Background: Surgical site infections (SSIs) following cesarean deliveries (C-sections) result in excess morbidity, mortality, and healthcare expenses in resource-limited countries such as Bangladesh. Over the past two decades, C-section rates have increased dramatically in Bangladeshi hospitals, and comprehensive data on SSI after cesarean delivery, which is vital for the improvement of maternal health outcomes, remains limited. In this study, we assessed the prevalence of SSIs including their determinants among patients undergoing C-sections in Bangladesh. Methods: From May to December 2023, we conducted a prospective observational study at six tertiary hospitals (3 public and 3 private) in Bangladesh. Participants were hospitalized pregnant women who had undergone C-sections. The WHO-guided methodology and tools were employed to acquire the data. Participants were systematically evaluated on days 1-3, 7, 14, and 30 of surgeries, with a rigorous inquiry into symptoms such as fever, abdominal pain, localized swelling and redness, wound dehiscence, and purulence or abscess. The SSI diagnosis was confirmed based on at least two present symptoms, or a physician’s assessment, or microbiological confirmation within the 30-day post-operative window. Descriptive and multivariate logistic analyses were performed to determine the prevalence and factors associated with SSI. Results: Of 1335 participants enrolled, the overall prevalence of SSIs was 19.1% (255/1335, 95%CI: 17.6-21.5), with public hospitals having almost twice as SSIs at 21.6% (215/995) compared to private hospitals (11.8%, 40/340). More than half of the patients (54.8%) were found with at least two SSI symptoms within the 7 to 14 days of follow-up. Approximately half of the patients (49.2%) had a history of previous C-sections. The C-sections performed in private hospitals were predominantly on an emergency basis (85.1%) compared to public hospitals (56.2%). The multivariate analysis identified key determinants of SSI following C-section were patients with prolonged labor > 18 hours (AOR: 2.2, 95%Cl: 1.16, 4.13), fetal distress (AOR: 1.82, 95%Cl: 1.33, 2.49), premature rupture of membrane (PROM) > 12 hours (AOR: 1.70, 95%Cl: 1.05, 2.75), and high BMI (AOR: 1.69, 95%Cl: 1.27, 2.25). Conclusions: This study highlights the burden of SSIs following C-sections in tertiary hospitals in Bangladesh, particularly in public healthcare settings. The findings highlight the critical need to enhance infection prevention and control measures to mitigate the occurance of SSIs within these healthcare settings.

Background: Infection prevention and control (IPC) is a critical feature of preventing the spread of healthcare-associated infections (HAIs) in hospitals. IPC practices are particularly important in resource-constrained and crowded hospital settings. The successful implementation of infection prevention measures depends on healthcare worker (HCW) knowledge of, attitude toward, and practice (KAP) of IPC. In this project, we assessed the KAP of HCWs and identified factors associated with IPC compliance at tertiary-care hospitals in Bangladesh. Methods: From September 2020 to January 2021, we conducted this hospital-based cross-sectional assessment at 11 tertiary-care hospitals. A semistructured questionnaire was used to conduct face-to-face interviews with physicians, nurses, and cleaning staff who were directly involved in patient care. Based on >75% of the total score, each KAP component was divided into adequate knowledge, favorable attitude, and safe practice. We performed descriptive analysis and multivariate logistic regression to determine the KAP score and associated factors influencing IPC compliance in hospital settings. Results: In total, 1,728 HCWs were interviewed; 76.8% of the participants had adequate knowledge on IPC and 54.6% reported safe practices. However, only 16.2% of HCWs had a favorable attitude toward IPC. Among the 3 HCW groups, nurses had the highest KAP scores (76.07±12.7) followed by physicians (69.8±16.2), and cleaning staff (34.4±27.3). Only 29.2% of HCWs reported having received IPC training, and they cited heavy workload as a barrier to IPC guideline adherence. HCWs having adequate knowledge showed 9 times higher odds of safe IPC practice (AOR, 9.36; 95% CI, 5.47–16.04). HCWs who had a favorable attitude toward IPC were 16 times as likely to perform safe practice toward IPC activities (AOR, 15.5; 95% CI, 10.27–23.42). Conclusions: Knowledge of safe practices and having a favorable attitude toward IPC are key components of a successful IPC program. Significant improvements are required among all levels of HCWs in Bangladesh tertiary-care hospitals, especially cleaning staff. Educational interventions to train on IPC guidelines, plus monitoring, could improve HCW safe practices.

Disclosures: None

Observational studies suggest that 25-hydroxy vitamin D (25(OH)D) concentration is inversely associated with pain. However, findings from intervention trials are inconsistent. We assessed the effect of vitamin D supplementation on pain using data from a large, double-blind, population-based, placebo-controlled trial (the D-Health Trial). 21 315 participants (aged 60–84 years) were randomly assigned to a monthly dose of 60 000 IU vitamin D3 or matching placebo. Pain was measured using the six-item Pain Impact Questionnaire (PIQ-6), administered 1, 2 and 5 years after enrolment. We used regression models (linear for continuous PIQ-6 score and log-binomial for binary categorisations of the score, namely ‘some or more pain impact’ and ‘presence of any bodily pain’) to estimate the effect of vitamin D on pain. We included 20 423 participants who completed ≥1 PIQ-6. In blood samples collected from 3943 randomly selected participants (∼800 per year), the mean (sd) 25(OH)D concentrations were 77 (sd 25) and 115 (sd 30) nmol/l in the placebo and vitamin D groups, respectively. Most (76 %) participants were predicted to have 25(OH)D concentration >50 nmol/l at baseline. The mean PIQ-6 was similar in all surveys (∼50·4). The adjusted mean difference in PIQ-6 score (vitamin D cf placebo) was 0·02 (95 % CI (−0·20, 0·25)). The proportion of participants with some or more pain impact and with the presence of bodily pain was also similar between groups (both prevalence ratios 1·01, 95 % CI (0·99, 1·03)). In conclusion, supplementation with 60 000 IU of vitamin D3/month had negligible effect on bodily pain.

Background: Hand hygiene (HH) is a core element of patient safety and the single most essential strategy for preventing healthcare-associated infections (HAIs). Adherence to HH among healthcare workers (HCWs) varies greatly depending on a range of factors, including risk perceptions, institutional culture, auditing mechanisms, and availability of HH supplies. We observed HH compliance among HCWs to determine the factors influencing practices in tertiary healthcare facilities in Bangladesh. Methods: During September 2020–February 2021, we conducted nonparticipatory observations at 11 tertiary-care hospitals in Bangladesh using the WHO “Five Moments for Hand Hygiene” tool to record compliance among physicians, nurses, and cleaning staff. We also performed semistructured interviews to determine the key barriers to complying with hand hygiene. Furthermore, we noted the presence, location, and functionality of existing HH stations within each hospital ward. Results: We observed 14,668 HH opportunities among HCWs. The overall HH compliance was 25.3%, and compliance differed significantly by professional category (P < .001). Physicians had the highest HH compliance at 28.5% (2,264 of 7,930), followed by nurses at 25.4% (1,272 of 5,008). Cleaning staff had the lowest rates of HH at 9.9% (171 of 3,221). HCWs of public hospitals had significantly higher odds of complying with HH practices than those in private hospitals (27.4% vs 17.9%; aOR, 1.73; 95% CI, 1.55–1.93; P < .001). HH compliance also varied by WHO Five Moments indicators. HCWs were 3 times more likely to perform HH ‘after touching a patient’ than ‘before touching patient’ (aOR, 3.36; 95% CI, 2.90–3.90; P < .001). Common barriers to using hand sanitizer were insufficient supply (57.9%), skin reaction (26.3%), shortage of time (14.5%), and lack of awareness (11.9%). Regarding handwashing with soap, inadequate supplies (27.0%), high workload (26.3%), and lack of facilities (22.7%) were the key factors for low adherence. The HH infrastructure observation in 82 wards showed that running water and soap were available in 168 (86.2%) of 195 HCW-designated basins, compared to 51 (35.9%) of 142 for the patient- and attendant-assigned basins. Handwashing posters were found in only 44 (13.1%) of 337 basin surroundings, and no hand drying supplies were observed for patients or attendants. Conclusions: Hand hygiene compliance among HCWs fall significantly short of the standard for safe patient care. Inadequate HH supplies in a resource-constrained setting like Bangladesh demonstrates a lack of leadership in prioritizing, promoting, and investing in infection prevention and control. The findings of this study might help to motivate and design interventions for HH compliance, which will help reduce HAIs in the hospital setting.

Funding: None

Disclosures: None