Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey.

BACKGROUND: Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. AIM: To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. METHODS: The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. FINDINGS: More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). CONCLUSION: Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities.

Plasma Renin in ipsilateral renal vein in patients with chronic unilateral pelvic ureteric junction obstruction.

Acute experimental hydronephrosis induces increased output of renin from ipsilateral kidney. In most clinical presentation of unilateral hydronephrosis the patients are however, normotensive with normal circulating plasma renin activity. In consideration of this argument we undertook this prospective study of ipsilateral renal vein renin activity in children with congenital Pelvic Ureteric Junction Obstruction (PUJO) and compared with other wise normal children. In this prospective cross-sectional study, started from July 99 to June 2001, twenty patients, age upto 12 years, with unilateral hydronephrosis and in control group ten patients without hydronephrosis were taken. 2ml blood was taken from the renal vein in study group and from infrarenal portion of inferior vena cava during exploratory laparotomy from the control group. All the patients had advanced grade of hydronephrosis and two patients (13%) had mild hypertension. In this study the mean plasma renin activity (PRA) was 45.58 ng/ml/hr (range: 11.69-67.56 ng/ml/hr) in study group. The mean PRA in control group was 5.9ng/ml/hr. The result of study group was significantly higher than normal (P value 0.0003). In Bangladesh we are doing more conservative kidney preserving surgery for PUJO, but need long term follow up of the patients undergoing surgery for PUJO in childhood for potential of developing renin-angiotensin induced hypertension in later life.

Effectiveness of baby friendly hospital initiative on the promotion of exclusive breast feeding among the Dhaka city dwellers in Bangladesh.

To assess the effectiveness of baby friendly hospital initiative on exclusive breast feeding status; this longitudinal study designed to compare the incidence of exclusive breast feeding at 30, 60, 90, 120 and 150 days post partum for mothers who delivered at baby friendly hospital and mothers who delivered at a nearby non-baby friendly hospital. 105 mothers from baby friendly hospital and 104 mothers from non-baby friendly hospital were recruited and followed up for determining duration of exclusive breast-feeding. The median survival time of exclusive breast-feeding was 73.85 days among mothers of baby friendly hospital and 30 days among mothers of non-baby friendly hospital, with a difference of 43.85 days. Life table cumulative surviving proportion for exclusive breast-feeding shows that 82 percent mothers of baby friendly hospital continue at 30 days, compared with 50 percent mothers off non-baby friendly hospital. At 150 days, 16 percent mothers of baby friendly hospital continue exclusive breast-feeding compared with 6 percent mothers of non-baby friendly hospital. Finally 8 percent mothers of baby friendly hospital continue exclusive breast feeding between two hospital was found highly significant (P < 0.001). Duration of exclusive breast-feeding is longer among the mothers who have been delivered in a baby friendly hospital than those mothers who have been delivered in a non-baby friendly hospital.