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.
Highlights
Hospital-acquired infection represents a major public health concern worldwide
The condition of and accessibility to sanitation facilities varied for different categories of ward occupants (Table 1)
A study conducted in a hospital in Singapore reported higher concentrations of airborne bacteria in the most densely occupied locations, such as the pharmacy and lobby, and an occupant density of 0.5 to one person per 10 m2 ward area [14] compared to our reported overall median of 3.7 persons per 10 m2
Summary
Hospital-acquired infection represents a major public health concern worldwide. Hospitals have played a significant role in the spread of emerging infections. In Toronto, 77% of case patients were exposed to severe acute respiratory syndrome (SARS) in hospital settings in 2003 [1]. Hospitals in South Asia can be at particular risk for transmission of emerging infections, Nipah virus [2,3,4]. 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]. 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]
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