Incidence of and Risk Factors for Hospital-Acquired Diarrhea in Three Tertiary Care Public Hospitals in Bangladesh

Bhuiyan, Mejbah; Luby, Stephen P.; Zaman, Rashid Uz; Sharker, M. A. Yushuf; Hossain, M. Jahangir; Rasul, Choudhury Habibur; Ekram, Arm Saifuddin; Rahman, Mahmudur; Sturm‐Ramirez, Katharine; Azziz‐Baumgartner, Eduardo; Gurley, Emily S.

doi:10.4269/ajtmh.13-0484

Cited by 16 publications

(21 citation statements)

References 32 publications

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“…5,22,32 Hospitalacquired infections are a major problem in health facilities in Bangladesh. 3 This problem is intensified by inadequate hand hygiene practices in this settings.…”

Section: Discussionmentioning

confidence: 99%

Observed Handwashing with Soap Practices Among Cholera Patients and Accompanying Household Members in a Hospital Setting (CHoBI7 Trial)

Zohura

Bhuyian

Monira

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Household members of cholera patients are at a 100 times higher risk of cholera than the general population. Despite this risk, there are only a handful of studies that have investigated the handwashing practices among hospitalized diarrhea patients and their accompanying household members. To investigate handwashing practices in a hospital setting among this high-risk population, 444 hours of structured observation was conducted in a hospital in Dhaka, Bangladesh, among 148 cholera patients and their household members. Handwashing with soap practices were observed at the following key events: after toileting, after cleaning the anus of a child, after removing child feces, during food preparation, before eating, and before feeding. Spot-checks were also conducted to observe the presence of soap at bathroom areas. Overall, 4% (4/103) of key events involved handwashing with soap among cholera patients and household members during the structured observation period. This was 3% (1/37) among cholera patients and 5% (3/66) for household members. For toileting events, observed handwashing with soap was 7% (3/46) overall, 7% (1/14) for cholera patients, and 6% (2/32) for household members. For food-related events, overall observed handwashing with soap was 2% (2/93 overall), and 0% (0/34) and 3% (2/59) for cholera patients and household members, respectively. Soap was observed at only 7% (4/55) of handwashing stations used by patients and household members during spot-checks. Observed handwashing with soap at key times among patients and accompanying household members was very low. These findings highlight the urgent need for interventions to target this high-risk population.

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“…5,22,32 Hospitalacquired infections are a major problem in health facilities in Bangladesh. 3 This problem is intensified by inadequate hand hygiene practices in this settings.…”

Section: Discussionmentioning

confidence: 99%

Observed Handwashing with Soap Practices Among Cholera Patients and Accompanying Household Members in a Hospital Setting (CHoBI7 Trial)

Zohura

Bhuyian

Monira

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…The leading non-surgical HAIs include respiratory and gastrointestinal illnesses. The incidence of hospital-acquired diarrhea at three tertiary care public hospitals was 4.8 cases per 1000 patient days during the 2007-2010 period [25]. Transmission was through fecal-oral route.…”

Section: Review Of Existing Literature On Hospital Acquired Infectionmentioning

confidence: 99%

Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh

Shahida¹,

Islam²,

Dey³

et al. 2016

OJOG

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Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks; inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socioeconomic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.

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“…For example, a large outbreak of Nipah virus was reported among healthcare workers and patients at hospitals in Siliguri, India in 2001 and evidence of Nipah virus transmission in Bangladesh has recently been reported [3]. In addition, patients in Bangladeshi hospitals face substantial risks from endemic infections; studies have shown that hospital-acquired respiratory infections occur at an incidence rate of 6.1 cases per 1000 patientdays [5], and diarrhea with an incidence rate of 3.9 cases among pediatric patients and 2.7 cases among adults per 1000 patientdays [6].…”

Section: Introductionmentioning

confidence: 99%

Infrastructure and Contamination of the Physical Environment in Three Bangladeshi Hospitals: Putting Infection Control into Context

et al. 2014

Self Cite

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ObjectiveThis paper describes the physical structure and environmental contamination in selected hospital wards in three government hospitals in Bangladesh.MethodsThe qualitative research team conducted 48 hours of observation in six wards from three Bangladeshi tertiary hospitals in 2007. They recorded environmental contamination with body secretions and excretions and medical waste and observed ward occupant handwashing and use of personal protective equipment. They recorded number of persons, number of open doors and windows, and use of fans. They measured the ward area and informally observed waste disposal outside the wards. They conducted nine focus group discussions with doctors, nurses and support staff.ResultsA median of 3.7 persons were present per 10 m2 of floor space in the wards. A median of 4.9 uncovered coughs or sneezes were recorded per 10 m2 per hour per ward. Floors in the wards were soiled with saliva, spit, mucous, vomitus, feces and blood 125 times in 48 hours. Only two of the 12 patient handwashing stations had running water and none had soap. No disinfection was observed before or after using medical instruments. Used medical supplies were often discarded in open containers under the beds. Handwashing with soap was observed in only 32 of 3,373 handwashing opportunities noted during 48 hours. Mosquitoes and feral cats were commonly observed in the wards.ConclusionsThe physical structure and environment of our study hospitals are conducive to the spread of infection to people in the wards. Low-cost interventions on hand hygiene and cleaning procedures for rooms and medical equipment should be developed and evaluated for their practicality and effectiveness.

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Incidence of and Risk Factors for Hospital-Acquired Diarrhea in Three Tertiary Care Public Hospitals in Bangladesh

Cited by 16 publications

References 32 publications

Observed Handwashing with Soap Practices Among Cholera Patients and Accompanying Household Members in a Hospital Setting (CHoBI7 Trial)

Observed Handwashing with Soap Practices Among Cholera Patients and Accompanying Household Members in a Hospital Setting (CHoBI7 Trial)

Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh

Infrastructure and Contamination of the Physical Environment in Three Bangladeshi Hospitals: Putting Infection Control into Context

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