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Sumon SA, Sarker S, Chowdhury ABMA, Abdullah SAHM, Shahjahan M, Sharmin S, Harun MGD. Antibiotic use in tertiary care hospitals in Bangladesh: Revealing the extent through a point prevalence survey. Am J Infect Control 2024; 52:1052-1059. [PMID: 38795902 DOI: 10.1016/j.ajic.2024.05.013] [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: 01/31/2024] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Prevalent use of antibiotics in hospitals results in antimicrobial resistance (AMR), rising mortality, and substantial financial burden. This study assessed the current pattern of antibiotic use among inpatients in tertiary hospitals in Bangladesh. METHODS Between August and November 2022, we conducted a point prevalence survey in 4 tertiary hospitals in Dhaka, Bangladesh. The World Health Organization-directed point prevalence survey methodology and tools were followed for the data collection. Descriptive and multivariate statistics were performed using Stata version 15. RESULTS Of 1,063 hospitalized patients, antibiotics were prescribed to 73.5% (781/1063, 95% confidence interval: 70.8-76.1) of patients. A total of 1,164 antibiotics were prescribed, and 49.1% of patients consumed multiple antibiotics. Only 31.4% of patients were prescribed antibiotics based on microbiology results. The reasons for antibiotic prescribing were mentioned only in 19.3% of patients. Infants (adjusted odds ratio: 8.52, P-value: <.001) and neonates (adjusted odds ratio: 4.32, P-value: <.001) were more likely to consume antibiotics compared to adults. Cephalosporins accounted for the majority (54.0%) of antibiotics used in hospitals. None of the hospitals had any antibiotic use guidelines. CONCLUSIONS Consumption of Watch group antibiotics empirically among all age groups demonstrates irrational antibiotic usage in Bangladeshi hospitals. Implementation of a tailored stewardship program, antibiotic use guidelines, and prescriber-patient awareness could improve the rational use of antibiotics.
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Affiliation(s)
- Shariful Amin Sumon
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh.
| | - Supta Sarker
- Health System and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Md Shahjahan
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Sabrina Sharmin
- Department of Public Health, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Asgedom AA. Status of infection prevention and control (IPC) as per the WHO standardised Infection Prevention and Control Assessment Framework (IPCAF) tool: existing evidence and its implication. Infect Prev Pract 2024; 6:100351. [PMID: 38469414 PMCID: PMC10926125 DOI: 10.1016/j.infpip.2024.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Healthcare settings have a high prevalence of infectious agents. This narrative review examines the existing evidence regarding infection prevention and control (IPC) using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool in healthcare facilities. A total of 13 full length papers from Africa, Asia and Europe were considered for this review. The findings showed that there are discrepancies in the IPCAF values from insufficient to advanced level. The current review shows an advanced IPCAF level in middle income and high income countries. Low income countries showed a lower IPCAF score. There is a need to enhance the IPC capacity building and to supply infection prevention resources to prevent healthcare associated infection (HAI) with a focus on low income countries.
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Affiliation(s)
- Akeza Awealom Asgedom
- Department of Environmental Health Science, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Ehsan A, Ehsan F, Hanif H. Infection control practices in public sector hospitals of Punjab: a critical analysis. BMJ Open Qual 2024; 13:e002380. [PMID: 38719521 PMCID: PMC11086194 DOI: 10.1136/bmjoq-2023-002380] [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: 04/19/2023] [Accepted: 11/29/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is imperative towards patient safety and health. The Infection Prevention and Control Assessment Framework (IPCAF) developed by WHO provides a baseline assessment at the acute healthcare facility level. This study aimed to assess the existing IPC level of selected public sector hospital facilities in Punjab to explore their strengths and deficits. METHODS Between October and April 2023, 11 public sector hospitals (including tertiary, secondary and primary level care) were selected. Data were collected using the IPCAF assessment tool comprising eight sections, which were then categorised into four distinct IPC levels- inadequate, basic, intermediate and advanced. Key performance metrics were summarised within and between hospitals. RESULTS The overall median IPCAF score for the public sector hospitals was 532.5 (IQR: 292.5-690) out of 800. Four hospitals each scored 'advanced' as well as 'basic' IPC level and three hospitals fell into 'intermediate level'. Most hospitals had IPC guidelines as well as IPC programme, environments, materials and equipments. Although 90% of secondary care hospitals had IPC education and training, only 2 out of 5 (40%) tertiary care and 2 out of 3 (67%) primary care hospitals have IPC or additional experts for training. Only 1 out of 5 tertiary care hospitals (20%) were recorded in an agreed ratio of healthcare workers to patients while 2 out of 5 (40%) of these hospitals lack staffing need assessment. CONCLUSION Overall the sampled public sector (tertiary, secondary and primary) hospitals demonstrated satisfactory IPC level. Challenging areas are the healthcare-associated infection surveillance, monitoring/audit and staffing, bed occupancy overall in all the three categories of hospitals. Periodic training and assessment can facilitate improvement in public sector systems.
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Affiliation(s)
| | - Fatima Ehsan
- Physiology, Riphah International University, Islamabad, Pakistan
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Sumon SA, Anwar MMU, Akther FM, Priyanka AS, Tamanna T, Rahman A, Islam MS, Harun MGD. Perceptions of antibiotic stewardship programmes and determinants of antibiotic prescribing patterns among physicians in tertiary hospitals in Bangladesh: implications for future policy and practice. J Hosp Infect 2024; 144:56-65. [PMID: 38070709 DOI: 10.1016/j.jhin.2023.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The concerning growth of antimicrobial resistance (AMR) renders common infections life-threatening due to irrational antibiotic use and a lack of effective antimicrobial stewardship programmes (ASPs). AIM To investigate the awareness, perceptions and practices of physicians regarding ASPs, AMR and antibiotic prescribing in tertiary care hospitals in Bangladesh. METHODS This hospital-based cross-sectional survey was conducted in 11 tertiary care hospitals across Bangladesh between September 2020 and January 2021. A semi-structured questionnaire was administered through face-to-face interviews for data collection. Descriptive and multi-variate analyses were performed using STATA Version 13. RESULTS In total, 559 physicians were enrolled in this survey. Overall, 40.6% [95% confidence interval (CI) 36.5-44.8] of physicians reported being aware of ASPs, and this figure was higher in public hospitals compared with private hospitals (43.8% vs 27.1%). None of the study hospitals had any ASP initiatives. More than half (55.1%) of the participants were willing to receive feedback from an ASP on their antibiotic selection. Only 30.9% of respondents stated that they wait for the findings of microbiological tests before prescribing antibiotics, although challenges included empiric use of broad-spectrum antibiotics, delayed laboratory results and the existence of drug-resistant patients. In contrast, physicians aware of ASPs were 33% (adjusted odds ratio 0.67, 95% CI 0.45-0.98; P=0.033) less likely to wait for laboratory results before prescribing antibiotics. However, 42.5% of physicians considered patient affordability of purchasing antibiotics when prescribing. CONCLUSIONS Physicians' fundamental knowledge of ASPs and rational antibiotic prescription were found to fall short of the standard. Context-specific and integrated ASP activities, availability and use of guidelines, and improved laboratory facilities are required to battle AMR in Bangladesh.
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Affiliation(s)
- S A Sumon
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - M M U Anwar
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - F M Akther
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - A S Priyanka
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - T Tamanna
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - A Rahman
- Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - M S Islam
- School of Population Health, University of New South Wales, Sydney, Australia
| | - M G D Harun
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
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Harun MGD, Sumon SA, Hasan I, Akther FM, Islam MS, Anwar MMU. Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review. Antimicrob Resist Infect Control 2024; 13:8. [PMID: 38263235 PMCID: PMC10804809 DOI: 10.1186/s13756-024-01369-6] [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: 08/09/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) are pivotal components of the World Health Organization's Global Action Plan to combat antimicrobial resistance (AMR). ASPs advocate rational antibiotic usage to enhance patient-centered outcomes. However, existing evidence on ASPs and their determinants is largely limited to well-equipped hospitals in high-income nations. OBJECTIVE This scoping review aimed to examine the current state of hospital-based ASPs in low- and middle-income countries (LMICs), shedding light on barriers, facilitators, prescribers' perceptions and practices, and the impact of ASP interventions. DESIGN Scoping review on ASP. METHODS Adhering to PRISMA guidelines, we conducted electronic database searches on PubMed, Scopus, and Google Scholar, covering ASP articles published between January 2015 and October 2023. Our review focused on four key domains: barriers to ASP implementation, facilitators for establishing ASP, ASP perceptions and practices of prescribers, and the impact of ASP interventions. Three reviewers separately retrieved relevant data from the included citations using EndNote 21.0. RESULTS Among the 7016 articles searched, 84 met the inclusion criteria, representing 34 LMICs. Notably, 58% (49/84) of these studies were published after 2020. Barriers to ASP implementation, including human-resources shortage, lack of microbiology laboratory support, absence of leadership, and limited governmental support, were reported by 26% (22/84) of the studies. Facilitators for hospital ASP implementation identified in five publications included the availability of antibiotic guidelines, ASP protocol, dedicated multidisciplinary ASP committee, and prompt laboratory support. The majority of the research (63%, 53/84) explored the impacts of ASP intervention on clinical, microbiological, and economic aspects. Key outcomes included increased antibiotic prescription appropriateness, reduced antimicrobial consumption, shorter hospital stays, decreased mortality rate, and reduced antibiotic therapy cost. CONCLUSIONS The published data underscores the imperative need for widespread antimicrobial stewardship in LMIC hospital settings. Substantial ASP success can be achieved through increasing human resources, context-specific interventions, the development of accessible antibiotic usage guidelines, and heightened awareness via training and education.
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Affiliation(s)
- Md Golam Dostogir Harun
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Shariful Amin Sumon
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Istiaque Hasan
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Fairoze Masuda Akther
- Infectious Diseases Division, icddr, b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Yilma M, Taye G, Tefera M, Tassew B, Fentie AM, Abebe W. Infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia. Front Public Health 2024; 12:1329410. [PMID: 38314092 PMCID: PMC10834730 DOI: 10.3389/fpubh.2024.1329410] [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: 10/28/2023] [Accepted: 01/02/2024] [Indexed: 02/06/2024] Open
Abstract
Background Infection prevention and control (IPC) is a set of practices that are designed to minimize the risk of healthcare-associated infections (HAIs) spreading among patients, healthcare workers, and visitors. Implementation of IPC is essential for reducing infection incidences, preventing antibiotic use, and minimizing antimicrobial resistance (AMR). The aim of the study was to assess IPC practices and associated factors in Pediatrics and Child Health at Tikur Anbessa Specialized Hospital. Methods In this study, we used a cross-sectional study design with a simple random sampling method. We determined the sample size using a single population proportion formula with the assumption of a 55% good IPC practice, a 5% accepted margin of error, and a 15% non-response rate and adjusted with the correction formula. The final sample size was 284 healthcare workers. The binary logistic regression model was used for analysis. The World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) tool was used to assess IPC core components. Result A total of 272 healthcare workers participated in the study, with a response rate of 96%. Of the total participants, 65.8% were female and 75.7% were nurses. The overall composite score showed that the prevalence of good IPC practices among healthcare workers was 50.4% (95% CI: 44.3-56.5). The final model revealed that nursing professionals and healthcare workers who received IPC training had AORs of 2.84 (95% CI: 1.34-6.05) and 2.48 (95% CI: 1.36-4.52), respectively. The final average total IPCAF score for the IPC level was 247.5 out of 800 points. Conclusion The prevalence of good IPC practice was suboptimal. The study participants, who were nursing professionals and healthcare workers who received IPC training, showed a statistically significant association with the IPC practice level. The facility-level IPCAF result showed a "Basic" level of practice based on the WHO categorization. These evidences can inform healthcare workers and decision-makers to identify areas for improvement in IPC practice at all levels. Training of healthcare workers and effective implementation of the eight IPC core components should be strengthened to improve suboptimal practices.
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Affiliation(s)
- Mengistu Yilma
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girma Taye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Muluwork Tefera
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhan Tassew
- Department of Health Systems and Health Policy, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Mulu Fentie
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Jarelnape AA. The Assessment of Nursing Staff Knowledge and Barriers Regarding Aseptic Techniques in Khartoum Teaching Hospital, Sudan. Cureus 2023; 15:e45265. [PMID: 37846261 PMCID: PMC10576657 DOI: 10.7759/cureus.45265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
Background Aseptic techniques are crucial in preventing healthcare-associated infections, which are an integral part of standard precautions, and encompass a range of practices designed to safeguard patients from healthcare-associated infections. Objective The objective of this study was to evaluate the level of knowledge and identify the barriers faced by nursing staff in implementing aseptic techniques. Methodology This study employed a stratified random sampling technique to ensure the representation of the research sample. A cross-sectional, descriptive research design was used to assess the knowledge and barriers of nursing staff in maintaining aseptic techniques in their medical practice at Khartoum Teaching Hospital, Sudan. The nursing staff members were divided into different units, and a proportionate number of participants were randomly selected from each stratum. A total of 83 nursing staff members were recruited for this study. Data collection was conducted using a structured questionnaire specifically designed for this study. The questionnaire consisted of items that assessed the nursing staff's knowledge and barriers to aseptic technique implementation. Results The study findings revealed that the mean knowledge score of nursing staff was 14.12, with a median score of 15. The knowledge score had a standard deviation of 3.22. Approximately two-thirds of the nurses (66.3%) had an average level of knowledge, while 33.7% had a below-average level of knowledge. The chi-square analysis indicated a significant association between educational level, years of experience, and knowledge scores (P value=0.010) at a significance level of 0.05. Additionally, 65% of the participants reported facing multiple challenges in maintaining aseptic techniques, including insufficient training, limited resources, and inadequate support. Conclusion In conclusion, the evaluation revealed that a significant proportion of participants felt that their unit lacked adequate training and resources for aseptic techniques. Many had observed colleagues not adhering to aseptic practices, and the participants faced multiple challenges in maintaining aseptic techniques, including insufficient training, limited resources, time constraints, and inadequate support.
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Affiliation(s)
- Ahmed A Jarelnape
- Department of Nursing, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, SAU
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Harun MGD, Anwar MMU, Sumon SA, Mohona TM, Hassan MZ, Rahman A, Abdullah SAHM, Islam MS, Oakley LP, Malpiedi P, Kaydos-Daniels SC, Styczynski AR. Hand hygiene compliance and associated factors among healthcare workers in selected tertiary-care hospitals in Bangladesh. J Hosp Infect 2023; 139:220-227. [PMID: 37516281 PMCID: PMC11149335 DOI: 10.1016/j.jhin.2023.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Hand hygiene (HH) is a fundamental element of patient safety. Adherence to HH among healthcare workers (HCWs) varies greatly depending on a range of factors, including risk perceptions, institutional culture, auditing mechanisms, and availability of HH supplies. AIMS This study aimed to evaluate HH compliance and associated factors among HCWs in selected tertiary-care hospitals in Bangladesh. METHODS During September 2020 to May 2021, we conducted non-participatory observations at 10 tertiary-care hospitals using the WHO's '5-moments for hand hygiene tool' to record HH compliance among physicians, nurses and cleaning staff. We also performed semi-structured interviews to determine the key barriers to complying with HH. RESULTS We observed 14,668 hand hygiene opportunities. The overall HH compliance was 25.3%, the highest among nurses (28.5%), and the lowest among cleaning staff (9.9%). HCWs in public hospitals had significantly higher odds of complying with HH practices than those in private hospitals (adjusted odds ratio: 1.73, 95% CI: 1.55-1.93). The odds of performing HH after touching a patient were 3.36 times higher compared with before touching a patient (95% CI: 2.90-3.90). The reported key barriers to performing HH were insufficient supplies (57.9%), skin reactions (26.3%), workload (26.3%) and lack of facilities (22.7%). Overall, observed HH supplies were available in 81.7% of wards for physicians and 95.1% of wards for nurses, however, no designated HH facilities were found for the cleaning staff. CONCLUSIONS HH compliance among HCWs fell significantly short of the standard for safe patient care. Inadequate HH supplies demonstrate a lack of prioritizing, promoting and investing in infection prevention and control.
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Affiliation(s)
- M G D Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh.
| | - M M U Anwar
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - S A Sumon
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - T M Mohona
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - M Z Hassan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - A Rahman
- Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | | | - M S Islam
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - L P Oakley
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - P Malpiedi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - S C Kaydos-Daniels
- Bangladesh Country Office, Centers for Disease Control and Prevention (CDC), Dhaka, Bangladesh
| | - A R Styczynski
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, USA
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Kamara RZ, Kamara IF, Moses F, Kanu JS, Kallon C, Kabba M, Moffett DB, Fofanah BD, Margao S, Kamara MN, Moiwo MM, Kpagoi SSTK, Tweya HM, Kumar AMV, Terry RF. Improvement in Infection Prevention and Control Compliance at the Three Tertiary Hospitals of Sierra Leone following an Operational Research Study. Trop Med Infect Dis 2023; 8:378. [PMID: 37505674 PMCID: PMC10385074 DOI: 10.3390/tropicalmed8070378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
Implementing infection prevention and control (IPC) programmes in line with the World Health Organization's (WHO) eight core components has been challenging in Sierra Leone. In 2021, a baseline study found that IPC compliance in three tertiary hospitals was sub-optimal. We aimed to measure the change in IPC compliance and describe recommended actions at these hospitals in 2023. This was a 'before and after' observational study using two routine cross-sectional assessments of IPC compliance using the WHO IPC Assessment Framework tool. IPC compliance was graded as inadequate (0-200), basic (201-400), intermediate (401-600), and advanced (601-800). The overall compliance scores for each hospital showed an improvement from 'Basic' in 2021 to 'Intermediate' in 2023, with a percentage increase in scores of 16.9%, 18.7%, and 26.9% in these hospitals. There was improved compliance in all core components, with the majority in the 'Intermediate' level for each hospital IPC programme. Recommended actions including the training of healthcare workers and revision of IPC guidelines were undertaken, but a dedicated IPC budget and healthcare-associated infection surveillance remained as gaps in 2023. Operational research is valuable in monitoring and improving IPC programme implementation. To reach the 'Advanced' level, these hospitals should establish a dedicated IPC budget and develop long-term implementation plans.
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Affiliation(s)
- Rugiatu Z. Kamara
- United States Centers for Disease Control and Prevention Country Office, Emergency Operation Centre, Wilkinson Road, Freetown 00232, Sierra Leone;
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, 21 A-B Riverside Drive, Off Kingharman Road, Freetown 00232, Sierra Leone; (I.F.K.); (B.D.F.)
| | - Francis Moses
- Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown 00232, Sierra Leone; (F.M.); (J.S.K.); (C.K.); (M.K.); (S.M.); (M.N.K.); (S.S.T.K.K.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown 00232, Sierra Leone; (F.M.); (J.S.K.); (C.K.); (M.K.); (S.M.); (M.N.K.); (S.S.T.K.K.)
- College of Medicine and Allied Health Science, University of Sierra Leone, Freetown 00232, Sierra Leone
| | - Christiana Kallon
- Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown 00232, Sierra Leone; (F.M.); (J.S.K.); (C.K.); (M.K.); (S.M.); (M.N.K.); (S.S.T.K.K.)
| | - Mustapha Kabba
- Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown 00232, Sierra Leone; (F.M.); (J.S.K.); (C.K.); (M.K.); (S.M.); (M.N.K.); (S.S.T.K.K.)
| | - Daphne B. Moffett
- United States Centers for Disease Control and Prevention Country Office, Emergency Operation Centre, Wilkinson Road, Freetown 00232, Sierra Leone;
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, 21 A-B Riverside Drive, Off Kingharman Road, Freetown 00232, Sierra Leone; (I.F.K.); (B.D.F.)
| | - Senesie Margao
- Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown 00232, Sierra Leone; (F.M.); (J.S.K.); (C.K.); (M.K.); (S.M.); (M.N.K.); (S.S.T.K.K.)
| | - Matilda N. Kamara
- Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown 00232, Sierra Leone; (F.M.); (J.S.K.); (C.K.); (M.K.); (S.M.); (M.N.K.); (S.S.T.K.K.)
| | - Matilda Mattu Moiwo
- Ministry of Defence, Republic of Sierra Leone Armed Forces, Freetown 00232, Sierra Leone;
| | - Satta S. T. K. Kpagoi
- Ministry of Health and Sanitation, Fourth Floor, Youyi Building, Freetown 00232, Sierra Leone; (F.M.); (J.S.K.); (C.K.); (M.K.); (S.M.); (M.N.K.); (S.S.T.K.K.)
| | - Hannock M. Tweya
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
- International Training and Education for Health, Lilongwe P.O. Box 30369, Malawi
| | - Ajay M. V. Kumar
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
- International Union against Tuberculosis and Lung Disease, South-East Asia Office, C-6, Qutub Institutional Area, New Delhi 110016, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to Be University), University Road, Deralakatte 75018, India
| | - Robert F. Terry
- The Special Program for Research and Training in Tropical Diseases (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland;
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Margao S, Fofanah BD, Thekkur P, Kallon C, Ngauja RE, Kamara IF, Kamara RZ, Tengbe SM, Moiwo M, Musoke R, Fullah M, Kanu JS, Lakoh S, Kpagoi SSTK, Kamara KN, Thomas F, Mannah MT, Katawera V, Zachariah R. Improvement in Infection Prevention and Control Performance Following Operational Research in Sierra Leone: A Before (2021) and After (2023) Study. Trop Med Infect Dis 2023; 8:376. [PMID: 37505672 PMCID: PMC10383112 DOI: 10.3390/tropicalmed8070376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) is crucial to limit health care-associated infections and antimicrobial resistance. An operational research study conducted in Sierra Leone in 2021 reported sub-optimal IPC performance and provided actionable recommendations for improvement. METHODS This was a before-and-after study involving the national IPC unit and all twelve district-level secondary public hospitals. IPC performance in 2021 (before) and in 2023 (after) was assessed using standardized World Health Organization checklists. IPC performance was graded as: inadequate (0-25%), basic (25.1-50%), intermediate (50.1-75%), and advanced (75.1-100%). RESULTS The overall IPC performance in the national IPC unit moved from intermediate (58%) to advanced (78%), with improvements in all six core components. Four out of six components achieved advanced levels when compared to the 2021 levels. The median score for hospitals moved from basic (50%) to intermediate (59%), with improvements in six of eight components. Three of four gaps identified in 2021 at the national IPC unit and four of seven at hospitals had been addressed by 2023. CONCLUSIONS The study highlights the role of operational research in informing actions that improved IPC performance. There is a need to embed operational research as part of the routine monitoring of IPC programs.
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Affiliation(s)
- Senesie Margao
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Bobson Derrick Fofanah
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75001 Paris, France;
| | - Christiana Kallon
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ramatu Elizabeth Ngauja
- National Infection Prevention and Control Coordinating Unit, Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (C.K.); (R.E.N.)
| | - Ibrahim Franklyn Kamara
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rugiatu Zainab Kamara
- US Centre for Disease Control and Prevention Country Office, Freetown 00232, Sierra Leone;
| | - Sia Morenike Tengbe
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Matilda Moiwo
- Republic of Sierra Leone Armed Forces, HIV/AIDS/TB Control Program Coordinator, 34th Military Hospital, Wilberforce, Western Area Urban 00232, Sierra Leone;
| | - Robert Musoke
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Mary Fullah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
| | - Satta Sylvia T. K. Kpagoi
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Kadijatu Nabie Kamara
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Fawzi Thomas
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown 00232, Sierra Leone;
- National Pharmacovigilance Center, Pharmacy Board of Sierra Leone, Freetown 047235, Sierra Leone
| | - Margaret Titty Mannah
- Ministry of Health and Sanitation, Freetown 00232, Sierra Leone; (S.M.T.); (M.F.); (J.S.K.); (S.L.); (S.S.T.K.K.); (K.N.K.); (M.T.M.)
| | - Victoria Katawera
- World Health Organization Country Office, Freetown 00232, Sierra Leone; (I.F.K.); (R.M.); (V.K.)
| | - Rony Zachariah
- UNICEF, UNDP, World Bank, WHO Special Programme for Research and Training in Tropical Diseases (TDR), 1211 Geneva, Switzerland;
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11
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Chowdhury F, Mah-E-Muneer S, Bollinger S, Sharma A, Ahmed D, Hossain K, Hassan MZ, Rahman M, Vanderende D, Sen D, Mozumder P, Khan AA, Sarker M, Smith RM, Styczynski A, Luvsansharav UO. Prevalence of Colonization With Antibiotic-Resistant Organisms in Hospitalized and Community Individuals in Bangladesh, a Phenotypic Analysis: Findings From the Antibiotic Resistance in Communities and Hospitals (ARCH) Study. Clin Infect Dis 2023; 77:S118-S124. [PMID: 37406054 DOI: 10.1093/cid/ciad254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance (AMR) but often lack adequate surveillance to inform mitigation efforts. Colonization can be a useful metric to understand AMR burden. We assessed the colonization prevalence of Enterobacterales with resistance to extended-spectrum cephalosporins, carbapenems, colistin, and methicillin-resistant Staphylococcus aureus among hospital and community dwellers. METHODS Between April and October 2019, we conducted a period prevalence study in Dhaka, Bangladesh. We collected stool and nasal specimens from adults in 3 hospitals and from community dwellers within the hospitals' catchment area. Specimens were plated on selective agar plates. Isolates underwent identification and antibiotic susceptibility testing using Vitek 2. We performed descriptive analysis and determined population prevalence estimates accounting for clustering at the community level. RESULTS The majority of both community and hospital participants were colonized with Enterobacterales with resistance to extended-spectrum cephalosporins (78%; 95% confidence interval [95% CI], 73-83; and 82%; 95% CI, 79-85, respectively). Thirty-seven percent (95% CI, 34-41) of hospitalized patients were colonized with carbapenems compared with 9% (95% CI, 6-13) of community individuals. Colistin colonization prevalence was 11% (95% CI, 8-14) in the community versus 7% (95% CI, 6-10) in the hospital. Methicillin-resistant Staphylococcus aureus colonization was similar in both community and hospital participants (22%; 95% CI, 19-26 vs 21% (95% CI, 18-24). CONCLUSIONS The high burden of AMR colonization observed among hospital and community participants may increase the risk for developing AMR infections and facilitating spread of AMR in both the community and hospital.
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Affiliation(s)
- Fahmida Chowdhury
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Syeda Mah-E-Muneer
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Susan Bollinger
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Aditya Sharma
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Kamal Hossain
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Md Zakiul Hassan
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mahmudur Rahman
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Daniel Vanderende
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Debashis Sen
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Palash Mozumder
- International Centre for Diarrhoeal Disease and Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | | | | | - Rachel M Smith
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ashley Styczynski
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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12
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Anwar MMU, Sumon SA, Mohona TM, Rahman A, Md Abdullah SAH, Islam MS, Harun MGD. Uptake of Influenza Vaccine and Factors Associated with Influenza Vaccination among Healthcare Workers in Tertiary Care Hospitals in Bangladesh: A Multicenter Cross-Sectional Study. Vaccines (Basel) 2023; 11:vaccines11020360. [PMID: 36851238 PMCID: PMC9966774 DOI: 10.3390/vaccines11020360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Influenza, highly contagious in hospital settings, imposes a substantial disease burden globally, and influenza vaccination is critical for healthcare workers (HCWs) to prevent this illness. This study assessed influenza vaccine uptake, including its associated factors among HCWs of tertiary care hospitals in Bangladesh. Between September and December 2020, this multicenter study included 2046 HCWs from 11 hospitals. Face-to-face interviews were conducted using a semi-structured questionnaire to collect data from physicians, nurses, and cleaning and administrative staff for the survey. Only 13.8% (283/2046) of HCWs received the influenza vaccine, of which the majority (76.7%, 217/283) received it for free from the hospital. Nurses had the highest (20.0%, 187/934) influenza vaccine coverage, followed by physicians at 13.5% (71/526), whereas cleaning staff had the lowest at 6.0% (19/318). Among unvaccinated HCWs, the desire to get vaccinated was high (86.2%), with half of the respondents even being willing to pay for it. The HCWs who were aware of the influenza vaccine were over five times more likely to get the vaccine (OR 5.63; 95% CI: 1.04, 1.88) compared to those who were not. HCWs in Bangladesh were vaccinated against influenza at a very low rate. Free and mandatory influenza vaccination programs should be initiated to optimize vaccine coverage among HCWs.
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Affiliation(s)
| | - Shariful Amin Sumon
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | - Tahrima Mohsin Mohona
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control (CDC), Directorate General of Health Services, Government of Bangladesh, Dhaka 1212, Bangladesh
| | | | - Md. Saiful Islam
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia
| | - Md. Golam Dostogir Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
- Correspondence:
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13
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Supriadi IR, Haanappel CP, Saptawati L, Widodo NH, Sitohang G, Usman Y, Anom IB, Saraswati RD, Heger M, Doevendans PA, Satari HI, Voor in ‘t holt AF, Severin JA. Infection prevention and control in Indonesian hospitals: identification of strengths, gaps, and challenges. Antimicrob Resist Infect Control 2023; 12:6. [PMID: 36732802 PMCID: PMC9894741 DOI: 10.1186/s13756-023-01211-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Infection prevention and control (IPC) in hospitals is key to safe patient care. There is currently no data regarding the implementation of IPC in hospitals in Indonesia. The aim of this study was to assess the existing IPC level in a nationwide survey, using the World Health Organization (WHO) IPC assessment framework tool (IPCAF), and to identify strengths, gaps, and challenges. METHODS A cross-sectional study was conducted from July to November 2021. Of all general hospitals in Indonesia, 20% (N = 475) were selected using stratified random sampling based on class (A, B, C and D; class D with a maximum of 50 beds and class A with ≥ 250 beds) and region. The IPCAF was translated into Indonesian and tested in four hospitals. Questions were added regarding challenges in the implementation of IPC. Quantitative IPCAF scores are reported as median (minimum-maximum). IPC levels were calculated according to WHO tools. RESULTS In total, 355 hospitals (74.7%) participated in this study. The overall median IPCAF score was 620.0 (535.0-687.5). The level of IPC was mostly assessed as advanced (56.9% of hospitals), followed by intermediate (35.8%), basic (7.0%) and inadequate (0.3%). In the eastern region of the country, the majority of hospitals scored intermediate level. Of the eight core components, the one with the highest score was IPC guidelines. Almost all hospitals had guidelines on the most important topics, including hand hygiene. Core components with the lowest score were surveillance of healthcare-associated infections (HAIs), education and training, and multimodal strategies. Although > 90% of hospitals indicated that surveillance of HAIs was performed, 57.2% reported no availability of adequate microbiology laboratory capacity to support HAIs surveillance. The most frequently reported challenges in the implementation of IPC were communication with the management of the hospitals, followed by the unavailability of antimicrobial susceptibility testing results and insufficient staffing of full-time IPC nurses. CONCLUSION The IPC level in the majority of Indonesian hospitals was assessed as advanced, but there was no even distribution over the country. The IPCAF in combination with interviews identified several priority areas for interventions to improve IPC in Indonesian hospitals.
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Affiliation(s)
- Indri Rooslamiati Supriadi
- Center for Health Policy on Resilience System and Resource, Health Policy Agency, Ministry of Health of Indonesia, Percetakan Negara 23, Jakarta, Indonesia. .,Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands. .,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
| | - Cynthia P. Haanappel
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Leli Saptawati
- grid.444517.70000 0004 1763 5731Department of Microbiology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia ,Department of Microbiology, Moewardi Teaching Hospital, Surakarta, Indonesia
| | - Nani H. Widodo
- grid.415709.e0000 0004 0470 8161Directorate of Referral Health Care, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - Gortap Sitohang
- grid.487294.40000 0000 9485 3821Infection Prevention and Control Committee, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Yuslely Usman
- grid.415709.e0000 0004 0470 8161Center for Health Financing and Decentralization Policy, Health Policy Agency, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - Ida Bagus Anom
- grid.415709.e0000 0004 0470 8161Directorate of Referral Health Care, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - Ratih Dian Saraswati
- grid.415709.e0000 0004 0470 8161Center for Health Policy on Resilience System and Resource, Health Policy Agency, Ministry of Health of Indonesia, Percetakan Negara 23, Jakarta, Indonesia
| | - Michal Heger
- grid.5477.10000000120346234Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands ,grid.5477.10000000120346234Membrane Biochemistry and Biophysics, Department of Chemistry, Faculty of Science, Utrecht University, Utrecht, The Netherlands ,grid.5645.2000000040459992XLaboratory for Experimental Oncology, Department of Pathology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands ,grid.411870.b0000 0001 0063 8301Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, Department of Pharmaceutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang China
| | - Pieter A. Doevendans
- grid.7692.a0000000090126352Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hindra Irawan Satari
- grid.487294.40000 0000 9485 3821Infection Prevention and Control Committee, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia ,grid.9581.50000000120191471Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anne F. Voor in ‘t holt
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Juliëtte A. Severin
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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14
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Harun MGD, Sumon SA, Mohona TM, Rahman A, Abdullah SAHM, Islam MS, Anwar MMU. Hepatitis B Vaccination Coverage among Bangladeshi Healthcare Workers: Findings from Tertiary Care Hospitals. Vaccines (Basel) 2022; 11:41. [PMID: 36679886 PMCID: PMC9865822 DOI: 10.3390/vaccines11010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Healthcare workers (HCWs) are at a four-fold higher risk of being infected with the hepatitis B virus in hospital settings. This study investigated the hepatitis B vaccination coverage among Bangladeshi HCWs in selected tertiary care hospitals. Between September 2020 to January 2021, a multicenter cross-sectional study was conducted in 11 hospitals across Bangladesh. Participants included physicians, nurses, cleaners, and administrative staff. A semi-structured questionnaire was used to collect data through face-to-face interviews. Descriptive and multivariate statistics were used to analyze the data. The overall hepatitis B vaccination coverage was 66.6% (1363/2046) among HCWs, with cleaning staff having the lowest at 38.8%. Among the unvaccinated, 89.2% of HCWs desired to receive the free vaccine in the near future. In the last year, over one-fourth of staff (27.9%) had at least one history of needlestick injury. Only 9.8% HCWs were found to have attended training on hepatitis B virus prevention and management in the previous two years. Multivariate analysis revealed that physicians (AOR: 7.13, 95% CI: 4.94-10.30) and nurses (AOR: 6.00, 95% CI: 4.09-8.81) were more likely to be vaccinated against hepatitis B than cleaners and administrative staff. Low uptake of hepatitis B vaccination among HCWs suggests policies that require vaccination are needed to achieve optimum vaccine coverage.
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Affiliation(s)
- Md. Golam Dostogir Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | - Shariful Amin Sumon
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | - Tahrima Mohsin Mohona
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control (CDC), Directorate General of Health Services, Government of Bangladesh, Dhaka 1212, Bangladesh
| | | | - Md. Saiful Islam
- National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia
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15
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Rahman MS, Harun MGD, Sumon SA, Mohona TM, Abdullah SAHM, Khan MNH, Gazi MI, Islam MS, Anwar MMU. Hospitalization and Mortality by Vaccination Status among COVID-19 Patients Aged ≥ 25 Years in Bangladesh: Results from a Multicenter Cross-Sectional Study. Vaccines (Basel) 2022; 10:vaccines10121987. [PMID: 36560397 PMCID: PMC9786706 DOI: 10.3390/vaccines10121987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
The COVID-19 pandemic has inflicted a massive disease burden globally, involving 623 million confirmed cases with 6.55 million deaths, and in Bangladesh, over 2.02 million clinically confirmed cases of COVID-19, with 29,371 deaths, have been reported. Evidence showed that vaccines significantly reduced infection, severity, and mortality across a wide age range of populations. This study investigated the hospitalization and mortality by vaccination status among COVID-19 patients in Bangladesh and identified the vaccine's effectiveness against severe outcomes in real-world settings. Between August and December 2021, we conducted this cross-sectional survey among 783 RT-PCR-confirmed COVID-19 hospitalized patients admitted to three dedicated COVID-19 hospitals in Bangladesh. The study used a semi-structured questionnaire to collect information. We reviewed the patient's records and gathered COVID-19 immunization status from the study participants or their caregivers. Patients with incomplete or partial data from the record were excluded from enrollment. Logistic regression analyses were performed to determine the association between key variables with a patient's vaccination status and mortality. The study revealed that overall hospitalization, severity, and morality were significantly high among unvaccinated study participants. Only one-fourth (25%) of hospitalized patients were found COVID-19 vaccinated. Morality among unvaccinated COVID-19 study participants was significantly higher (AOR: 7.17) than the vaccinated (11.17% vs. 1.53%). Severity was found to be seven times higher among unvaccinated patients. Vaccination coverage was higher in urban areas (29.8%) compared to rural parts (20.8%), and vaccine uptake was lower among female study participants (22.7%) than male (27.6%). The study highlighted the importance of COVID-19 vaccines in reducing mortality, hospitalization, and other severe consequences. We found a gap in vaccination coverage between urban and rural settings. The findings would encourage the entire population toward immunization and aid the policymakers in the ground reality so that more initiatives are taken to improve vaccination coverage among the pocket population.
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Affiliation(s)
- Md. Saydur Rahman
- Department of Administration, DNCC Dedicated COVID-19 Hospital, Dhaka 1212, Bangladesh
| | - Md. Golam Dostogir Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
- Department of Public Health, Daffodil International University, Dhaka 1341, Bangladesh
- Correspondence:
| | - Shariful Amin Sumon
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
- Department of Public Health, Daffodil International University, Dhaka 1341, Bangladesh
| | - Tahrima Mohsin Mohona
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka 1212, Bangladesh
| | | | - Md. Nazuml Huda Khan
- Department of Administration, Kurmitola General Hospital, Dhaka 1206, Bangladesh
| | - Md. Ismail Gazi
- Sheikh Russel National Gastroliver Institute and Hospital, Dhaka 1212, Bangladesh
| | - Md. Saiful Islam
- School of Medical Science, University of New South Wales, Sydney 2052, Australia
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