Appropriate Infection Control Practices in Refugee Camps and Post-conflict Settings Público

Moturi, Edna Kwamboka (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/8s45q945s?locale=es
Published

Abstract


Abstract

Background

HAIs are a global public health problem, affecting developed and developing countries alike. In the US alone, over 1.4 million people are affected each year. More than 40% of hospitalized patients in developing countries in Asia, Latin America and Sub Saharan Africa, are estimated to be at risk of contracting HAIs. However, administrators of healthcare facilities located in resource-limited settings are faced with the challenge of inadequate resources, with which to implement the recommended infection control guidelines.

Objectives

Study objectives were: to review literature and determine the burden of HAIs in resource-limited settings and refugee camps; search literature bases for guidelines related to infection control; and then draw on personal working experience, to identify realistic infection control recommendations that are financially feasible, adaptable, practical and usable, for application in these settings.

Methods

A literature review was conducted, with inclusion criteria of English studies, unrestricted by time, applicable to resource-limited settings, and not specific to disease, or hospital procedure areas. Search terms included: urinary tract infections, wound infections, surgical site infections, nosocomial, hospital associated, refugee camps, and guidelines. Electronic databases Pub Med, MEDLINE and Google scholar, as well as international agencies' websites, were searched.

Results

145 articles were retrieved. 27 articles had epidemiology data on HAIs in resource-limited settings; these were utilized in the review. 14 guidelines were found to be practical to resource-limited settings. Overall pooled HAIs prevalence was 12.2/100 patients. Most HAIs were found to be associated with improper use of medical devices. SSI's were the most studied, and common infections (12.74/100 procedures). Gram negative bacilli were the most common bacteria isolated.

Conclusion

There is limited available data on HAI epidemiology in developing countries, with no data present for refugee camps and post-conflict settings. There are existing guidelines that can be utilized in refugee camps and post-conflict settings. However, the question of their being used, and their effects is unknown. Practical, administrative, environmental, personal protections, and surveillance infection control measures, need to be implemented, so as to reduce HAI transmission in healthcare facilities.

Table of Contents

Table of Contents

I.
INTRODUCTION .................................................................................................................................. 12
A.
HEALTHCARE FACILITIES IN RESOURCE-LIMITED SETTINGS ............................................................ 12
B.
MY PROFESSIONAL EXPERIENCE IN HEALTHCARE FACILITIES IN RESOURCE-LIMITED SETTINGS ... 14
C.
PATIENT CARE UNITS ...................................................................................................................... 16
(i)
IN-PATIENT WARD FACILITIES ..................................................................................................... 16
(ii)
OUT-PATIENT CLINIC FACILITIES ............................................................................................. 20
(iii)
LABORATORY AND IMAGING SERVICES .................................................................................. 21
(iv)
OPERATING THEATERS ............................................................................................................ 22
D. OPERATIONAL SERVICES ................................................................................................................. 24
(i)
SANITATION FACILITIES ............................................................................................................... 24
(ii)
WATER FACILITIES ................................................................................................................... 24
(iii)
PEST CONTROL ........................................................................................................................ 25
(iv)
WASTE MANAGEMENT ........................................................................................................... 26
(v)
FOOD FACILITIES ..................................................................................................................... 27
(vi)
HEALTHCARE WORKERS (HCWs) ............................................................................................. 28
II.
BACKGROUND .................................................................................................................................... 29
(i)
REFUGEES AND REFUGEE CAMPS ................................................................................................... 29
(ii)
RESOURCE-LIMITED SETTINGS .................................................................................................... 36
(iii)
HEALTHCARE-ASSOCIATED INFECTIONS (HAIs) .......................................................................... 37
(iv)
MODE OF TRANSMISSION OF HEALTHCARE-ASSOCIATED INFECTIONS ..................................... 39
(v)
HEALTHCARE WORKERS AND HEALTHCARE-ASSOCIATED INFECTIONS ..................................... 41

(vi)
GLOBAL ANTIMICROBIAL RESISTANCE ........................................................................................ 43
III.STUDY OBJECTIVES ................................................................................................................................. 47
IV. METHODS .............................................................................................................................................. 48
V. RESULTS ................................................................................................................................................. 50
A. HEALTHCARE-ASSOCIATED ARTICLES ................................................................................................. 50
(i) RESULTS .......................................................................................................................................... 50
B. INFECTION CONTROL GUIDELINES PRACTICAL TO REFUGEE CAMPS AND POST-CONFLICT SETTINGS ............... 51
C. DISCUSSION........................................................................................................................................ 54
D. STUDY LIMITATIONS........................................................................................................................ 59
E.
GUIDELINE LIMITATIONS ................................................................................................................. 60
VI.
RECOMMENDATIONS ..................................................................................................................... 61
A.
ADMINISTRATIVE CONTROLS .......................................................................................................... 61
(i)
TRAINING AND EDUCATION OF HCWS, PATIENTS AND/ OR FAMILY MEMBERS ............................ 62
(ii)
RAPID DIAGNOSIS AND TREATMENT OF PATIENTS WITH INFECTIOUS DISEASES .................. 64
(iii)
INVESTIGATE INFECTIOUS DISEASE PATIENTS AS OUT-PATIENTS .......................................... 65
(iv)
COHORTING AND PATIENT PLACEMENT ................................................................................. 66
(v)
FAMILY MEMBERS OF PATIENTS ............................................................................................. 68
(vi)
HEALTHCARE WORKERS' SAFETY ............................................................................................ 69
B.
ENGINEERING CONTROLS ............................................................................................................... 72
(i)
HOSPITAL DESIGN ....................................................................................................................... 72
(ii)
VENTILATION ........................................................................................................................... 73
(iii)
CLEANING OF THE HEALTHCARE ENVIRONMENT ................................................................... 74
(iv)
WASTE MANAGEMENT ........................................................................................................... 75
(v)
HEALTHCARE LINEN AND BEDDINGS ...................................................................................... 77
(vi)
INSTRUMENTS AND EQUIPMENTS .......................................................................................... 77

(vii)
HAND WASHING FACILITIES .................................................................................................... 78
(viii)
DRINKING WATER ................................................................................................................... 80
(ix)
SANITATION FACILITIES ........................................................................................................... 80
(x)
PEST CONTROL ........................................................................................................................ 81
(xi)
FOOD ....................................................................................................................................... 81
C.
PERSONAL PROTECTION EQUIPMENT (PPE) ................................................................................... 82
D. SURVEILLANCE AND LABORATORY ................................................................................................. 85
VII. REFERENCES……………………………………………………………………………………………………………………………………84
VII. APPENDIX……………………………………………………………………………………………………………………………………….89


Table of Figures

Table 1: Classification of articles according to region .................................................................. 95
Table 2: Classification of articles according to type of study ....................................................... 95
Table 3: Healthcare-associated infections (HAIs) in developing countries according to WHO
region, and type of infection (1984-2008), n= 27 ........................................................................ 96
Table 4. A: Overall Healthcare-associated infections ................................................................... 97
Table 5: Infection Control Guidelines Practical to Resource-limited Settings ............................ 102
Table 6: Observed Causes of Healthcare-associated infections (HAIs) in Kakuma and Kisii hospitals ..... 103
Table 7: Summary of Infections Control Recommendations for Post-Conflict Settings and Refugee Camps
.................................................................................................................................................................. 105

Figure 1: Location of Kisii District and Kakuma Hospitals ........................................................................... 92
Figure 2: Modes of Infection Transmission within Healthcare Facilities .................................................... 93
Figure 3: Flow diagram for selection of articles .......................................................................................... 94
Figure 4: Prevalence and point incidence rates of HAIs in resource-limited settings (1984-2008) ......... 100
Figure 5: Prevalence and point incidence rates of surgical site infections in resource-limited settings
(1984-2008), n=16 ..................................................................................................................................... 101
Figure 6: Sequence for wearing and removing Personal Protective Equipment (PPE) ............................ 104


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