Water, sanitation, and hygiene in selected health facilities in Ethiopia: risks for healthcare acquired antibiotic resistant infections

Abstract

Background Inadequate water, sanitation and hygiene (WASH) in health facilities and the low adherence to infection control protocols can increase the risk of hospital-acquired (nosocomial) infections, which in turn can increase morbidity and mortality, health care cost, but also contribute to increased microbial resistance. Objectives The study aimed to assess WASH facilities and practices, and levels of nosocomial pathogens in surface and water samples collected from selected health facilities in Oromia Region and Southern, Nations and Nationalities and Peoples Region (SNNPR). Methods WASH in health care facilities in Bulle and Doyogena (SNNPR) and Bidre (Oromia) were assessed through interviews and direct observations (n= 26 facilities). Water and surface samples were collected from major hospitals and health centers. A total of 90 surface swabs and 14 water samples were collected from which a number of bacteria (n=224) were identified, characterized and tested for antimicrobial susceptibility. Results Water supply, toilet facilities, and waste management procedures were suboptimal. Only 11/26 of the health facilities had access to water at the time of the survey. The lowest hand-hygiene compliance was for Bidre (4%), followed by Doyogena (14%), and Bulle (36%). Over 70% of the identified bacteria were from four categories: Staphylococcus spp, Bacillus spp, E. coli, and Klebsiella spp. These bacteria were also found in high risk locations including neonatal intensive care units, delivery and surgical rooms. Antimicrobial susceptibility was detected in ≥ 50% of the isolates for penicillin, cefazolin, ampicillin, oxacillin, and cotrimoxazole, and ≥ 50% of the isolates displayed multi-drug resistance. Conclusion Investing in WASH infrastructures, promotion of handwashing practices, implementing infection prevention and control (IPC) measures and antibiotic stewardship is critical to ensure quality care in these settings.

Potensi Media Transport Modifikasi Sebagai Penunjang Pemeriksaan Kultur Bakteri

“…Gambar 2. (Bekele et al, 2023)Persentase pertumbuhan bakteri pada sampel Ulkus kaki diabetik pada media transport ampas tahu (MTAT) yang paling dominan yaitu pada bakteri Citrobacter sp sebanyak 28% dan yang paling sedikit yaitu pertumbuhan bakteri Staphylococcus sp, E.coli dan Candida sp masing-masing sebanyak 5%. Bakteri golongan Citrobacter sp merupakan bakteri dari famili Enterobacteriales yang biasa ditemukan di air, tanah, pembuangan, saluran pencernaan manusia dan hewan.…”

“…Pada hasil yang tidak terdapat pertumbuhan petugas kebersihan baru membersihkan bed ICU tersebut. Pada pengujian air, sanitasi dan higienitas fasilitas Kesehatan didapatkan pertumbuhan jenis bakteri yang mirip dianatara nya Staphylococcus sp, Bacillus sp, E.coli dan Klebsiella sp (Bekele et al, 2023). Penelitian lain dari swab pada dinding, lantai, tempat tidur, baju petugas, peralatan dan sampel udara pada ruang ICU dan ruang operasi didapatkan bakteri yang dominan gram negatif yaitu Proteus morganii (19,7%) dan gram positif didominasi oleh Staphylococcus aureus (13,1%) (Tuntun, 2022).…”