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Amin N, Foster T, Hossain MI, Hasan MR, Sarkar S, Rahman A, Adnan SD, Rahman M, Willetts J. Inadequate sanitation in healthcare facilities: A comprehensive evaluation of toilets in major hospitals in Dhaka, Bangladesh. PLoS One 2024; 19:e0295879. [PMID: 38776266 PMCID: PMC11111017 DOI: 10.1371/journal.pone.0295879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Lack of access to functional and hygienic toilets in healthcare facilities (HCFs) is a significant public health issue in low- and middle-income countries (LMICs), leading to the transmission of infectious diseases. Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban hospitals in LMICs. We conducted a cross-sectional study in 10-government and two-private hospitals to explore the availability, functionality, cleanliness, and user-to-toilet ratio in Dhaka, Bangladesh. METHODS From Aug-Dec 2022, we undertook infrastructure assessments of toilets in selected hospitals. We observed all toilets and recorded attributes of intended users, including sex, disability status, patient status (in-patient/out-patient/caregiver) and/or staff (doctor/nurse/cleaner/mixed-gender/shared). Toilet functionality was defined according to criteria used by the WHO/UNICEF Joint-Monitoring Programme in HCFs. Toilet cleanliness was assessed, considering visible feces on any surface, strong fecal odor, presence of flies, sputum, insects, and rodents, and solid waste. RESULTS Amongst 2875 toilets, 2459 (86%) were observed. Sixty-eight-percent of government hospital toilets and 92% of private hospital toilets were functional. Only 33% of toilets in government hospitals and 56% in private hospitals were clean. A high user-to-toilet ratio was observed in government hospitals' outpatients service (214:1) compared to inpatients service (17:1). User-to-toilet ratio was also high in private hospitals' outpatients service (94:1) compared to inpatients wards (19:1). Only 3% of toilets had bins for menstrual-pad disposal and <1% of toilets had facilities for disabled people. CONCLUSION A high percentage of unclean toilets coupled with high user-to-toilet ratio hinders the achievement of SDG by 2030 and risks poor infection-control. Increasing the number of usable, clean toilets in proportion to users is crucial. The findings suggest an urgent call for attention to ensure basic sanitation facilities in Dhaka's HCFs. The policy makers should allocate resources for adequate toilets, maintenance staff, cleanliness, along with strong leadership of the hospital administrators.
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Affiliation(s)
- Nuhu Amin
- Institute for Sustainable Futures, University of Technology Sydney, Ultimo, NSW, Australia
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tim Foster
- Institute for Sustainable Futures, University of Technology Sydney, Ultimo, NSW, Australia
| | - Md. Imam Hossain
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Rezaul Hasan
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Supriya Sarkar
- Hospital Services Management, Directorate General of Health Services (DGHS), MoH&FW, Mohakhali, Dhaka, Bangladesh
| | - Aninda Rahman
- Communicable Disease Control (CDC) Program, Directorate General of Health Services (DGHS), MoH&FW, Mohakhali, Dhaka, Bangladesh
| | - Shaikh Daud Adnan
- Hospital Services Management, Directorate General of Health Services (DGHS), MoH&FW, Mohakhali, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Health System and Population Studies Division, Environmental Health and WASH, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Juliet Willetts
- Institute for Sustainable Futures, University of Technology Sydney, Ultimo, NSW, Australia
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Amin N, Haque R, Rahman MZ, Rahman MZ, Mahmud ZH, Hasan R, Islam MT, Sarker P, Sarker S, Adnan SD, Akter N, Johnston D, Rahman M, Liu P, Wang Y, Shirin T, Rahman M, Bhattacharya P. Dependency of sanitation infrastructure on the discharge of faecal coliform and SARS-CoV-2 viral RNA in wastewater from COVID and non-COVID hospitals in Dhaka, Bangladesh. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161424. [PMID: 36623655 PMCID: PMC9822545 DOI: 10.1016/j.scitotenv.2023.161424] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/31/2022] [Accepted: 01/02/2023] [Indexed: 05/25/2023]
Abstract
The detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA in wastewater can be used as an indicator of the presence of SARS-CoV-2 infection in specific catchment areas. We conducted a hospital-based study to explore wastewater management in healthcare facilities and analyzed SARS-CoV-2 RNA in the hospital wastewater in Dhaka city during the Coronavirus disease (COVID-19) outbreak between September 2020-January 2021. We selected three COVID-hospitals, two non-COVID-hospitals, and one non-COVID-hospital with COVID wards, conducted spot-checks of the sanitation systems (i.e., toilets, drainage, and septic-tank), and collected 90 untreated wastewater effluent samples (68 from COVID and 22 from non-COVID hospitals). E. coli was detected using a membrane filtration technique and reported as colony forming unit (CFU). SARS-CoV-2 RNA was detected using the iTaq Universal Probes One-Step kit for RT-qPCR amplification of the SARS-CoV-2 ORF1ab and N gene targets and quantified for SARS-CoV-2 genome equivalent copies (GEC) per mL of sample. None of the six hospitals had a primary wastewater treatment facility; two COVID hospitals had functional septic tanks, and the rest of the hospitals had either broken onsite systems or no containment of wastewater. Overall, 100 % of wastewater samples were positive with a high concentration of E. coli (mean = 7.0 log10 CFU/100 mL). Overall, 67 % (60/90) samples were positive for SARS-CoV-2. The highest SARS-CoV-2 concentrations (median: 141 GEC/mL; range: 13-18,214) were detected in wastewater from COVID-hospitals, and in non-COVID-hospitals, the median SARS-CoV-2 concentration was 108 GEC/mL (range: 30-1829). Our results indicate that high concentrations of E. coli and SARS-CoV-2 were discharged through the hospital wastewater (both COVID and non-COVID) without treatment into the ambient water bodies. Although there is no evidence for transmission of SARS-CoV-2 via wastewater, this study highlights the significant risk posed by wastewater from health care facilities in Dhaka for the many other diseases that are spread via faecal oral route. Hospitals in low-income settings could function as sentinel sites to monitor outbreaks through wastewater-based epidemiological surveillance systems. Hospitals should aim to adopt the appropriate wastewater treatment technologies to reduce the discharge of pathogens into the environment and mitigate environmental exposures.
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Affiliation(s)
- Nuhu Amin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Institute for Sustainable Futures, University of Technology Sydney, 235 Jones St, Ultimo, NSW, 2007, Australia.
| | - Rehnuma Haque
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Medicine, Stanford University, Stanford, CA, USA
| | - Md Ziaur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zahid Hayat Mahmud
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rezaul Hasan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tahmidul Islam
- COVID-19 Research@KTH, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE 114 28 Stockholm, Sweden; WaterAid, Bangladesh
| | - Protim Sarker
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Supriya Sarker
- Directorate General of Health Services (DGHS), Bangladesh
| | | | - Nargis Akter
- Water, Sanitation & Hygiene (WASH) section, UNICEF, Bangladesh
| | - Dara Johnston
- Water, Sanitation & Hygiene (WASH) section, UNICEF, Bangladesh
| | - Mahbubur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh
| | - Pengbo Liu
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, USA
| | - Yuke Wang
- Center for Global Safe Water, Sanitation, and Hygiene, Emory University, Atlanta, GA, USA
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Prosun Bhattacharya
- COVID-19 Research@KTH, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE 114 28 Stockholm, Sweden
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Sujon H, Biswas TK, Chowdhury A, Chowdhury ME. Medical Waste Management: An Assessment of District-Level Public Health Facilities in Bangladesh. Cureus 2022; 14:e24830. [PMID: 35693375 PMCID: PMC9173732 DOI: 10.7759/cureus.24830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Due to the huge patient load and different types of services, public health facilities produce a bulk of medical waste (MW) in Bangladesh. Improper disposal of MW increases the risk of infection among healthcare service personnel, patients, and attendants. To ensure quality services, this study aimed to assess the practices of MW management and quantify those to find out the shortcomings in the specific steps of waste management. Methodology As part of a larger interventional study, a facility assessment was conducted from February to April 2016 at a District Hospital (DH) and a Mother and Child Welfare Centre (MCWC) in one district. Non-participatory observation of MW management was done using a checklist that was developed following the Guideline for Medical Waste Management of Bangladesh. Scoring was applied for various activities of MW management performed in the study facilities. Results The overall scores for bin management, segregation, and collection of waste were 64.5%, 58.1%, and 62.0% in DH and 53.1%, 41.5%, and 48.0% in MCWC, respectively. The performance of operation theater in MCWC was the lowest among different corners (16.7% to 36.0%). Reusable waste was segregated poorly (32% in DH and 0% in MCWC), and almost none was shredded (4% in DH and 0% in MCWC). Waste was transported from in-house to out-house temporary storage area in an open bin without any trolley or specific route. The storage area was accessible to unauthorized persons, for example, a waste picker in DH. While DH segregated 84% of its infectious waste at the source, it eventually got mixed up with other waste in the storage area and delivered to the municipality to be dumped. MCWC could segregate only 40% of its infectious waste at the source and disposed of them using the pit method. Both the facilities disposed of sharp MW by open-air burning and liquid waste through sewerage without any treatment. Conclusions The performance of MW management was poor in both study facilities. Advocacy to the healthcare personnel and refresher training along with supportive supervision and monitoring may improve the situation. Moreover, a larger study is needed to find out the reasons behind such poor MW management.
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Affiliation(s)
- Hasnat Sujon
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, BGD
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, BGD
| | - Taposh Kumar Biswas
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, BGD
| | - Aklima Chowdhury
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, BGD
| | - Mahbub Elahi Chowdhury
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, BGD
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Ara ML, Billah MW, Bashar DF, Mahmud MS, Amin MA, Iqbal MR, Rahman DT, Haque Alam DMN, Alam Sarker DMS. Effectiveness of a multimodal capacity building initiative for upgrading biomedical waste management practices at healthcare facilities in Bangladesh: a 21 st century challenge for developing countries. J Hosp Infect 2021; 121:49-56. [PMID: 34813874 DOI: 10.1016/j.jhin.2021.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/14/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Bio-medical Waste Management (BMWM) has attracted critical attention across the world as its improper management can pose a serious threat for healthcare workers (HCWs), the general population and the environment as well. This study aims to analyse the effectiveness of a multimodal intervention (MMI) in upgrading BMWM practices at healthcare facilities across Bangladesh. METHODS This quasi-experimental study, with a pre- and post-test design, was carried out at nine healthcare facilities (five public, three private and one autonomous) over three phases and concluded in 2019. The MMI included various strategies including: i) system change; ii) education and training, iii) visual reminders, iv) monitoring and feedback; v) ensuring sustainability at the study hospitals. The data collected from 2726 HCWs and waste handlers through direct observation was statistically analysed using SPSS 24. RESULT Significant improvements were observed in waste segregation practices (rising from 1% to 79%) using colour-coded bins. Use of PPEs during transportation and final management/disposal was also enhanced from 3% to 55%. Compliance to use of standardized methods for collecting and transporting biomedical waste (BMW) increased substantially from 0% to 78% while compliance to standard final management/disposal of BMW practices improved by 39%. CONCLUSION Compliance to BMWM practices is very poor in Bangladesh due to a lack of knowledge, manpower and resources. Nevertheless, MMI can be used as a tool to significantly upgrade BMWM practices across healthcare facilities. Such initiatives will assist the government of Bangladesh to achieve sustainable development goal (SDG) 3.3 and universal health coverage by 2030.
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Affiliation(s)
- Ms Lutfe Ara
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212.
| | - Mr Waseq Billah
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
| | - Dr Farzana Bashar
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
| | - Mr Shohel Mahmud
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
| | - Md Al Amin
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
| | - Mr Riyasad Iqbal
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
| | - Dr Tarannum Rahman
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
| | - Dr Md Nur Haque Alam
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
| | - Dr Md Shafiqul Alam Sarker
- Nutrition and Clinical Services Division, icddr,b68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka - 1212
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Alam MU, Rahman M, Abdullah-Al-Masud, Islam MA, Asaduzzaman M, Sarker S, Rousham E, Unicomb L. Human exposure to antimicrobial resistance from poultry production: Assessing hygiene and waste-disposal practices in Bangladesh. Int J Hyg Environ Health 2019; 222:1068-1076. [DOI: 10.1016/j.ijheh.2019.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/25/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
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