Impact of Poor WASH Infrastructure on Environmental Contamination with Pathogens Known to Cause Neonatal Sepsis Open Access
Carr, Kristen (Spring 2020)
Published
Abstract
Poor water and sanitation-hygiene (WASH) in health care facilities (HCF) is associated with adverse neonatal outcomes, but coverage remains poor in low to middle-income countries (LMIC). Sepsis is associated with 520,000 neonatal deaths per year globally, and many cases may be acquired in HCF from hand and environmental contamination. It is hypothesized that a large portion of healthcare-associated infections can be prevented by reducing this contamination through good WASH infrastructure and practice, but little evidence exists to show the impact of WASH on HCF contamination. This study examines if 1) bacteria known to cause hospital-acquired neonatal sepsis in LMIC (E. coli, S. aureus, and K. pneumoniae) can be detected in environmental samples from maternity and neonatal intensive care wards with limited WASH, and 2) how WASH and environmental conditions change over time. A modified WASH Conditions Assessment “WASHCon” was deployed in multiple wards in two Ethiopian hospitals in the Amhara Region over 32 weeks. WASHCon collects data on hand hygiene, infection prevention and control practices, environmental cleanliness and water availability and quality. Responses were scored “Good (1)”, “Moderate (.5)” or “Poor (-1)” and a composite score was created by hospital, ward and time. Assessments included environmental sample collection. Surface swabs, handrinses, drinking water, and medical device water were collected and tested for E. coli, S. aureus, and other coliforms and results were matched with scores by hospital, ward, and time. WASH conditions and environmental contamination varied over time. Positive swab and handrinses indicate increased exposure opportunities. A logistic regression model using WASH score, hospital, ward, month and sample type was constructed to predict bacterial contamination. Hospital, ward and sample type were significant (α=0.05). Felege Hiwot had significantly lower odds of contamination compared to Debere Tabor (OR 0.42, p<0.001). The Kangaroo-Mother Care ward had significantly higher odds of contamination compared to Post-natal Care (OR 2.89, p<0.001). Compared to handrinses, swabs did not have significantly lower odds of contamination (OR 0.76, p=0.29). The WASH score was not a significant predictor of contamination, suggesting multiple factors not measured by WASHCon may be associated with bacterial contamination of these hospital wards (OR 1.01, p=0.48).
Table of Contents
Table of Contents
Introduction………………………………………………………………………………………..1
Literature Review………………………………………………………………………………..2
Research Questions and Rationale………………………………………………………20
Manuscript………………………………………………………………………………………….21
Title, Authors and Abstract………………………………………………………………….21
Introduction………………………………………………………………………………………..22
Methods……………………………………………………………………………………………..26
Results………………………………………………………………………………………………..31
Discussion…………………………………………………………………………………………..42
Conclusions and Recommendations……………………………………………………57
Summary, Public Health Implications and Future Directions ………………60
References………………………………………………………………………………………….62
Tables and Figures………………………………………………………………………………71
Appendix…………………………………………………………………………………………….85
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