Assessing Environmental Contamination in the Maternity Wards of Two National Hospitals in Phnom Penh, Cambodia Open Access

Abstract

Background: The burden of healthcare-associated infections in low- and middle-income countries is substantial, in part due to limited resources, lack of adequate infrastructure, insufficient healthcare services, and inadequate training on infection prevention and control. Poor water, sanitation and hygiene (WASH) infrastructure in the maternity ward is likely to increase the risks of infections among mothers and neonates. Cambodia has one of the highest maternal and infant mortality rates worldwide, and some of these deaths may be due to inadequate WASH provision.

Objectives: The goal of this mixed-method study was to examine the associations between WASH conditions and environmental contamination in the maternity wards of two national hospitals in Phnom Penh, Cambodia.

Methods: Four types of environmental samples (surfaces, medical equipment, tap water, and hand rinses) were collected over an eight-week period between June and August 2016. Samples were analyzed for Escherichia coli, Total coliforms, and Staphylococcus aureus by the membrane filtration method with Compact Dry plates. Information on WASH conditions were collected through observations and interviews with the hospital directors.

Results: Hospital A was observed to have better access to, and quality of, WASH infrastructure compared to Hospital B. Hand rinses collected in Hospital B had a higher incidence of microbial contamination compared to those collected in Hospital A (S. aureus OR: 21.43, 95% CI: 4.30-104.60). The odds of a tap water sample meeting the WHO drinking water guideline was significantly higher for Hospital A compared to Hospital B (p < 0.05). The odds of detecting any of the three target microorganisms on one of the high-touch surfaces was 1.9 times higher in Hospital B compared to Hospital A (p < 0.05).

Conclusions: The study suggested that inadequate WASH infrastructure may increase the likelihood of environmental contamination in the maternity ward. Interdisciplinary studies are needed to fully understand the burden of HAIs caused by inadequate and unsafe WASH infrastructure in maternity wards in resource-limited settings.

Table of Contents

Introduction 1
Literature Review 3
Methods 28
Results 34
Discussion 40
Conclusions and Recommendations 49

References 52
Tables and Figures 59
Appendices 63

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Health
Keyword	Water, Sanitation, and Hygiene Healthcare Associated Infection Maternal and Child Health Hand Hygiene Environmental Contamination
Committee Chair / Thesis Advisor	Moe, Christine L, Emory University
Committee Members	Tolbert, Paige, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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