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Tang F, Chen Z, Zhu H, Xi L, Li C, Luo W. Genetic relatedness, antibiotic resistance, and virulence of Klebsiella pneumoniae isolated from health care and food sources in Wuhan, China. Am J Infect Control 2024; 52:1043-1051. [PMID: 38782211 DOI: 10.1016/j.ajic.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/06/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To investigate genetic relatedness and antibiotic resistance of Klebsiella pneumoniae from retail meat samples, clinical source samples, and hospital environmental samples in Wuhan, China. METHODS Hypermucoviscosity and biofilm formation of K. pneumoniae were assessed by string test and crystal violet staining. MICs of 18 antimicrobials were determined by broth microdilution. PCR detected 14 antibiotic resistance genes. Genetic relatedness and clonal dissemination were analyzed by PFGE. RESULTS Among 5,730 samples, 46 were tested positive for K pneumoniae, with higher rates observed in meat (23.4%) than in clinical samples (0.6%) and hospital environmental samples (8.0%). Meat-derived isolates showed high resistance to tetracycline (36.4%, 4/11), sulfonamide (27.3%, 3/11), and gentamicin (27.3%, 3/11), whereas clinical isolates exhibited significant resistance to ampicillin-sulbactam (32.3%, 10/31). Multidrug resistance was observed in 17.4% (8/46) of the isolates, particularly in hospital environmental samples (3/4). Biofilm production was observed in 88.1% (37/42) of K pneumoniae. Pulsed-field gel electrophoresis analysis revealed patient-to-patient K pneumoniae transmission, transmission between patients and hospital environment, as well as cross-contamination between markets. CONCLUSIONS The findings underscore the importance of comprehensive surveillance, infection control, and judicious antibiotic use in mitigating the impact of K pneumoniae on public health, especially in the food chain and health care settings.
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Affiliation(s)
- Feng Tang
- Department of Laboratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Zhi Chen
- Microbiological Laboratory, Wuhan Center for Disease Control and Prevention, Wuhan, China
| | - Hanjue Zhu
- Plastic Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lei Xi
- Department of Laboratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
| | - Changzhen Li
- Department of Laboratory Medicine, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
| | - Wanjun Luo
- Hospital-Acquired Infection Control Department, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
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Harun MGD, Anwar MMU, Sumon SA, Hassan MZ, Haque T, Mah-E-Muneer S, Rahman A, Abdullah SAHM, Islam MS, Styczynski AR, Kaydos-Daniels SC. Infection prevention and control in tertiary care hospitals of Bangladesh: results from WHO infection prevention and control assessment framework (IPCAF). Antimicrob Resist Infect Control 2022; 11:125. [PMID: 36203207 PMCID: PMC9535892 DOI: 10.1186/s13756-022-01161-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/16/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) in healthcare settings is imperative for the safety of patients as well as healthcare providers. To measure current IPC activities, resources, and gaps at the facility level, WHO has developed the Infection Prevention and Control Assessment Framework (IPCAF). This study aimed to assess the existing IPC level of selected tertiary care hospitals in Bangladesh during the COVID-19 pandemic using IPCAF to explore their strengths and deficits. METHODS Between September and December 2020, we assessed 11 tertiary-care hospitals across Bangladesh. We collected the information from IPC focal person and/or hospital administrator from each hospital using the IPCAF assessment tool.. The score was calculated based on eight core components and was used to categorize the hospitals into four distinct IPC levels- Inadequate, Basic, Intermediate, and Advanced. Key performance metrics were summarized within and between hospitals. RESULTS The overall median IPCAF score was 355.0 (IQR: 252.5-397.5) out of 800. The majority (73%) of hospitals scored as 'Basic' IPC level, while only 18% of hospitals were categorized as 'Intermediate'. Most hospitals had IPC guidelines as well as environments, materials and equipments. Although 64% of hospitals had IPC orientation and training program for new employees, only 30% of hospitals had regular IPC training program for the staff. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs. Around 90% of hospitals did not have an active IPC monitoring and audit system. Half of the hospitals had inadequate staffing considering the workload. Bed occupancy of one patient per bed in all units was found in 55% of hospitals. About 73% of hospitals had functional hand hygiene stations, but sufficient toilets were available in only 37% of hospitals. CONCLUSION The majority of sampled tertiary care hospitals demonstrate inadequate IPC level to ensure the safety of healthcare workers, patients, and visitors. Quality improvement programs and feedback mechanisms should be implemented to strengthen all IPC core components, particularly IPC surveillance, monitoring, education, and training, to improve healthcare safety and resilience.
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Affiliation(s)
- Md Golam Dostogir Harun
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - Md Mahabub Ul Anwar
- Centers for Disease Control and Prevention (CDC), Bangladesh Country Office, Dhaka, Bangladesh
| | - Shariful Amin Sumon
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Tahmidul Haque
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Syeda Mah-E-Muneer
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | | | - Md Saiful Islam
- Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
- University of New South Wales, Sydney, Australia
| | - Ashley R Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, 94305, USA
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Hassan MZ, Shirin T, Rahman M, Alamgir ASM, Jahan N, Al Jubayer Biswas MA, Khan SH, Basher MAK, Islam MA, Hussain K, Islam MN, Rabbany MA, Haque MA, Chakraborty SR, Parvin SR, Rahman M, Chowdhury F. Seasonal influenza vaccine uptake among healthcare workers in tertiary care hospitals, Bangladesh: Study protocol for influenza vaccine supply and awareness intervention. BMC Public Health 2022; 22:1819. [PMID: 36153529 PMCID: PMC9509585 DOI: 10.1186/s12889-022-14182-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Healthcare workers (HCWs), such as doctors, nurses, and support staffs involved in direct or indirect patient care, are at increased risk of influenza virus infections due to occupational exposures. Vaccination is the most effective way to prevent influenza. Despite the World Health Organization (WHO) recommendations, Bangladesh lacks a seasonal influenza vaccination policy for HCWs, and thus vaccination rates remain low. The current project aims to investigate the effect of interventions on influenza vaccine awareness and availability of vaccine supply, explore HCWs’ knowledge and perceptions about influenza vaccination, understand the barriers and motivators for influenza vaccine uptake, and understand policymakers' views on the practicality of influenza vaccination among HCWs.
Method
We will conduct the study at four tertiary care teaching hospitals in Bangladesh, using a cluster randomized controlled trial approach, with the hospital as the unit of randomization and intervention. The study population will include all types of HCWs.The four different types of intervention will be randomly allocated and implemented in four study hospitals separately. The four interventions will be: i) ensuring the availability of influenza vaccine supply; ii) developing influenza vaccine awareness; iii) both ensuring influenza vaccine supply and developing influenza vaccine awareness and iv) control arm with no intervention. Both quantitative and qualitative approaches will be applied to assess the intervention effect. We will estimate the Difference in Differences (DID) with 95% CI of the proportion of vaccine uptake between each intervention and control (non-intervention) arm, adjusting for the clustering effect. The qualitative data will be summarised using a framework matrix method.
Discussion
The results of this study will inform the development and implementation of a context-specific strategy to enhance influenza vaccination rates among Bangladeshi HCWs.
Trial registration
Clinicaltrials.gov NCT05521763. Version 2.0 was registered in September 2022, and the first participant enrolled in March 2022. Retrospectively registered.
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The Effectiveness of Interventions in Improving Hand Hygiene Compliance: A Meta-Analysis and Logic Model. ACTA ACUST UNITED AC 2021; 2021:8860705. [PMID: 34336066 PMCID: PMC8313351 DOI: 10.1155/2021/8860705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/12/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Background Despite the availability of various guidelines, rules, and strategies, hand hygiene adherence rates among healthcare workers are reported significantly lower than expected. The aim of this meta-analysis is to determine the most effective interventions to improve hand hygiene and to develop a logic model based on the characteristics of the most effective interventions. Methods A literature search was conducted on PubMed, ProQuest, Web of Knowledge, Scopus, Cochrane Library, and ScienceDirect databases up to December 21, 2019, with no time limit. Randomized clinical trials which had designed interventions to improve hand hygiene were reviewed. Data were extracted independently by two authors. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software (version 2.0). A random-effects model was used to estimate odds ratios. Results Although 14 studies were initially reviewed, only 12 studies entered the meta-analysis, since they had identified percentage rates of hand hygiene compliance. The most effective intervention (odds ratio 18.4, 95% CI (13.6–24.8)) was a multilevel strategy that influenced the determinants of hand hygiene behavior at individual, interpersonal, and organizational levels. Following this, a theory-driven logic model was mapped out to promote hand hygiene, based on situational analysis. Conclusion This study suggests that designing integrated interventions based on a multilevel socioecological approach has the greatest potential to improve hand hygiene compliance in healthcare workers. The logical model proposed in this study can thus provide a useful guide for designing and conducting future experimental research.
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Park JY, Pardosi JF, Seale H. Examining the inclusion of patients and their family members in infection prevention and control policies and guidelines across Bangladesh, Indonesia, and South Korea. Am J Infect Control 2020; 48:599-608. [PMID: 31919010 PMCID: PMC7132722 DOI: 10.1016/j.ajic.2019.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although familial involvement during inpatient care is not uncommon in western countries, the types of caring activities that family members in Asian countries provide are significantly different. These activities may place the family member at risk from a health care-associated infection. This study aimed to examine whether the role of patients' families has been accounted for in the infection prevention and control (IPC) guidelines and policy, using examples from Bangladesh (low-income country), Indonesia (middle-income country), and South Korea (high-income country). METHODS The World Health Organization website and Institutional Repository for Information Sharing, Centers for Disease Control and Prevention website, Australian Government Web Archive, Open Grey, Grey Matters, World Bank, and advanced Google search, as well as the Health Department/Ministry of Health websites for each target country and 4 western countries (Australia, Canada, England, and the United States) were searched. Other databases, such as Embase, Medline, CINAHL, Global Health, ProQuest databases, Google scholar, Web of Science, and Scopus were also searched. This was to review the reflection of the cultural influence in IPC policies/guidelines by reviewing those from the global organizations, which are often used as a blueprint for policy development, as well as those from western countries, which hold different cultures in care arrangement. Search was conducted with attention to the key areas: definition and role of carer in the acute health care facility, involvement of patients/family members in IPC activities, patient and family member hand hygiene, and IPC education. RESULTS Ninety-two articles were identified based on the criteria for the study. Only 6 acknowledged that care is provided to hospitalized patients by their family members, and only 1 recommended that family members receive the same level of training as health care workers on IPC precautions. Other guides recommended the provision of information on IPC measures as means of patient involvement in the IPC program. Recognition of family caregivers or inclusion of them in the IPC strategies was not included in the target countries' guidelines. CONCLUSIONS Although health care workers are the primary actors when it comes to providing care in acute health care settings, it is important to expand the IPC guides by considering the role of other caregivers. Policies and guidelines should reflect the cultural influence over healthcare. This is especially true when cultural values strongly influence over healthcare arrangements and the healthcare accommodates these cultural influences in the practice. Further work needs to be undertaken on the level of training/education provided to family members in Bangladesh, Indonesia, and South Korea.
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Affiliation(s)
- Ji Yeon Park
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
| | | | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Hassan MZ, Sturm-Ramirez K, Rahman MZ, Hossain K, Aleem MA, Bhuiyan MU, Islam MM, Rahman M, Gurley ES. Contamination of hospital surfaces with respiratory pathogens in Bangladesh. PLoS One 2019; 14:e0224065. [PMID: 31658279 PMCID: PMC6816543 DOI: 10.1371/journal.pone.0224065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023] Open
Abstract
With limited infection control practices in overcrowded Bangladeshi hospitals, surfaces may play an important role in the transmission of respiratory pathogens in hospital wards and pose a serious risk of infection for patients, health care workers, caregivers and visitors. In this study, we aimed to identify if surfaces near hospitalized patients with respiratory infections were contaminated with respiratory pathogens and to identify which surfaces were most commonly contaminated. Between September-November 2013, we collected respiratory (nasopharyngeal and oropharyngeal) swabs from patients hospitalized with respiratory illness in adult medicine and paediatric medicine wards at two public tertiary care hospitals in Bangladesh. We collected surface swabs from up to five surfaces near each case-patient including: the wall, bed rail, bed sheet, clinical file, and multipurpose towel used for care giving purposes. We tested swabs using real-time multiplex PCR for 19 viral and 12 bacterial pathogens. Case-patients with at least one pathogen detected had corresponding surface swabs tested for those same pathogens. Of 104 patients tested, 79 had a laboratory-confirmed respiratory pathogen. Of the 287 swabs collected from surfaces near these patients, 133 (46%) had evidence of contamination with at least one pathogen. The most commonly contaminated surfaces were the bed sheet and the towel. Sixty-two percent of patients with a laboratory-confirmed respiratory pathgen (49/79) had detectable viral or bacterial nucleic acid on at least one surface. Klebsiella pneumoniae was the most frequently detected pathogen on both respiratory swabs (32%, 33/104) and on surfaces near patients positive for this organism (97%, 32/33). Surfaces near patients hospitalized with respiratory infections were frequently contaminated by pathogens, with Klebsiella pneumoniae being most common, highlighting the potential for transmission of respiratory pathogens via surfaces. Efforts to introduce routine cleaning in wards may be a feasible strategy to improve infection control, given that severe space constraints prohibit cohorting patients with respiratory illness.
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Affiliation(s)
- Md. Zakiul Hassan
- icddr,b (formerly, International Centre for Diarrheal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Katharine Sturm-Ramirez
- icddr,b (formerly, International Centre for Diarrheal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mohammad Ziaur Rahman
- icddr,b (formerly, International Centre for Diarrheal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Kamal Hossain
- icddr,b (formerly, International Centre for Diarrheal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mohammad Abdul Aleem
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mejbah Uddin Bhuiyan
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, WA, Australia
| | - Md. Muzahidul Islam
- icddr,b (formerly, International Centre for Diarrheal Disease Research, Bangladesh), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Emily S. Gurley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Alam MS, Chakraborty S, Rahman T, Hosen MI, Paul A, Hasan AKMM, Hossain MA. Investigation of the Potential Association between Clustered Regularly Interspersed Short Palindromic Repeats (CRISPR) and Antibiotic Resistance Pattern of Bacterial Strains Isolated from Medical Waste and Environmental Water. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojmm.2018.82002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Santosaningsih D, Erikawati D, Santoso S, Noorhamdani N, Ratridewi I, Candradikusuma D, Chozin IN, Huwae TECJ, van der Donk G, van Boven E, Voor In 't Holt AF, Verbrugh HA, Severin JA. Intervening with healthcare workers' hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study. Antimicrob Resist Infect Control 2017; 6:23. [PMID: 28239452 PMCID: PMC5312519 DOI: 10.1186/s13756-017-0179-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 02/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Hand hygiene is recognized as an important measure to prevent healthcare-associated infections. Hand hygiene adherence among healthcare workers is associated with their knowledge and perception. This study aimed to evaluate the effect of three different educational programs on improving hand hygiene compliance, knowledge, and perception among healthcare workers in a tertiary care hospital in Indonesia. Methods The study was performed from May to October 2014 and divided into a pre-intervention, intervention, and post-intervention phase. This cluster randomized controlled trial allocated the implementation of three interventions to the departments, including role model training-pediatrics, active presentation-surgery, a combination of role model training and active presentation-internal medicine, and a control group-obstetrics-gynecology. Both direct observation and knowledge-perception survey of hand hygiene were performed using WHO tools. Results Hand hygiene compliance was observed during 2,766 hand hygiene opportunities, and knowledge-perception was assessed among 196 participants in the pre-intervention and 88 in the post-intervention period. After intervention, the hand hygiene compliance rate improved significantly in pediatrics (24.1% to 43.7%; P < 0.001), internal medicine (5.2% to 18.5%; P < 0.001), and obstetrics-gynecology (10.1% to 20.5%; P < 0.001). The nurses’ incorrect use of hand rub while wearing gloves increased as well (P < 0.001). The average knowledge score improved from 5.6 (SD = 2.1) to 6.2 (SD = 1.9) (P < 0.05). In the perception survey, “strong smell of hand alcohol” as a reason for non-compliance increased significantly in the departments with intervention (10.1% to 22.9%; P = 0.021). Conclusion The educational programs improved the hand hygiene compliance and knowledge among healthcare workers in two out of three intervention departments in a limited-resource hospital in Indonesia. Role model training had the most impact in this setting. However, adjustments to the strategy are necessary to further improve hand hygiene.
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Affiliation(s)
- Dewi Santosaningsih
- Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia.,Infection Prevention and Control Committee, Dr. Saiful Anwar Hospital, Malang, Indonesia.,Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE The Netherlands
| | - Dewi Erikawati
- Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia
| | - Sanarto Santoso
- Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia
| | - Noorhamdani Noorhamdani
- Department of Microbiology, Faculty of Medicine, Brawijaya University/Dr. Saiful Anwar Hospital, Malang, Indonesia.,Infection Prevention and Control Committee, Dr. Saiful Anwar Hospital, Malang, Indonesia
| | - Irene Ratridewi
- Infection Prevention and Control Committee, Dr. Saiful Anwar Hospital, Malang, Indonesia
| | - Didi Candradikusuma
- Infection Prevention and Control Committee, Dr. Saiful Anwar Hospital, Malang, Indonesia
| | - Iin N Chozin
- Infection Prevention and Control Committee, Dr. Saiful Anwar Hospital, Malang, Indonesia
| | - Thomas E C J Huwae
- Infection Prevention and Control Committee, Dr. Saiful Anwar Hospital, Malang, Indonesia
| | - Gwen van der Donk
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE The Netherlands
| | - Eva van Boven
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE The Netherlands
| | - Henri A Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 's-Gravendijkwal 230, Rotterdam, 3015 CE The Netherlands
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Homaira N, Luby SP, Hossain K, Islam K, Ahmed M, Rahman M, Rahman Z, Paul RC, Bhuiyan MU, Brooks WA, Sohel BM, Banik KC, Widdowson MA, Willby M, Rahman M, Bresee J, Ramirez KS, Azziz-Baumgartner E. Respiratory Viruses Associated Hospitalization among Children Aged <5 Years in Bangladesh: 2010-2014. PLoS One 2016; 11:e0147982. [PMID: 26840782 PMCID: PMC4739641 DOI: 10.1371/journal.pone.0147982] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 01/11/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We combined hospital-based surveillance and health utilization survey data to estimate the incidence of respiratory viral infections associated hospitalization among children aged < 5 years in Bangladesh. METHODS Surveillance physicians collected respiratory specimens from children aged <5 years hospitalized with respiratory illness and residing in the primary hospital catchment areas. We tested respiratory specimens for respiratory syncytial virus, parainfluenza viruses, human metapneumovirus, influenza, adenovirus and rhinoviruses using rRT-PCR. During 2013, we conducted a health utilization survey in the primary catchment areas of the hospitals to determine the proportion of all hospitalizations for respiratory illness among children aged <5 years at the surveillance hospitals during the preceding 12 months. We estimated the respiratory virus-specific incidence of hospitalization by dividing the estimated number of hospitalized children with a laboratory confirmed infection with a respiratory virus by the population aged <5 years of the catchment areas and adjusted for the proportion of children who were hospitalized at the surveillance hospitals. RESULTS We estimated that the annual incidence per 1000 children (95% CI) of all cause associated respiratory hospitalization was 11.5 (10-12). The incidences per 1000 children (95% CI) per year for respiratory syncytial virus, parainfluenza, adenovirus, human metapneumovirus and influenza infections were 3(2-3), 0.5(0.4-0.8), 0.4 (0.3-0.6), 0.4 (0.3-0.6), and 0.4 (0.3-0.6) respectively. The incidences per 1000 children (95%CI) of rhinovirus-associated infections among hospitalized children were 5 (3-7), 2 (1-3), 1 (0.6-2), and 3 (2-4) in 2010, 2011, 2012 and 2013, respectively. CONCLUSION Our data suggest that respiratory viruses are associated with a substantial burden of hospitalization in children aged <5 years in Bangladesh.
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Affiliation(s)
- Nusrat Homaira
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P. Luby
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Kamal Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kariul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Makhdum Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Repon C. Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mejbah Uddin Bhuiyan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - W. Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Bloomberg School of Public, Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Badrul Munir Sohel
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kajal Chandra Banik
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Marc-Alain Widdowson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Melisa Willby
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, (IEDCR), Dhaka, Bangladesh
| | - Joseph Bresee
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Katharine-Sturm Ramirez
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Eduardo Azziz-Baumgartner
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Shahida SM, Islam A, Dey BR, Islam F, Venkatesh K, Goodman A. Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojog.2016.61004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hoque R, Mostafa A, Haque M. Intern doctors' views on the current and future antibiotic resistance situation of Chattagram Maa O Shishu Hospital Medical College, Bangladesh. Ther Clin Risk Manag 2015; 11:1177-85. [PMID: 26316762 PMCID: PMC4542475 DOI: 10.2147/tcrm.s90110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bacterial resistance due to antibiotic misuse is reported every day. Such threat calls for a consensus to develop new strategies to prevent the development of antibiotic resistance of bacteria. Medical doctors must play a pivotal role to control and prevent the misuse of antibiotics. There were complaints that prescribers are lacking behind in updates and advancement in the field. To address such knowledge gap, a study was conducted to know the views of interns on the current antibiotic resistance situation in a teaching hospital in Bangladesh. METHODS This study was a cross-sectional, randomized, and questionnaire-based survey. Interns of the medicine, gynecology, and surgery departments of Chattagram Maa O Shishu Hospital Medical College were the study population. RESULTS Out of 50 respondents, 98% would like more education on antibiotic selection. All respondents believed that prescribing inappropriate or unnecessary antibiotics was professionally unethical. Ninety percent of the participants were confident in making an accurate diagnosis of infection. Eighty-four percent of them were confident about dosage schedule. In all, 98% participants thought that antibiotic resistance is a national problem and 64% of the respondents thought that same problem also existed in their hospital. Study participants were of the view that 41%-60% of antibiotic usages are irrational in Bangladesh. Fifty-eight percent of the study population thought that antimicrobial resistance (AR) would be a greater problem in the future. CONCLUSION The interns believe that there is a knowledge gap on AR. More emphasis should be given to AR and its implications in the undergraduate curriculum. Latest national and international guidelines for antimicrobial therapy and resistance should be made available to the interns.
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Affiliation(s)
- Rozina Hoque
- Department of Pharmacology, Chattagram Maa O Shishu Hospital Medical College, Agrabad, Chittagong, Bangladesh
| | - Asma Mostafa
- Department of Anatomy, Chattagram Maa O Shishu Hospital Medical College, Agrabad, Chittagong, Bangladesh
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu, Malaysia
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Ndegwa LK, Katz MA, McCormick K, Nganga Z, Mungai A, Emukule G, Kollmann MKHM, Mayieka L, Otieno J, Breiman RF, Mott JA, Ellingson K. Surveillance for respiratory health care-associated infections among inpatients in 3 Kenyan hospitals, 2010-2012. Am J Infect Control 2014; 42:985-90. [PMID: 25179331 DOI: 10.1016/j.ajic.2014.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/23/2014] [Accepted: 05/23/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although health care-associated infections are an important cause of morbidity and mortality worldwide, the epidemiology and etiology of respiratory health care-associated infections (rHAIs) have not been documented in Kenya. In 2010, the Ministry of Health, Kenya Medical Research Institute, and Centers for Disease Control and Prevention initiated surveillance for rHAIs at 3 hospitals. METHODS At each hospital, we surveyed intensive care units (ICUs), pediatric wards, and medical wards to identify patients with rHAIs, defined as any hospital-onset (≥3 days after admission) fever (≥38°C) or hypothermia (<35°C) with concurrent signs or symptoms of acute respiratory infection. Nasopharyngeal and oropharyngeal specimens were collected from these patients and tested by real-time reverse transcription polymerase chain reaction for influenza and 7 other viruses. RESULTS From April 2010-September 2012, of the 379 rHAI cases, 60.7% were men and 57.3% were children <18 years old. The overall incidence of rHAIs was 9.2 per 10,000 patient days, with the highest incidence in the ICUs. Of all specimens analyzed, 45.7% had at least 1 respiratory virus detected; 92.2% of all positive viral specimens were identified in patients <18 years old. CONCLUSION We identified rHAIs in all ward types under surveillance in Kenyan hospitals. Viruses may have a substantial role in these infections, particularly among pediatric populations. Further research is needed to refine case definitions and understand rHAIs in ICUs.
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Affiliation(s)
- Linus K Ndegwa
- Centers for Disease Control and Prevention-Nairobi, Kenya; Jomo Kenyatta University, Nairobi, Kenya.
| | - Mark A Katz
- Centers for Disease Control and Prevention-Nairobi, Kenya
| | - Kelly McCormick
- Centers for Disease Control and Prevention-Atlanta, Atlanta, GA
| | - Z Nganga
- Centers for Disease Control and Prevention-Atlanta, Atlanta, GA
| | - Ann Mungai
- Kenyatta National Hospital, Nairobi, Kenya
| | - Gideon Emukule
- Centers for Disease Control and Prevention-Nairobi, Kenya
| | | | - Lilian Mayieka
- Diagnostics and Laboratory Systems Program, Kenya Medical Research Institute/Centers for Disease Control, Kisumu, Kenya
| | - J Otieno
- Kenya Ministry of Medical Services, Nairobi, Kenya; New Nyanza Provincial Hospital, Nairobi, Kenya
| | | | - Joshua A Mott
- Centers for Disease Control and Prevention-Nairobi, Kenya
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Bhuiyan MU, Luby SP, Zaman RU, Rahman MW, Sharker MAY, Hossain MJ, Rasul CH, Ekram ARMS, Rahman M, Sturm-Ramirez K, Azziz-Baumgartner E, Gurley ES. Incidence of and risk factors for hospital-acquired diarrhea in three tertiary care public hospitals in Bangladesh. Am J Trop Med Hyg 2014; 91:165-172. [PMID: 24778198 PMCID: PMC4080557 DOI: 10.4269/ajtmh.13-0484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
During April 2007–April 2010, surveillance physicians in adult and pediatric medicine wards of three tertiary public hospitals in Bangladesh identified patients who developed hospital-acquired diarrhea. We calculated incidence of hospital-acquired diarrhea. To identify risk factors, we compared these patients to randomly selected patients from the same wards who were admitted > 72 hours without having diarrhea. The incidence of hospital-acquired diarrhea was 4.8 cases per 1,000 patient-days. Children < 1 year of age were more likely to develop hospital-acquired diarrhea than older children. The risk of developing hospital-acquired diarrhea increased for each additional day of hospitalization beyond 72 hours, whereas exposure to antibiotics within 72 hours of admission decreased the risk. There were three deaths among case-patients; all were infants. Patients, particularly young children, are at risk for hospital-acquired diarrhea and associated deaths in Bangladeshi hospitals. Further research to identify the responsible organisms and transmission routes could inform prevention strategies.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- *Address correspondence to Mejbah Uddin Bhuiyan, Centre for Communicable Diseases, icddr,b, Dhaka, Bangladesh, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka-1212, Bangladesh. E-mail:
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Islam MS, Luby SP, Sultana R, Rimi NA, Zaman RU, Uddin M, Nahar N, Rahman M, Hossain MJ, Gurley ES. Family caregivers in public tertiary care hospitals in Bangladesh: risks and opportunities for infection control. Am J Infect Control 2014; 42:305-10. [PMID: 24406254 PMCID: PMC4681270 DOI: 10.1016/j.ajic.2013.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
Background Family caregivers are integral to patient care in Bangladeshi public hospitals. This study explored family caregivers' activities and their perceptions and practices related to disease transmission and prevention in public hospitals. Methods Trained qualitative researchers conducted a total of 48 hours of observation in 3 public tertiary care hospitals and 12 in-depth interviews with family caregivers. Results Family caregivers provided care 24 hours a day, including bedside nursing, cleaning care, and psychologic support. During observations, family members provided 2,065 episodes of care giving, 75% (1,544) of which involved close contact with patients. We observed family caregivers washing their hands with soap on only 4 occasions. The majority of respondents said diseases are transmitted through physical contact with surfaces and objects that have been contaminated with patient secretions and excretions, and avoiding contact with these contaminated objects would help prevent disease. Conclusion Family caregivers are at risk for hospital-acquired infection from their repeated exposure to infectious agents combined with their inadequate hand hygiene and knowledge about disease transmission. Future research should explore potential strategies to improve family caregivers' knowledge about disease transmission and reduce family caregiver exposures, which may be accomplished by improving care provided by health care workers.
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Affiliation(s)
- M Saiful Islam
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.
| | - Stephen P Luby
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh; Global Disease Detection Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rebeca Sultana
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nadia Ali Rimi
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Rashid Uz Zaman
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Main Uddin
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nazmun Nahar
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology Disease Control and Research, Dhaka, Bangladesh
| | - M Jahangir Hossain
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Emily S Gurley
- Centre for Communicable Diseases, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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Infrastructure and contamination of the physical environment in three Bangladeshi hospitals: putting infection control into context. PLoS One 2014; 9:e89085. [PMID: 24586516 PMCID: PMC3929649 DOI: 10.1371/journal.pone.0089085] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 01/18/2014] [Indexed: 11/19/2022] Open
Abstract
Objective This paper describes the physical structure and environmental contamination in selected hospital wards in three government hospitals in Bangladesh. Methods The 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. Results A 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. Conclusions The 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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Azziz-Baumgartner E, Rahman M, Al Mamun A, Haider MS, Zaman RU, Karmakar PC, Nasreen S, Muneer SME, Homaira N, Goswami DR, Ahmed BN, Husain MM, Jamil KM, Khatun S, Ahmed M, Chakraborty A, Fry A, Widdowson MA, Bresee J, Azim T, Alamgir ASM, Brooks A, Hossain MJ, Klimov A, Rahman M, Luby SP. Early detection of pandemic (H1N1) 2009, Bangladesh. Emerg Infect Dis 2012; 18:146-9. [PMID: 22257637 PMCID: PMC3310083 DOI: 10.3201/eid1801.101996] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To explore Bangladesh’s ability to detect novel influenza, we examined a series of laboratory-confirmed pandemic (H1N1) 2009 cases. During June–July 2009, event-based surveillance identified 30 case-patients (57% travelers); starting July 29, sentinel sites identified 252 case-patients (1% travelers). Surveillance facilitated response weeks before the spread of pandemic (H1N1) 2009 infection to the general population.
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Azziz-Baumgartner E, Alamgir ASM, Rahman M, Homaira N, Sohel BM, Sharker MAY, Zaman RU, Dee J, Gurley ES, Al Mamun A, Mah-E-Muneer S, Fry AM, Widdowson MA, Bresee J, Lindstrom S, Azim T, Brooks A, Podder G, Hossain MJ, Rahman M, Luby SP. Incidence of influenza-like illness and severe acute respiratory infection during three influenza seasons in Bangladesh, 2008-2010. Bull World Health Organ 2011; 90:12-9. [PMID: 22271960 DOI: 10.2471/blt.11.090209] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/12/2011] [Accepted: 08/22/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine how much influenza contributes to severe acute respiratory illness (SARI), a leading cause of death in children, among people of all ages in Bangladesh. METHODS Physicians obtained nasal and throat swabs to test for influenza virus from patients who were hospitalized within 7 days of the onset of severe acute respiratory infection (SARI) or who consulted as outpatients for influenza-like illness (ILI). A community health care utilization survey was conducted to determine the proportion of hospital catchment area residents who sought care at study hospitals and calculate the incidence of influenza using this denominator. FINDINGS The estimated incidence of SARI associated with influenza in children < 5 years old was 6.7 (95% confidence interval, CI: 0-18.3); 4.4 (95% CI: 0-13.4) and 6.5 per 1000 person-years (95% CI: 0-8.3/1000) during the 2008, 2009 and 2010 influenza seasons, respectively. The incidence of SARI in people aged ≥ 5 years was 1.1 (95% CI: 0.4-2.0) and 1.3 (95% CI: 0.5-2.2) per 10,000 person-years during 2009 and 2010, respectively. The incidence of medically attended, laboratory-confirmed seasonal influenza in outpatients with ILI was 10 (95% CI: 8-14), 6.6 (95% CI: 5-9) and 17 per 100 person-years (95% CI: 13-22) during the 2008, 2009 and 2010 influenza seasons, respectively. CONCLUSION Influenza-like illness is a frequent cause of consultation in the outpatient setting in Bangladesh. Children aged less than 5 years are hospitalized for influenza in greater proportions than children in other age groups.
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Affiliation(s)
- Eduardo Azziz-Baumgartner
- International Centre for Diarrhoeal Disease Research, 68, Shaheed Tajuddin Ahmed, Sarani, Mohakhali, Dhaka 1212, Bangladesh.
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