Water-, Sanitation-, and Hygiene-Based Healthcare-Associated Infections in the Low- and Middle-Income Countries of South and East Asia: A Systematic Review Open Access

Belbis, Stephanie (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/b5644r65x?locale=en
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Abstract

Background
Low- and middle-income countries have a high burden due to healthcare-associated infections, which may be prevented with proper water, sanitation, and hygiene.

Aim
To review the prevalence of water, sanitation, and hygiene-based healthcare-associated infections and pathogens in the low- and middle-income countries in South and East Asia

Methods
A systematic review was conducted using English PubMed and EMBASE articles published between 2000 and 2014 about the prevalence of healthcare-associated infections in the low- and middle-income countries in South and East Asia. Information on the types of healthcare-associated infections and pathogens was also collected.

Findings
Twelve articles met the inclusion criteria and were included in this review. The reported prevalence of healthcare-associated infections in the low- and middle-income countries of South and East Asia ranged from 3.53% to 33.33%. The most common type of healthcare-associated infections reported in these studies was respiratory tract infections with a prevalence ranging from 24.0 to 65.2%. The most common pathogens implicated with healthcare-associated infections included Acinetobacter baumannii, Enterococcus spp., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. All pathogens linked to healthcare-associated infections were related to water, sanitation, and hygiene.

Conclusion
The low- and middle-income countries in South and East Asia are affected by healthcare-associated infections that are transmitted through water, sanitation, and hygiene. Further surveillance studies, particularly in rural hospitals, are needed in each country to provide a better estimate of the prevalence of healthcare-associated infections in low- and middle-income countries.

Table of Contents

Chapter 1: Introduction.......................................................................................................................................................4
Research Question.................................................................................................................................................................4
Introduction..........................................................................................................................................................................4


Chapter 2: Literature Review...............................................................................................................................................8
Healthcare-associated Infections...............................................................................................................................................8
Burden of Healthcare-Associated Infections.................................................................................................................................9
High-Income Countries............................................................................................................................................................9
Low- and Middle-Income Countries............................................................................................................................................11
High-Income Countries Versus Low/Middle-Income Countries.........................................................................................................13
High-Income and Low/Middle-Income Countries in Southeast Asia..................................................................................................14
Healthcare-Associated Infections in Non-Patients.........................................................................................................................15

Pathogens in Healthcare-Associated Infections............................................................................................................................15
Antimicrobial Resistance..........................................................................................................................................................17
Water, Sanitation, and Hygiene in Healthcare-Associated Infections................................................................................................19
Water in Healthcare-Associated Infections..................................................................................................................................20
Sanitation and Hygiene in Healthcare-Associated Infections...........................................................................................................21
Studies Linking WASH and HAI.................................................................................................................................................22

Prevention of Healthcare-Associated Infections...........................................................................................................................24
Recent Initiatives to Reduce HAIs.............................................................................................................................................25
Conclusion............................................................................................................................................................................26


Chapter 3: Manuscript.........................................................................................................................................................32
Contribution of Student...........................................................................................................................................................33
Introduction..........................................................................................................................................................................35
Methods...............................................................................................................................................................................37
Sample Population.................................................................................................................................................................37
Data Collection......................................................................................................................................................................37
Ethical Approvals...................................................................................................................................................................38

Results................................................................................................................................................................................38
Healthcare-associated infections..............................................................................................................................................39
Types of healthcare-associated infections..................................................................................................................................39
Pathogens............................................................................................................................................................................41
Pathogens and Transmission....................................................................................................................................................43
Pathogens and Infection..........................................................................................................................................................44

Discussion............................................................................................................................................................................44
Prevalence of HAI..................................................................................................................................................................45
Prevalence of Types of Infections.............................................................................................................................................45
Prevalence of Pathogens.........................................................................................................................................................46
Antimicrobial Resistance.........................................................................................................................................................47
Study Limitations..................................................................................................................................................................47

Conclusion...........................................................................................................................................................................48
Tables and Figures................................................................................................................................................................50
Figure 1: Search strategy of articles and results.........................................................................................................................50

Table 1: Characteristics of studies on healthcare-associated infection prevalence in the developing countries of South and East Asia.........51
Table 2: Prevalence of healthcare-associated infections...............................................................................................................55
Table 3: Prevalence of the types of healthcare-associated infections..............................................................................................55

Table 4: Prevalence of the halthcare-associated infection pathogens and the likely modes of transmission...........................................56
Table 5: Pathogens and Known Infections Caused by Pathogen.....................................................................................................57

References..........................................................................................................................................................................58


Chapter 4: Conclusion and Recommendations.....................................................................................................................63
Research Implications...........................................................................................................................................................63
Recommendations to Improve This Review...............................................................................................................................63
Additional Research Topics Measuring HAIs...............................................................................................................................64
Additional Research Topics on HAIs.........................................................................................................................................66

Programming implications.....................................................................................................................................................67
Education...........................................................................................................................................................................67
Innovations........................................................................................................................................................................68

Policy & Economic implications..............................................................................................................................................68
Conclusion.........................................................................................................................................................................69
References.........................................................................................................................................................................69

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