The Clean Clinic Approach: All Guatemalan Health Facilities In Project Achieve ‘Clean Clinic’ Status Within One Year

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

Written by Dr. Sergio Tumax Sierra, Water, Sanitation and Hygiene Manager, Guatemala

As the water, sanitation and hygiene (WASH) manager for Save the Children’s Clean Clinic program in Guatemala, I saw firsthand how this novel, low-cost strategy delivered very encouraging results over a short period of time in 2018-19.

Clean Clinic – one of the three pillars of the BASICS initiative – is our proven process that empowers healthcare staff to make infection prevention improvements through easy-to-use monitoring, accountability and rewards systems.

In Guatemala, we implemented Clean Clinic at 11 Ministry of Public Health and Social Assistance health facilities, including district and department hospitals. It enabled and motivated the facilities to set WASH goals and make incremental improvements towards the ultimate goal of obtaining “Clean Clinic” status.

Within the year, after our close work with the Ministry to develop a weighted evaluation for conducting standardized ward evaluations in each health facility, all 11 had achieved one of three “Clean Clinic” certification levels. Facility staff, from cleaners and nurses to doctors and management personnel, were motivated to make actions sustainable.

We found that even small improvements made a difference in providing patients with better quality services. For example, facilities enrolled in Clean Clinic:

  • Improved the management of water quality for consumption
  • Improved solid and liquid waste management processes
  • Ensured that hand-washing stations were identified and functional and had the necessary supplies
  • Assigned operation and maintenance roles and responsibilities

Clean Clinic’s 10-step improvement process and monthly action plans made it easier for facilities to make WASH improvements despite limited external financing. These activities contributed to quality of care improvements and very likely the reduction of puerperal and neonatal sepsis infections.

The innovativeness of the strategy was also seen in the establishment or revitalizing of infection prevention and control committees at each facility. They monitored bi-monthly evaluations and made plans for timely improvements to achieve Clean Clinic standards in the least time possible.

Evaluations were conducted by personnel outside the healthcare facility, including regional Ministry of Health staff, after which committees made their improvement plans and assigned responsibilities for their management and monitoring. Likewise, a monitoring team was established at the Ministry’s head office to help manage resources and for sensitizing staff on the topic of infection prevention.


To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings), visit