Abstract
Background: Healthcare-associated infections are an important cause of morbidity and mortality globally. Grey’s Hospital introduced an Infection Control Programme in August 2016, which included Best Care Always bundles for reducing the occurrence of central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilatorassociated pneumonia. Methods: An observational before–after quasi-experiment was conducted retrospectively reviewing healthcare-associated infection rates in the Grey’s Hospital paediatric intensive care unit a year prior to (August 2015 to July 2016) and after (September 2016 to August 2017) implementation of an Infection Control Programme.Results: There was an absolute decrease in healthcare-associated infection from 102 to 81 and a statistically significant decrease in bloodstream infections per 1 000 central venous catheter days from 36/1 000–15/1 000 after intervention (RR 0.42, 95% CI 0.23–0.79, p = 0.004). The rate of healthcare-associated infection decreased from 23/100 admissions prior to the intervention to 20/100 admissions after the intervention (RR 0.87, 95% CI 0.51–1.48, p = 0.61) and from 40/1 000 patient days to 32/1 000 patient days (RR 0.80, 95% CI 0.51–1.26, p = 0.34). Reductions in healthcare-associated infection were also seen in bloodstream infections and urinary tract infections.Conclusion: The observed downward trend in overall healthcare-associated infections, bloodstream infections and urinary tract infections did not reach statistical significance except for bloodstream infections per 1 000 central venous catheter days. Further research or audit is needed to ascertain reasons for this less than expected decrease in healthcare-associated infections. In the meantime, meticulous adherence to bundles should be encouraged.
Highlights
Healthcare-associated infections are an important cause of morbidity and mortality globally
The paediatric intensive care unit (PICU) at Grey’s Hospital is an eight-bed intensive care and high care unit that serves the western part of KwaZulu-Natal, which has a population of approximately 1.2 million children.[14]
There was a total of 449 admissions to the PICU in the year prior to the Infection Control Programme and 410 in the year after (Table 1)
Summary
Healthcare-associated infections are an important cause of morbidity and mortality globally. The burden of HAIs is significantly higher in low- and middleincome countries compared with upper-income countries.[4] HAI rates in ICUs in low- and middle-income countries are at least double and even sometimes triple the rates of those in the USA.[5] Due to lack of adequate surveillance programmes in South Africa, there are limited data on local HAI rates.[6] In a meta-analysis of studies from 1995 to 2008 looking at HAIs in low- and middle-income countries, only 13 African studies were included and none was from South Africa These studies showed HAI rates between double and triple those reported in the USA and the UK, highlighting the problem in low- and middle-income countries. This difference was most striking in the ICU setting.[7]
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