much of the world’s population does not have access to clean water in their homes – putting an estimated 1 billion people at immediate risk of contracting COVID-19. But the water situation is even worse inside healthcare facilities in low-resource settings. Worldwide, 45 percent of healthcare facilities in low-resource settings lack basic water services at points of care: no water, no soap, no hand sanitizer. With or without personal protective equipment, proper hygiene can stop COVID-19, and a myriad of other infectious agents, from finding new pathways to spread. Hand hygiene is so effective in stopping viruses that, in March, the World Health Organization revised its technical guidance for water, sanitation and hygiene in healthcare facilities, upgrading its importance.

Because hand hygiene is the primary response to contain the coronavirus in healthcare settings in scores of countries, understanding the WASH landscape is essential. This has created a massive challenge for international non-governmental organizations like mine, Food for the Hungry, as well as national ministries of health. Simply put, how can we improve hygiene access when we do not know where it is lacking? With no travel internationally or in-country, how do our field offices determine how to address emergency WASH needs when everyone is literally stuck at home? Local communities and healthcare facility staff are not trained in this kind of data collection work, yet assessments are critical in aligning needs and solutions in each healthcare setting. By late March, COVID-19 was breaking out everywhere. Healthcare facilities needed to quickly identify essential fixes for problems that would seriously impede response to the pandemic and increased patient load.

FH recognized that the WHO’s WASH FIT manual provided the best tools available for assessment of WASH conditions in healthcare facilities. A widely used technical tool, WASH FIT offers an extensive matrix of assessment indicators. It enables national Ministries of Health to assess healthcare facility needs and share data with WHO to improve national and global guidelines. However, this level of complexity was not appropriate for a community-based health committee, plumber, or health facility administrator, and the indicators are not COVID-19 specific. We needed an assessment tool sophisticated enough to evaluate COVID-19 related WASH needs inside healthcare facilities and return accurate data that was easy enough to be effectively used by nonexperts.

Those last two weeks of March, we focused on adapting the WASH FIT platform into simplified assessment tools that addressed specific COVID-19 indicators using the latest WHO guidelines. Like WASH FIT, the tools were originally designed to be used in printed form, but we reached out to Engineers Without Borders USA to develop a digital version using a mobile smartphone or tablet. EWB chose the KoBoToolbox software platform developed for field data collection because it is free, open source, and specifically made for people working in developing countries and in challenging environments. A simple link to the assessment can be emailed to someone working onsite where they answer a range of questions about the facility. This includes data on general conditions, hygiene, water, sanitation and building systems. When completed, the information is uploaded to a central database that identifies the greatest WASH needs and even geographically maps out findings regionally and countrywide.

Recognizing it was not just our organizations’ field staff that needed this information, FH and EWB made the KoBoToolbox survey accessible for all interested NGOs and governments, in three languages – English, French and Spanish. The WHO quickly recognized the value of the tools, adopted them, and has provided them to country and organizational partners all around the world. Having a common tool for use in each country helps to ensure that WASH needs are identified consistently and correctly across a wider area and helps to ensure collaborative efforts are implemented to effectively meet those needs. The survey has also been adopted by Catholic Relief Services and Save the Children, and they have already conducted hundreds of healthcare facility assessments across the world.

EWB-USA Guatemala, in partnership with Rotary Guatemala, was an early user and an excellent example of the tools in action. Steve Crowe, EWB’s Guatemala Country Director and a mechanical engineer, was very involved in developing an online dashboard to display the KoBoTools data. By mid-April, 40 healthcare facilities in Guatemala were assessed and a wide array of changes were underway to help curtail regional spread. Most importantly, they installed 20 mobile, hands-free (and easily replicated) handwashing stations at healthcare facility entrances. Other work included filtration of river water that was plentiful but contaminated; increased water storage; and getting dozens of toilets and sinks repaired and working inside facilities. Crowe has shared the tool and findings with the Ministry of Health and multiple INGOs working there, including FH, Living Water International and Water for People. This means that everyone can access the same information about pressing WASH needs in healthcare facilities across Guatemala.

Early results anecdotally underscore the value of WASH improvements in the face of COVID-19: In Guatemalan hospitals that underwent essential WASH improvements and had locally made PPE, only one healthcare worker contracted COVID-19. But in an area hospital with no WASH improvements and no PPE, nearly half the staff contracted COVID-19 and the Ministry of Health shut it down.

As we were developing this assessment tool, we had considered a similar tool to assess back-to-school COVID-19 readiness. Because, at the time, no one was considering reopening schools in the midst of the global pandemic, we remained focused on healthcare facilities. With recent plans to reopen schools now on the rise, we just developed WASH in School COVID-19 assessment tools called WinS. It has just been released, like KoBoToolbox, online and paper-based.

Enabling people on the frontlines to quickly gather data and target emergency responses where they’re needed most will save lives. Our work is among many involving thousands of people trying their creative best to curb this terrible pandemic. Everyone benefits from frontline containment and this work deserves our concerted support.

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