Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review

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Abstract

Background

Healthcare-associated infections (HAI) especially outbreaks of multi-drug-resistant organisms within hospitals are recognized as a major contributor to morbidity and mortality of hospitalized patients. The healthcare environment can act as an amplifier of HAI during outbreaks. The risk of acquiring HAI are 20 times higher in Low-and-middle-income countries.

The purpose of this article is to review the challenges associated with controlling environmental contamination in low and lower-middle income countries (LMIC), highlighting possible solutions.

Method

This is a narrative review. A literature search was carried out in Google scholar, PubMed, Science Direct, EBSCOHOST, CENGAGE, Scopus, ProQuest, Clinical Key and African journals online using the key words - Health care Associated Infections (HCAIs) in LMICs, Challenges of HAIs in LMIC, Challenges of Prevention and Control of HAIs in LMICs, Environment of care and infection transmission, Contaminated environment and HAIs.

Results

From the accessed databases, 1872 articles related to environmental sources of contamination in healthcare settings were found. Of these, only 530 articles focused on LMICs. However, only 186 articles met the inclusion criteria studies published in English, conducted between 2000 and 2019 and exploring environmental sources of contamination in LMIC healthcare settings). The sources of environmental contamination in healthcare are numerous and commonly associated with poor governance, Inadequate infrastructure, human capacity and inadequate funding. Low awareness exists at all levels as to the role of the environment in healthcare outcomes and may explain in part the low priority given for funding.

Conclusion

Leadership and trained personnel, both Infection prevention and control practitioners and cleaners are crucial to drive and sustain the process to reduce environmental contamination in healthcare environments.

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Most cited references 39

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Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.

Stephanie Dancer (2014)

There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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The effect of environmental parameters on the survival of airborne infectious agents.

Julian Tang (2009)

The successful transmission of infection via the airborne route relies on several factors, including the survival of the airborne pathogen in the environment as it travels between susceptible hosts. This review summarizes the various environmental factors (particularly temperature and relative humidity) that may affect the airborne survival of viruses, bacteria and fungi, with the aim of highlighting specific aspects of environmental control that may eventually enhance the aerosol or airborne infection control of infectious disease transmission within hospitals.

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Is Open Access

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Julie Storr, Anthony Twyman, Walter Zingg … (2017)

Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline. Electronic supplementary material The online version of this article (doi:10.1186/s13756-016-0149-9) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

Folasade T. Ogunsola:

ORCID: http://orcid.org/0000-0001-7734-685X

sade.ogunsola@gmail.com

Journal

Journal ID (nlm-ta): Antimicrob Resist Infect Control

Journal ID (iso-abbrev): Antimicrob Resist Infect Control

Title: Antimicrobial Resistance and Infection Control

Publisher: BioMed Central (London )

ISSN (Electronic): 2047-2994

Publication date (Electronic): 9 June 2020

Publication date PMC-release: 9 June 2020

Publication date Collection: 2020

Volume: 9

Electronic Location Identifier: 81

Affiliations

[1 ]GRID grid.411782.9, ISNI 0000 0004 1803 1817, College of Medicine, , University of Lagos, ; Ishaga, Lagos, PMB 12003 Nigeria

[2 ]Infection Control Africa Network, Cape Town, South Africa

[3 ]Stellenbosch University Cape Town, Cape Town, South Africa

Author information

Folasade T. Ogunsola http://orcid.org/0000-0001-7734-685X

Article

Publisher ID: 747

DOI: 10.1186/s13756-020-00747-0

PMC ID: 7285732

PubMed ID: 32517810

SO-VID: 2378756d-66ba-43fa-8072-f8ace0a66194

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 September 2019

Date accepted : 1 June 2020

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: challenges,environment,contamination,infection control,low-and-lower middle income

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: challenges, environment, contamination, infection control, low-and-lower middle income

Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review

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Abstract

Background

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Results

Conclusion

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JAMA Network: Coronavirus

Most cited references 39

Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.

The effect of environmental parameters on the survival of airborne infectious agents.

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

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