Water, sanitation, and hygiene in selected health facilities in Ethiopia: risks for healthcare acquired antibiotic resistant infections

BackgroundInadequate water, sanitation and hygiene (WASH) in health facilities and the low adherence to infection control protocols can increase the risk of hospital-acquired (nosocomial) infections, which in turn can increase morbidity and mortality, health care cost, but also contribute to increased microbial resistance. ObjectivesThe study aimed to assess WASH facilities and practices, and levels of nosocomial pathogens in surface and water samples collected from selected health facilities in Oromia Region and Southern, Nations and Nationalities and Peoples Region (SNNPR). MethodsWASH in health care facilities in Bulle and Doyogena (SNNPR) and Bidre (Oromia) were assessed through interviews and direct observations (n= 26 facilities). Water and surface samples were collected from major hospitals and health centers. A total of 90 surface swabs and 14 water samples were collected from which a number of bacteria (n=224) were identified, characterized and tested for antimicrobial susceptibility. ResultsWater supply, toilet facilities, and waste management procedures were suboptimal. Only 11/26 of the health facilities had access to water at the time of the survey. The lowest hand-hygiene compliance was for Bidre (4%), followed by Doyogena (14%), and Bulle (36%). Over 70% of the identified bacteria were from four categories: Staphylococcus spp, Bacillus spp, E. coli, and Klebsiella spp. These bacteria were also found in high risk locations including neonatal intensive care units, delivery and surgical rooms. Antimicrobial susceptibility was detected in [≥] 50% of the isolates for penicillin, cefazolin, ampicillin, oxacillin, and cotrimoxazole, and [≥] 50% of the isolates displayed multi-drug resistance. ConclusionInvesting in WASH infrastructures, promotion of handwashing practices, implementing infection prevention and control (IPC) measures and antibiotic stewardship is critical to ensure quality care in these settings.