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• W2111392012 abstract "To the Editor: Infection control is a major part of health care in industrialized nations.1Wenzel R.P. Health care-associated infections: major issues in the early years of the 21st century.Clin Infect Dis. 2007; 45: S85-S88Crossref PubMed Scopus (108) Google Scholar Health care in developing countries is relatively resource poor, and information about infection control in hospitals in developing countries is limited, and is this reflective of whether the same infections are of equal importance as in industrialized countries. The purpose of this study was to investigate infection control practice in internal medicine wards in 2 developing countries: Cambodia and Afghanistan. Infection control practice on internal medicine wards was studied at hospitals in Phnom Penh, Cambodia (Khmer Soviet Friendship Hospital), and Kabul, Afghanistan (Ali Abad Hospital). Health care workers (HCW) were interviewed according to a checklist for selected areas of infection control. The study was approved by both hospitals. Standard Precautions, eg, the use of gloves and handwashing, were used in Phnom Penh and not in Kabul. Contact, Droplet, or Enteric Precautions were not used in Phnom Penh or Kabul. Education about infection control principles (eg, handwashing) was provided to HCW, patients, and visitors in Phnom Penh. No occupational health infection control program was available in either hospital. No chemoprophylaxis (eg, Bordetella pertussis, Neisseria meningitidis, influenza) or immunoprophylaxis (varicella, rubella, measles) was available in either hospital. No multidrug-resistant bacterial organisms such as vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus have been detected in either hospital. Disposable needles and syringes and sharps containers for the disposal of used needles and syringes were available in Phnom Penh and Kabul. In Phnom Penh, needlestick injury postexposure prophylaxis against HIV but not against hepatitis B virus (HBV) was available. HBV vaccination and HBV or hepatitis C virus (HCV) testing of HCW were not available in either hospital. Standardized respirators for the prevention of transmission of airborne pathogens (eg, Mycobacterium tuberculosis) were used in Phnom Penh. No surgical masks or respirators were used in Kabul. There was no respirator fit testing, seal-check training, airborne pathogen negative-pressure rooms, or tuberculin skin testing in either hospital. There was no infection control staff in either hospital. No soaps or disinfectants were available to HCW, but, in Phnom Penh, handwashing basins were available to HCW. In developing countries, infections with M tuberculosis in hospitals and the community remain major problems.2Centers for Disease Control and Prevention (CDC) Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs worldwide, 2000-2004.MMWR Morb Mortal Wkly Rep. 2006; 55: 301-305PubMed Google Scholar No airborne pathogen negative-pressure rooms were available in Phnom Penh and Kabul, and it is unlikely that any hospital in either country can afford airborne pathogen negative-pressure rooms, which cost approximately US $100,000.3Escombe A.R. Oeser C.C. Gilman R.H. et al.Natural ventilation for the prevention of airborne contagion.PLoS Med. 2007; 4: e68Crossref PubMed Scopus (259) Google Scholar Mask use alone was shown to be effective in reducing infection with M tuberculosis,4Jarvis W.R. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis.Am J Infect Control. 1995; 23: 146-151Abstract Full Text PDF PubMed Scopus (48) Google Scholar and, to improve tuberculosis infection control in hospitals in both countries, the use of certified respirators could be effective in reducing the risk of infection with M tuberculosis in hospitals.4Jarvis W.R. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis.Am J Infect Control. 1995; 23: 146-151Abstract Full Text PDF PubMed Scopus (48) Google Scholar HIV and HBV needlestick injury postexposure prophylaxis and HBV vaccination were not available to all HCW in the studied hospitals, and no testing for HBV and HCV was performed. The prevalence of HBV and HCV is relatively high in Asia,5Liu J. Fan D. Hepatitis B in China.Lancet. 2007; 369: 1582-1583Abstract Full Text Full Text PDF PubMed Scopus (205) Google Scholar and little is known about the prevalence in HCW and patients in both countries.6Vong S. Perz J.F. Sok S. et al.Rapid assessment of injection practices in Cambodia, 2002.BMC Public Health. 2005; 5: 56Crossref PubMed Scopus (53) Google Scholar In Afghanistan, the HIV prevalence of patients treated for tuberculosis was less than 1% and of intravenous drug users was 3%.7Sanders-Buell E. Saad M.D. Abed A.M. et al.A nascent HIV type 1 epidemic among injecting drug users in Kabul, Afghanistan, is dominated by complex AD recombinant strain, CRF35_AD.AIDS Res Hum Retroviruses. 2007; 23: 834-839Crossref PubMed Scopus (35) Google Scholar Most blood for transfusion in Afghanistan is not tested for HIV.8Saif-Ur-Rehman Rasoul M.Z. Wodak A. Claeson M. Friedman J. Sayed G.D. Responding to HIV in Afghanistan.Lancet. 2008; 370: 2167-2169Abstract Full Text Full Text PDF Scopus (13) Google Scholar Developing countries and industrialized nations can benefit from exchange of health professionals and researchers.9Wood J.B. Hills E.A. Hands across the equator: the Hereford/Muheza link.BMJ. 1988; 297: 604-607Crossref PubMed Scopus (5) Google Scholar Infection control in industrialized nations can benefit from insight into infection control practice in resource-poor settings by seeing a different perspective to the approach of similar problems.10Apisarnthanarak A. Mundy L.M. Infection control for emerging infectious diseases in developing countries and resource-limited settings.Infect Control Hosp Epidemiol. 2006; 27: 885-887Crossref PubMed Scopus (9) Google Scholar Multidrug-resistant bacterial organisms were apparently of minor importance in the 2 developing countries, and this could indicate to health care planners in industrialized nations that advanced health care requires timely dealing with complications such as the development of multidrug-resistant bacterial organisms. Developing countries benefit from exchange by acquiring knowledge of effective prevention such as HIV and HBV needlestick injury postexposure prophylaxis if resources are available. Finally, the importance of infection control for health care including research studies in developing countries is not widely appreciated. In summary, tuberculosis infection control could be improved with increased use of respirators. The risk of transmission of HBV, HCV, and HIV to both HCW and patients in hospitals should be investigated, and an undetected number of infections are a concern in developing countries with limited resources. Infection control should be supported in both countries and funding made available for safe injection practice, prevention of transmission during procedures with possible blood exposure, HCW training, and needlestick injury postexposure prophylaxis." @default.
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• W2111392012 title "Infection control in developing countries: Phnom Penh and Kabul" @default.
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