Observed Handwashing with Soap Practices Among Cholera Patients and Accompanying Household Members in a Hospital Setting (CHoBI7 Trial)

Fatema Zohura International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Sazzadul Islam Bhuyian International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Shirajum Monira International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Farzana Begum International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Shwapon K. Biswas International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Tahmina Parvin International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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David Sack Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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R. Bradley Sack Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Elli Leontsini Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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K. M. Saif-Ur-Rahman International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Mahamud-ur Rashid International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Rumana Sharmin International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Xiaotong Zhang International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Munirul Alam International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

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Christine Marie George Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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Abstract

Household members of cholera patients are at a 100 times higher risk of cholera than the general population. Despite this risk, there are only a handful of studies that have investigated the handwashing practices among hospitalized diarrhea patients and their accompanying household members. To investigate handwashing practices in a hospital setting among this high-risk population, 444 hours of structured observation was conducted in a hospital in Dhaka, Bangladesh, among 148 cholera patients and their household members. Handwashing with soap practices were observed at the following key events: after toileting, after cleaning the anus of a child, after removing child feces, during food preparation, before eating, and before feeding. Spot-checks were also conducted to observe the presence of soap at bathroom areas. Overall, 4% (4/103) of key events involved handwashing with soap among cholera patients and household members during the structured observation period. This was 3% (1/37) among cholera patients and 5% (3/66) for household members. For toileting events, observed handwashing with soap was 7% (3/46) overall, 7% (1/14) for cholera patients, and 6% (2/32) for household members. For food-related events, overall observed handwashing with soap was 2% (2/93 overall), and 0% (0/34) and 3% (2/59) for cholera patients and household members, respectively. Soap was observed at only 7% (4/55) of handwashing stations used by patients and household members during spot-checks. Observed handwashing with soap at key times among patients and accompanying household members was very low. These findings highlight the urgent need for interventions to target this high-risk population.

Author Notes

* Address correspondence to Christine Marie George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E5535, Baltimore, MD 21205-2103. E-mail: cmgeorge@jhsph.edu

Financial support: This study was supported by Grant NIAID 3R01 AI039129-13S1.

Authors' addresses: Fatema Zohura, Sazzadul Islam Bhuyian, Farzana Begum, K. M. Saif-Ur-Rahman, Rumana Sharmin, and Munirul Alam, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Centers for Disease Control and Prevention, Dhaka, Bangladesh, E-mails: fzohura@icddrb.org, sazzadul.islam@icddrb.org, farzanab@icddrb.org, r.sharmin@icddrb.org, su.rahman@icddrb.org, and munirul@icddrb.org. Shirajum Monira and Mahamud-ur Rashid, International Health, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: smonira@icddrb.org and mahamudur@icddrb.org. Shwapon K. Biswas, Center for Communicable Diseases, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: drskbiswas2004@yahoo.com. Tahmina Parvin, Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mail: tparvin@icddrb.org. David Sack, R. Bradley Sack, Elli Leontsini, Xiaotong Zhang, and Christine Marie George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: dsack@jhsph.edu, rsack1@jhu.edu, eleontsi@jhu.edu, xzhang75@jhmi.edu, and cmgeorge@jhsph.edu.

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