title: Infrastructure and contamination of the physical environment in three Bangladeshi hospitals: putting infection control into context.
abstract: OBJECTIVE
  This paper describes the physical structure and environmental contamination in selected hospital wards in three government hospitals in Bangladesh.
  
  
  METHODS
  The qualitative research team conducted 48 hours of observation in six wards from three Bangladeshi tertiary hospitals in 2007. They recorded environmental contamination with body secretions and excretions and medical waste and observed ward occupant handwashing and use of personal protective equipment. They recorded number of persons, number of open doors and windows, and use of fans. They measured the ward area and informally observed waste disposal outside the wards. They conducted nine focus group discussions with doctors, nurses and support staff.
  
  
  RESULTS
  A median of 3.7 persons were present per 10 m(2) of floor space in the wards. A median of 4.9 uncovered coughs or sneezes were recorded per 10 m(2) per hour per ward. Floors in the wards were soiled with saliva, spit, mucous, vomitus, feces and blood 125 times in 48 hours. Only two of the 12 patient handwashing stations had running water and none had soap. No disinfection was observed before or after using medical instruments. Used medical supplies were often discarded in open containers under the beds. Handwashing with soap was observed in only 32 of 3,373 handwashing opportunities noted during 48 hours. Mosquitoes and feral cats were commonly observed in the wards.
  
  
  CONCLUSIONS
  The physical structure and environment of our study hospitals are conducive to the spread of infection to people in the wards. Low-cost interventions on hand hygiene and cleaning procedures for rooms and medical equipment should be developed and evaluated for their practicality and effectiveness.
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Nadia Ali
authors.initials: NA
authors.lastname: Rimi
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Rebeca
authors.initials: R
authors.lastname: Sultana
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh ; Global Disease Detection Program, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Mohammed Saiful
authors.initials: MS
authors.lastname: Islam
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Main
authors.initials: M
authors.lastname: Uddin
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Mohammad Jahangir
authors.initials: MJ
authors.lastname: Hossain
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Rashid Uz
authors.initials: RU
authors.lastname: Zaman
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Nazmun
authors.initials: N
authors.lastname: Nahar
authors.affiliation: Centre for Communicable Diseases, icddr, b, Dhaka, Bangladesh.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D003428:Cross Infection / Q000453:epidemiology; D004866:Equipment Contamination / Q000706:statistics & numerical data; D063373:Hand Hygiene; D006749:Hospital Design and Construction / Q000592:standards*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D008505:Medical Staff, Hospital / Q000592:standards / Q000600:supply & distribution; D011156:Population Density; D012499:Sanitation / Q000379:methods / Q000592:standards