Antibiotic resistance : implications of hospital practices for public health : a study from Hanoi, Vietnam

Background: Antibiotic resistance is a global challenge, requiring urgent attention. Inefficient hospital infection control and hospital dissemination of antibiotic residues and antibiotic resistant bacteria contribute to the spread of antibiotic resistance. Overall aim: To explore hospital practices in relation to the spread of antibiotic resistance in a rural and an urban hospital in Hanoi, Vietnam. Methods: The thesis consists of one qualitative (II) and three quantitative studies (I,III&IV). In Paper I, a cross-sectional study, questionnaires consisting of items on knowledge and practices of infection control were collected from 339 hospital staff. For analysis, total knowledge or practice score ranged from 0-15. In Paper II, individual interviews and focus group discussions were conducted with a total of 50 doctors, nurses and cleaning workers. A semi-structured guide on infection control was used. Content analysis was applied. In Papers III & IV, wastewater samples were collected every month over one year in the two hospitals; quantities of antibiotics used were also collected in the rural hospital. High-performance liquid chromatography-tandem mass spectrometry was used to determine antibiotic concentrations; standard disk diffusion and E-test were applied for antibiotic susceptibility testing in 265 Escherichia coli (E. coli) isolates from the water samples; polymerase chain reactions were used to detect antibiotic resistance genes. Results: The majority of hospital staff showed good knowledge of infection control and had good or adequate practice scores. Median knowledge scores were 11.8 (6.8-13.9) and 12 (1.4-14.5) (p=0.17); median practice scores were 11.4 (4.7-15.0) and 12.4 (1.0-15.0) in the rural and the urban hospitals respectively (p=0.003). Cleaning workers had lower knowledge as well as practice scores than doctors and nurses (I). The staff acknowledged poor infection control practices during interviews and groups discussions. They pointed out various difficulties but were not aware of ...