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

Abstract

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.

Evolving epidemiology of Nipah virus infection in Bangladesh: evidence from outbreaks during 2010–2011

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

“…Most patients have at least one personal caregiver, usually a family member, who provides the majority of hands-on care that nursing staff would typically provide in high-income countries 14. Hand washing stations often lack soap and consistent water supply 15. Moreover, limited routine infection control in crowded wards, lead to situations where patients are at high risk of being infected by contaminated food, water, and hospital surfaces and also during contact with other patients, caregivers, and healthcare workers 11,16…”

Hand hygiene infrastructure and behaviours in resource-limited healthcare facilities

“…Whilst not reported in the present study, feral cats have been observed in hospitals in Bangladesh, scavenging for food and sleeping on patient beds. 4 In sum, this study provides insights into the complexities of infection control in underresourced healthcare facilities, and the types of physical environments under which infection prevention and control take place globally. Additional challenges stem from the role of family in patient care for whom hand hygiene may not be a priority.…”