Subtyping of Shigella sonnei for tracing nosocomial transmission

Inadequate sanitation in healthcare facilities: A comprehensive evaluation of toilets in major hospitals in Dhaka, Bangladesh

BACKGROUND

Lack of access to functional and hygienic toilets in healthcare facilities (HCFs) is a significant public health issue in low- and middle-income countries (LMICs), leading to the transmission of infectious diseases. Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban hospitals in LMICs. We conducted a cross-sectional study in 10-government and two-private hospitals to explore the availability, functionality, cleanliness, and user-to-toilet ratio in Dhaka, Bangladesh.

METHODS

From Aug-Dec 2022, we undertook infrastructure assessments of toilets in selected hospitals. We observed all toilets and recorded attributes of intended users, including sex, disability status, patient status (in-patient/out-patient/caregiver) and/or staff (doctor/nurse/cleaner/mixed-gender/shared). Toilet functionality was defined according to criteria used by the WHO/UNICEF Joint-Monitoring Programme in HCFs. Toilet cleanliness was assessed, considering visible feces on any surface, strong fecal odor, presence of flies, sputum, insects, and rodents, and solid waste.

RESULTS

Amongst 2875 toilets, 2459 (86%) were observed. Sixty-eight-percent of government hospital toilets and 92% of private hospital toilets were functional. Only 33% of toilets in government hospitals and 56% in private hospitals were clean. A high user-to-toilet ratio was observed in government hospitals' outpatients service (214:1) compared to inpatients service (17:1). User-to-toilet ratio was also high in private hospitals' outpatients service (94:1) compared to inpatients wards (19:1). Only 3% of toilets had bins for menstrual-pad disposal and <1% of toilets had facilities for disabled people.

CONCLUSION

A high percentage of unclean toilets coupled with high user-to-toilet ratio hinders the achievement of SDG by 2030 and risks poor infection-control. Increasing the number of usable, clean toilets in proportion to users is crucial. The findings suggest an urgent call for attention to ensure basic sanitation facilities in Dhaka's HCFs. The policy makers should allocate resources for adequate toilets, maintenance staff, cleanliness, along with strong leadership of the hospital administrators.

Worker Protection Scenarios for General Analytical Testing Facility under Several Infection Propagation Risks: Scoping Review, Epidemiological Model and ISO 31000

Infectious disease is a risk threating industrial operations and worker health. In gastrointestinal disease cases, outbreak is sporadic, and propagation is often terminated within certain populations, although cases in industrial sites are continuously reported. The ISO 31000 international standard for risk management, an epidemiological triad model, and a scoping review were the methods used to establish response procedures (scenarios) to protect workers from the risk of the propagation of a gastrointestinal disease. First, human reservoirs and transmission routes were identified as controllable risk sources based on a scoping review and the use of a triad model. Second, the possibility of fomite- or surface-mediated transmission appeared to be higher based on environmental characterization. Thus, the propagation could be suppressed using epidemiological measures categorized by reservoirs (workers) or transmission routes during a primary case occurrence. Next, using results of a matrix, a strengths-weaknesses-opportunities-threats analysis and a scoping review, the risk treatment option was determined as risk taking and sharing. According to epidemiology of gastrointestinal infections, systematic scenarios may ensure the efficacy of propagation control. Standardized procedures with practicality and applicability were established for categorized scenarios. This study converged ISO 31000 standards, an epidemiological model, and scoping review methods to construct a risk management scenario (non-pharmaceutical intervention) optimized for the unique characteristics of a specific occupational cluster.

Toilet hygiene-review and research needs

The goal of good toilet hygiene is minimizing the potential for pathogen transmission. Control of odours is also socially important and believed to be a societal measure of cleanliness. Understanding the need for good cleaning and disinfecting is even more important today considering the potential spread of emerging pathogens such as SARS‐CoV‐2 virus. While the flush toilet was a major advancement in achieving these objectives, exposure to pathogens can occur from failure to clean and disinfect areas within a restroom, as well as poor hand hygiene. The build‐up of biofilm within a toilet bowl/urinal including sink can result in the persistence of pathogens and odours. During flushing, pathogens can be ejected from the toilet bowl/urinal/sink and be transmitted by inhalation and contaminated fomites. Use of automatic toilet bowl cleaners can reduce the number of microorganisms ejected during a flush. Salmonella bacteria can colonize the underside of the rim of toilets and persist up to 50 days. Pathogenic enteric bacteria appear in greater numbers in the biofilm found in toilets than in the water. Source tracking of bacteria in homes has demonstrated that during cleaning enteric bacteria are transferred from the toilet to the bathroom sinks and that these same bacteria colonize cleaning tools used in the restroom. Quantitative microbial risk assessment has shown that significant risks exist from both aerosols and fomites in restrooms. Cleaning with soaps and detergents without the use of disinfectants in public restrooms may spread bacteria and viruses throughout the restroom. Odours in restrooms are largely controlled by ventilation and flushing volume in toilet/urinals. However, this results in increased energy and water usage. Contamination of both the air and surfaces in restrooms is well documented. Better quantification of the risks of infection are needed as this will help determine what interventions will minimize these risks.

Antibiotic resistance and genetic diversity of Shigella sonnei isolated from patients with diarrhoea between 1999 and 2003 in Bangladesh

Shigella sonnei is a significant cause of diarrhoeal infection in both developing and industrialized countries. From 1999 to 2003, 445 strains of Shigella sonnei were isolated from patients admitted to the diarrhoea treatment centre of the International Center for Diarrhoeal Disease Research, Bangladesh. More than 60% of the isolates were resistant to nalidixic acid, 89% to sulfamethoxazole-trimethoprim and 9.5% to ampicillin. In addition, 4% of strains were resistant to multiple antibiotics (AmpR TetR SxtR StrR) and 4.2% of strains were sensitive to all antibiotics tested. None of the strains were positive for the set1 gene, whereas 46% were positive for the sen gene. Forty-six per cent of the strains (stored at -70 degrees C) harboured the 120 MDa invasive plasmid and representative strains produced keratoconjunctivitis in the guinea pig eye. In addition, three plasmids of approximately 5, 1.8 and 1.4 MDa were found to be present in more than 90% of the strains. A self-transmissible, middle-ranged plasmid (35-80 MDa) carrying the multiple antibiotic resistance gene was found in some strains. PFGE analysis of the strains identified five unique types with many subtypes, which were characterized into four unique types by ribotyping analysis. It can be concluded that endemic strains of Shigella sonnei isolated from patients in Bangladesh are diverse in their genetic pattern.

Nurses' perception of single-occupancy versus multioccupancy rooms in acute care environments: an exploratory comparative assessment

Health care design professionals, planners, and administrators cite the advantages of private patient rooms, including reduction of hospital-acquired infections, reduction of patient stress levels, and facilitation of nurses' and health care workers' efficiency [e.g., Ulrich, R. (2003). Creating a healing environment with evidence-based design. Paper presented at the American Institute of Architects, Academy of Architecture for Health virtual seminar-Healing environments; Ulrich, R., Quan, X., Zimring, C., Joseph, A., & Choudhary, R. (2004). The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime-opportunity. ]. A review of the literature revealed that operating costs are reduced in single-patient rooms compared with multioccupancy rooms due to reduction in transfer cost, higher bed occupancy rates, and reduction in labor cost. In addition, single rooms can positively impact patients' hospital experience through increased privacy, better interaction between family and staff, and reduced noise and anxiety. This pilot study focused on nurses' perception of the advantages and disadvantages of single-occupancy versus multioccupancy patient rooms in medical-surgical units in four hospitals in the northwest. A majority of respondents in the four hospitals favored single rooms over double-occupancy rooms for the majority of the 15 categories, including the following: appropriateness for patient examination, interaction with or accommodation of family members, and lower probability of dietary mix-ups. Future studies need to carefully examine the objective measures of patient care variables (e.g., incidents of medication errors, opportunities for surveillance), patient outcomes (e.g., recovery rate, falls), and implications of room occupancy on operating costs.

Advantages and Disadvantages of Single-Versus Multiple-Occupancy Rooms in Acute Care Environments

Private patient rooms have become the industry standard in the United States based on the assumption that they reduce the rate of hospital-acquired infections, facilitate patient care and management, and afford greater therapeutic benefits for patients. The objective of this article is to reviewand analyze the existing literature to identify the empirical evidence related to the advantages and disadvantages of single versus multiple-occupancy patient rooms in hospitals. Three substantive areas were identified for synthesis of the review: (a) first and operating cost of hospitals, (b) infection control, and (c) health care facility management and hospital design and therapeutic impacts. The analysis reveals that private patient rooms reduce the risk of hospital-acquired infections, allow for greater flexibility in operation and management, and have positive therapeutic impacts on patients. This review highlights the need to consider room occupancy issues along with other patient care issues and environmental and management policies.