Background: Unimproved water consumption, unimproved sanitation and open defecation indicated as poor water, sanitation and hygiene practices remain a public health challenge in developing countries, including Ethiopia. In previous studies, aforementioned practices were not reported as combined burden at household level using water, sanitation and hygiene resource index. Objective: The overall objective of the study was to assess water, sanitation and hygiene practices using water, sanitation and hygiene resource index and its associated factors in Bugina Woreda, North Wollo Zone, Amhara region, Northeast Ethiopia 2019. Method: A community based cross sectional study design was conducted on October, 2019 on a total of 843 households living in six randomly selected kebeles. A multi stage systematic sampling technique was applied to select study households. A pre-tested structured questionnaire was used to collect data. The data were coded, entered and cleaned using EpiData version 3.1 and analyzed by SPSS version 20. Principal component analysis was used to construct water, sanitation and hygiene resource index. Stepwise multivariable linear regression analysis was used to identify significant predictors of water, sanitation and hygiene resource index. Results: Water, sanitation and hygiene resource index has a mean value of 0E−7 and a standard deviation of 1. The significance of the model was; Adjusted R2 =0.522, SeR2=0.691, F11, 831=84.685, p-value < 0.001 and Durbin Watson value of 1.721. After controlling the effects of other variables, family size (t=5.54, β=−0.077, 95% CI (−0.104, −0.05), p-value < 0.001), type of drinking water source (t=3.809, β= 0.202, 95% CI (0.098, 0.306), p-value < 0.001), type of sanitation facility (t =11.132, β = 0.706, 95% CI (0.581, 0.83), p-value < 0.001) and knowledge on WASH (t=7.225, β=0.586, 95% CI (0.427, 0.745), p-value < 0.001) were significant predictors of water ,sanitation and hygiene resource index. Conclusion: Water, sanitation and hygiene practice as measured by water, sanitation and hygiene resource index was low in the study area. Family size, educational status, source of drinking water, type of sanitation facility and knowledge on water, sanitation and hygiene were significant predictors of water, sanitation and hygiene resource index. Keywords: WASH Resource Index, Linear regression, Bugina Woreda and PCA