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

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

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Hygiene
Keyword	nosocomial infections low-income countries middle-income countries sanitation healthcare-associated infections Asia hygiene WASH water
Committee Chair / Thesis Advisor	Moe, Christine L, Emory University
Committee Members	McGriff, Joanne A., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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