■环境卫生服务(例如,水,卫生,卫生,清洁,废物管理)对改善健康结果和加强卫生系统至关重要,但覆盖差距仍然存在。世界卫生组织和联合国儿童基金会开发了WASHFIT,质量改进工具,帮助评估和改善环境卫生服务。有53个国家采用了它。然而,几乎没有证据表明它的有效性。本系统评价评估WASHFIT是否改善了环境卫生服务或相关的健康结果和影响。
■我们进行了数据库搜索,以确定相关研究并提取研究设计的数据,医疗机构的特点,和输入,活动,输出,结果,以及与WASHFIT相关的影响。我们使用逻辑模型框架和叙事综合对研究结果进行了总结。
■我们纳入了31项研究。大多数投入和活动都是定性描述的。23项研究报告了定量产出,主要WASHFIT指标得分,以及受过WASHFIT培训的人员。九项研究报告了纵向数据,表明在整个WASHFIT实施过程中这些输出的变化。六项研究报告了定量结果测量;其余的定性或根本没有描述结果。共同成果包括为环境卫生服务分配资金,社区参与,和政府合作,知识的变化,态度,或医护人员的做法,病人,或社区成员,和政策变化。没有研究直接测量影响或评估WASHFIT对严格对照组的影响。
■现有证据不足以评估WASHFIT对输出的影响,结果,和影响。需要进一步努力,全面确定实施WASHFIT所需的投入和活动,并在产出变化之间建立具体联系,结果,和影响。通过更全面地报告WASHFIT评估和利用健康管理信息系统中的健康影响数据,存在改善证据的短期机会。从长远来看,我们推荐实验研究。这些证据对于确保为WASHFIT实施投入的资金得到经济有效的利用,并且随着WASHFIT的使用和影响力的不断增长,适应和完善WASHFIT的机会得到充分实现非常重要。
■WASHFIT非常有影响力,但是对其有效性知之甚少。我们回顾了WASHFIT对环境卫生服务输出和健康影响的影响九项研究纵向测量了输出;没有任何直接测量健康影响的研究将WASHFIT的性能与严格对照组进行比较。证据不足以评估WASHFIT对输出或健康影响的影响。
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UNASSIGNED: Environmental health services (e.g., water, sanitation, hygiene, cleaning, waste management) in healthcare facilities are important to improve health outcomes and strengthen health systems, but coverage gaps remain. The World Health Organization and United Nations Children\'s Fund developed WASH FIT, a quality improvement tool, to help assess and improve environmental health services. Fifty-three countries have adopted it. However, there is little evidence of its effectiveness. This systematic review evaluates whether WASH FIT improves environmental health services or associated health outcomes and impacts.
UNASSIGNED: We conducted database searches to identify relevant studies and extracted data on study design, healthcare facility characteristics, and inputs, activities, outputs, outcomes, and impacts associated with WASH FIT. We summarized the findings using a logic model framework and narrative synthesis.
UNASSIGNED: We included 31 studies in the review. Most inputs and activities were described qualitatively. Twenty-three studies reported quantitative outputs, primary WASH FIT indicator scores, and personnel trained on WASH FIT. Nine studies reported longitudinal data demonstrating changes in these outputs throughout WASH FIT implementation. Six studies reported quantitative outcomes measurements; the remainder described outcomes qualitatively or not at all. Common outcomes included allocated funding for environmental health services, community engagement, and government collaboration, changes in knowledge, attitudes, or practices among healthcare staff, patients, or community members, and policy changes. No studies directly measured impacts or evaluated WASH FIT against a rigorous control group.
UNASSIGNED: Available evidence is insufficient to evaluate WASH FIT\'s effects on outputs, outcomes, and impacts. Further effort is needed to comprehensively identify the inputs and activities required to implement WASH FIT and to draw specific links between changes in outputs, outcomes, and impacts. Short-term opportunities exist to improve evidence by more comprehensive reporting of WASH FIT assessments and exploiting data on health impacts within health management information systems. In the long term, we recommend experimental studies. This evidence is important to ensure that funding invested for WASH FIT implementation is used cost-effectively and that opportunities to adapt and refine WASH FIT are fully realized as it continues to grow in use and influence.