Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh

Abstract

Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks; inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socioeconomic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.

Are Invasive Procedures and a Longer Hospital Stay Increasing the Risk of Healthcare-Associated Infections among the Admitted Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia?

“…Even though there was no association between the absence of hand washing basin, absence of antiseptic for hand rubbing, absence of medical waste container and poor mechanical ventilation, and HCAIs in the current study, there has been a number of reports that describe the risk of these factors [3,15]. Hand washing habit using soap [12], use of protective clothing, good personnel and hospital hygiene, adequate management of soiled linen, proper management of waste in the hospital, aseptic techniques in the operating theatre, and isolation of highly contagious patients are cited as important precaution to prevention and control of HCAI in the hospital [3,27].…”

“…Healthcare-associated infection is defined as a localized or systemic infection occurring in a patient during the process of care in a hospital that was not present or incubating at the time of admission. Most HCAIs become evident at 48 hours or more following admission [3,4]. Infection may also prevail after discharge because the patient has become colonized or infected while in hospital, but the pathogen incubation period exceeds the patient's hospital stay [2].…”

Implementation of a Multimodal Multicentre Hand Hygiene Study: Evidence From Bangladesh Hospitals

“…The study did not meticulously explore the possible influences on HH behavior of HCWs but lack of essential HH infrastructure and infection control management, overcrowding of patients as well as poor supply of HH materials were found as barriers to absolute HHC, which is similar to former studies (Horng et al, 2016;Lee et al, 2011;Pittet & Boyce, 2001;Shahida et al, 2016;Whitby et al, 2006). At healthcare facilities in Bangladesh, sanitizers were reported to be available at only 32-39% locations for physicians and 39-51% for nurses (Ministry of Local Government et al, 2014).…”

Risk Factors for Wound Infection Following Caesarean Section: A Case Control Study from Sir Salimullah Medical College & Mitford Hospital in Dhaka, Bangladesh

“…Best practices including antibiotic prophylaxis, vaginal preparation, and spontaneous placental removal have been recommended as an infection control [6]. Although the incidence CS-SSIs reported to range from 2% -7% in high-income countries [7], it is not well known in low and middle-income countries [8]. Generally speaking, risk factors for CS-SSIs have been reported to include body mass index (BMI) more than 25, anemia, prolonged operative time, premature rupture of membranes (PROM), emergency procedure, pre-existing medical illness, and procedures performed by junior surgeons [9].…”