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Fijan S, Kürti P, Rozman U, Šostar Turk S. A critical assessment of microbial-based antimicrobial sanitizing of inanimate surfaces in healthcare settings. Front Microbiol 2024; 15:1412269. [PMID: 38933019 PMCID: PMC11199901 DOI: 10.3389/fmicb.2024.1412269] [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: 04/04/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
The global rise in antimicrobial resistance (AMR) poses a significant public health threat, especially in healthcare settings, where controlling the spread of antimicrobial genes is crucial. While person-to-person transmission remains the primary route for healthcare-associated infections (HAIs), hospital surfaces serve as key reservoirs for antimicrobial-resistant microorganisms. Regular cleaning and disinfection of these surfaces are essential. Microbial-based products for sanitizing hospital surfaces have emerged as promising tools to combat HAIs and AMR. However, a review of 32 publications found inconsistencies and potential risks. A total of 15 publications included hospital-based trials, while the rest were either in vitro or in situ assays, reviews, book chapters, or commentaries. In most of the hospital-based studies, specific strains of applied microorganisms were not identified, and the term "probiotic" was inaccurately used. These products mainly featured spores from Bacillus and Priestia genera, which was mainly hypothesized to work through competitive exclusion. Most hospital-based studies have shown that the application of microbial-based products resulted in a significant reduction in pathogens on surfaces, thereby contributing to a decrease in the incidence of healthcare-associated infections (HAIs). Further research is however needed to understand the effectiveness, mechanisms of action, and safety of microbial-based sanitizing agents. Strain-level identification is crucial for safety assessments, yet many reviewed products lacked this information. Consequently, there is a need for rigorous safety evaluations within existing regulatory frameworks to ensure the efficacy and safety of microbial-based cleaning products in healthcare settings.
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Affiliation(s)
- Sabina Fijan
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | | | - Urška Rozman
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Sonja Šostar Turk
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Amin N, Foster T, Hossain MI, Hasan MR, Sarkar S, Rahman A, Adnan SD, Rahman M, Willetts J. Inadequate sanitation in healthcare facilities: A comprehensive evaluation of toilets in major hospitals in Dhaka, Bangladesh. PLoS One 2024; 19:e0295879. [PMID: 38776266 PMCID: PMC11111017 DOI: 10.1371/journal.pone.0295879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Lack of access to functional and hygienic toilets in healthcare facilities (HCFs) is a significant public health issue in low- and middle-income countries (LMICs), leading to the transmission of infectious diseases. Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban hospitals in LMICs. We conducted a cross-sectional study in 10-government and two-private hospitals to explore the availability, functionality, cleanliness, and user-to-toilet ratio in Dhaka, Bangladesh. METHODS From Aug-Dec 2022, we undertook infrastructure assessments of toilets in selected hospitals. We observed all toilets and recorded attributes of intended users, including sex, disability status, patient status (in-patient/out-patient/caregiver) and/or staff (doctor/nurse/cleaner/mixed-gender/shared). Toilet functionality was defined according to criteria used by the WHO/UNICEF Joint-Monitoring Programme in HCFs. Toilet cleanliness was assessed, considering visible feces on any surface, strong fecal odor, presence of flies, sputum, insects, and rodents, and solid waste. RESULTS Amongst 2875 toilets, 2459 (86%) were observed. Sixty-eight-percent of government hospital toilets and 92% of private hospital toilets were functional. Only 33% of toilets in government hospitals and 56% in private hospitals were clean. A high user-to-toilet ratio was observed in government hospitals' outpatients service (214:1) compared to inpatients service (17:1). User-to-toilet ratio was also high in private hospitals' outpatients service (94:1) compared to inpatients wards (19:1). Only 3% of toilets had bins for menstrual-pad disposal and <1% of toilets had facilities for disabled people. CONCLUSION A high percentage of unclean toilets coupled with high user-to-toilet ratio hinders the achievement of SDG by 2030 and risks poor infection-control. Increasing the number of usable, clean toilets in proportion to users is crucial. The findings suggest an urgent call for attention to ensure basic sanitation facilities in Dhaka's HCFs. The policy makers should allocate resources for adequate toilets, maintenance staff, cleanliness, along with strong leadership of the hospital administrators.
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Affiliation(s)
- Nuhu Amin
- Institute for Sustainable Futures, University of Technology Sydney, Ultimo, NSW, Australia
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tim Foster
- Institute for Sustainable Futures, University of Technology Sydney, Ultimo, NSW, Australia
| | - Md. Imam Hossain
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Rezaul Hasan
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Supriya Sarkar
- Hospital Services Management, Directorate General of Health Services (DGHS), MoH&FW, Mohakhali, Dhaka, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control (CDC) Program, Directorate General of Health Services (DGHS), MoH&FW, Mohakhali, Dhaka, Bangladesh
| | - Shaikh Daud Adnan
- Hospital Services Management, Directorate General of Health Services (DGHS), MoH&FW, Mohakhali, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Juliet Willetts
- Institute for Sustainable Futures, University of Technology Sydney, Ultimo, NSW, Australia
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Purwandari R, Daniel D, Hafidz F. Analysis of water, sanitation, and hygiene facilities using the WASH-FIT approach and its relation to patient satisfaction and maternal mortality at hospitals in Indonesia. Front Public Health 2024; 12:1322470. [PMID: 38362217 PMCID: PMC10867246 DOI: 10.3389/fpubh.2024.1322470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The provision of Water, Sanitation, and Hygiene (WASH) is critical to reducing infection and enhancing the quality of health care services. The study aims to assess WASH facilities in Indonesian hospitals using the Water, Sanitation, and Hygiene Facility Improvement Tool (WASH-FIT) approach and examine their association with customer satisfaction and maternal mortality owing to infection. Methods We utilized the national scale Health Facilities Research dataset in Indonesian hospitals in 2019. WASH status is determined using WASH-FIT indicators, i.e., water, sanitation, waste management, hand hygiene, environmental cleaning, and management services, and then divided into three levels: poor, adequate, and good categories. Results The majority of hospitals in Indonesia had a good category, i.e., the range of hospitals with a good category was 79-97% nationally, in 6 aspects: water, sanitation, hand hygiene, environmental cleaning, and management services, except for waste management services (13%). Good WASH service facilities are more frequently found in government hospitals than in private and specialized hospitals, while lower-level hospitals tend to have poor levels of all WASH-FIT indicators. There are significant relationships between adequate sanitation services (β = 0.724), adequate and good categories of hand hygiene services (β = 0.712 and 0.866, respectively), environmental cleaning (β = -0.501 and -0.503, respectively), and management (β = -0.645 and 0.446, respectively), with the proportion of maternal mortality owing to infection. Furthermore, there was no relationship between WASH-FIT indicators and patient satisfaction, except for good hand hygiene services (β = 0.453). Discussion Despite good conditions in almost all WASH-FIT indicators, the improvement of waste management is urgently needed to improve the WASH services in hospitals in Indonesia, as also found in other developing countries.
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Affiliation(s)
- Rina Purwandari
- Master of Public Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - D. Daniel
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Firdaus Hafidz
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Tesfaw A, Tiruneh M, Mamuye M, Walle Z, Teshager W, Teshome F, Taye A, Dessalegn W, Walle G, Gebeyehu AA. Magnitude and determinants of improved household latrine utilization in Ethiopia: Multilevel analysis of the mini Ethiopian Demographic Health Survey (EDHS) 2019. PLoS One 2023; 18:e0289427. [PMID: 37531358 PMCID: PMC10395897 DOI: 10.1371/journal.pone.0289427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/18/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Lack of sanitation is a major global problem mainly for the poor and disadvantaged. According to the 2016 Ethiopian Demographic and Health Surveys (EDHS) report, one out of every three households lack a toilet in Ethiopia and about 56% of rural households use unimproved toilet facilities. We aimed to determine the magnitude of improved household latrine utilization and its determinants in Ethiopia using the mini-Ethiopian Demographic Health Survey (EDHS) 2019 data set. METHOD A secondary data analysis was conducted based on the mini 2019 EDHS data set. A total weighted sample of 8663 households were involved in analysis. After selecting the relevant variables for the outcome variable, we have fitted four different models. The null (empty) model with no independent variables and the second model contained the effects of the individual-level factors on the outcome variable. The third model included the influence of the community-level factors on the response variable, and the final multilevel multivariable logistic regression model examined the effects of individual-level and community-level variables on the outcome variable. The measure of variation was quantified using Intra-Class Correlation (ICC), Median Odds Ratio, and Proportional Change in Variance (PCV). The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was used to show the strength of association and statistical significance was declared at p value < 0.05. RESULTS The magnitude of improved latrine utilization in Ethiopia was 19.5% with 95% CI (18.6%, 20.3%). The factors: educational status (AOR = 1.67; 95% CI: (1.10, 2.55), highest wealth index (AOR = 3.73; 95% CI: (2.73, 5.12), urban residence (AOR = 3.09; 95% CI: (1.68, 5.67), living in Addis Ababa (AOR = 4.08; 95% CI: (1.03, 16.2) and Dire Dawa (AOR = 8.22; 95% CI: (2.46, 27.42) and Somali regions (AOR = 3.11; 95% CI: (1.15, 8.42) were significantly associated to improved latrine utilization in Ethiopia. CONCLUSION The magnitude of improved latrine utilization was quite low in Ethiopia. Higher wealth index, living in more urbanized areas, and the household head's educational status were all significant predictors of improved latrine utilization. The finding implies a need to increase household's access to latrine facilities and improve latrine utilization, particularly for rural households in the country.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Melkalem Mamuye
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Zebader Walle
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wondossen Teshager
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alebachew Taye
- Department of Statistics, College of Natural Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wondimnew Dessalegn
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Asaye Alemneh Gebeyehu
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Kalankesh LR, Rezaei Z, Mohammadpour A, Taghavi M. COVID-19 pandemic and socio-environmental inequality: A narrative review. Health Sci Rep 2023; 6:e1372. [PMID: 37388271 PMCID: PMC10300242 DOI: 10.1002/hsr2.1372] [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: 01/18/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023] Open
Abstract
Background and Aims The COVID-19 pandemic has provided preliminary evidence of the existence of health, social, and environmental inequalities. This inequality encompasses inadequate access to safe water, clean air, and wastewater management, as well as limited socioeconomic and educational opportunities. These issues have not received sufficient attention during the pandemic. The purpose of this narrative review is to provide a comprehensive summary and analysis of the existing literature on a specific topic, ultimately leading to a conclusion based on the evidence presented. Methods The search methodology for this study involved conducting comprehensive searches of scientific databases, including PubMed, ScienceDirect, LILACS, and Google Scholar, from 2019 to 2023. The study focused on a specific theme and its relevant aspects related to global environmental health and society. Keywords such as COVID-19, inequities, and environmental health were used for searching. Additionally, the Boolean operator "AND" was used to combine these descriptors. Results Unequal exposure to air pollution has been reported in Africa, as well as in large parts of Asia and Latin America, according to the data that has been obtained. The pandemic has also resulted in a surge in healthcare waste generation, exacerbating the environmental impact of solid waste. Furthermore, there is evidence indicating significant disparities in the severe lack of access to sanitation services between developing nations and low-income regions. The issues related to water availability, accessibility, and quality are subject to debate. It has been reported that SARS-CoV-2 is present not only in untreated/raw water, but also in water bodies that act as reservoirs. Moreover, insufficient education, poverty, and low household income have been identified as the most significant risk factors for COVID-19 infection and mortality. Conclusion It is evident that addressing socio-environmental inequality and striving to narrow the gap by prioritizing vulnerable populations are imperative.
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Affiliation(s)
- Laleh R. Kalankesh
- Social Determinants of Health Research CenterGonabad University of Medical SciencesGonabadIran
| | - Zahed Rezaei
- Social Determinants of Health Research CenterGonabad University of Medical SciencesGonabadIran
| | - Ali Mohammadpour
- Social Determinants of Health Research CenterGonabad University of Medical SciencesGonabadIran
| | - Mahmoud Taghavi
- Social Determinants of Health Research CenterGonabad University of Medical SciencesGonabadIran
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Shrestha A, Kunwar BM, Meierhofer R. Water, sanitation, hygiene practices, health and nutritional status among children before and during the COVID-19 pandemic: longitudinal evidence from remote areas of Dailekh and Achham districts in Nepal. BMC Public Health 2022; 22:2035. [PMID: 36344970 PMCID: PMC9640870 DOI: 10.1186/s12889-022-14346-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background The COVID-19 pandemic drew hygiene to the center of disease prevention. The provision of adequate water, sanitation, and hygiene (WASH) services is crucial to protect public health during a pandemic. Yet, access to levels of water supply that support adequate hygiene measures are deficient in many areas in Nepal. We examined WASH practices and their impact on child health and nutritional status in two districts before and during the COVID-19 pandemic. Methods A longitudinal and mixed method study was conducted in March–May 2018 and November–December 2021. In total, 715 children aged 0–10 years were surveyed at baseline. Of these, 490 children were assessed at endline. Data collection methods included observations, a questionnaire, stool analysis, anthropometric measurements, water quality analysis, and an assessment of clinical signs of nutritional deficiencies. We conducted 10 in-depth interviews to understand major problems related to COVID-19. Results Most respondents (94.2%) had heard about COVID-19; however, they did not wear face masks or comply with any social distancing protocols. Almost 94.2% of the households self-reported handwashing with soap 5–10 times per day at endline, especially after defecation, compared to 19.6% at baseline. Water quality was better at endline than at baseline with median 12 to 29 CFU Escherichia coli/100 mL (interquartile range at baseline [IQR] = 4–101) at the point of collection and 34 to 51.5 CFU Escherichia coli/100 mL (IQR = 8–194) at the point of consumption. Fever (41.1–16.8%; p = 0.01), respiratory illness (14.3–4.3%; p = 0.002), diarrhea (19.6–9.5%; p = 0.01), and Giardia lamblia infections (34.2–6.5%, p = 0.01) decreased at endline. In contrast, nutritional deficiencies such as bitot’s spots (26.7–40.2%; p = 0.01), pale conjunctiva (47.0–63.3%; p = 0.01), and dermatitis (64.8–81.4%; p = 0.01) increased at endline. The inadequacy of the harvest and the lack of household income to meet households’ nutritional needs increased drastically (35.0–94.2%; p = 0.01). Conclusion We found that improved water quality and handwashing practices were associated with a decrease in infectious diseases. However, food security also decreased resulting in a high prevalence of nutritional deficiencies. Our findings underline that disaster preparedness should consider access to adequate WASH, nutrition, and health supplies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14346-8.
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Berihun G, Walle Z, Teshome D, Berhanu L, Derso M. COVID-19 Vaccine Acceptance and Associated Factors Among College Students in Dessie City, Northeastern Ethiopia. J Multidiscip Healthc 2022; 15:1735-1746. [PMID: 35990405 PMCID: PMC9384869 DOI: 10.2147/jmdh.s381151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background The COVID-19 vaccine is regarded as an effective measure for reducing the pandemic’s impact. But, COVID-19 disease burden reduction efforts are being affected by the rising vaccine resistance. Objective To assess the COVID-19 vaccine acceptance and associated factors among college students in Dessie city, Northeastern Ethiopia. Methods An institutional-based cross-sectional study was carried out among college students in Dessie town from July 1–20, 2021. The association between independent and dependent variables was assessed by binary logistic regression analysis using crude odds ratio and adjusted odds ratio. Variables having p values of less than 0.05 at the 95% confidence interval were regarded as potential determinants of COVID-19 vaccine acceptance. Results A total of 422 college students participated in the study with a response rate of 95.6%. More than half 226 (56.2%) of the participants had willingness to accept COVID-19 vaccine. Respondents who had history of chronic medical illness (AOR: 4.340, 95% CI: 1.166, 16.149), training on COVID-19 vaccine (AOR: 4.755, 95% CI: 2.606, 6.674), history of regular vaccine uptake (AOR: 2.534, 95% CI: 1.412, 4.549), perception of COVID-19 severity (AOR: 4.109, 95% CI: 2.190, 7.710), perception that COVID-19 can be prevented by vaccine (AOR: 2.420, 95% CI: 1.160, 5.049), and development of herd immunity against COVID-19 vaccines (AOR: 2.566, 95% CI: 1.431, 4.599) were factors significantly associated with COVID-19 vaccine acceptance. Conclusion The acceptance of COVID-19 vaccine among college students was low. The history of chronic medical illness, training on COVID-19 vaccine, history of vaccine uptake, perception that COVID-19 can be prevented by vaccine, perception of herd immunity development against COVID-19, and severity of COVID 19 infection were factors significantly associated with the acceptance of COVID-19 vaccine. Hence, it is necessary to promote COVID-19 vaccination among college students through health education and vaccine outreach.
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Affiliation(s)
- Gete Berihun
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zebader Walle
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Daniel Teshome
- Department of Anatomy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Leykun Berhanu
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mohammed Derso
- Department of Biochemistry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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