Predictors of Nosocomial Infections among Geriatric Patients in the Internal Medicine Department of the University Teaching Hospital of Butare (CHUB), South, Huye, Rwanda

Abstract

Purpose: Nosocomial infections pose a significant burden worldwide, particularly in resource-limited settings. This study aimed to determine predictors of nosocomial infections among geriatric patients at the University Teaching Hospital of Butare (CHUB) in Rwanda. Methodology: A quantitative cross-sectional cohort study over seven months included participants admitted to CHUB's Internal Medicine department from July 2023 to January 2024 with the aim to determine the Nosocomial infections predictors among elderly aged 61 years and above. The target sample size was 313, but a census approach with 400+ participants was used. Data collection involved physician examinations, laboratory testing, interviews, facility observations, specimen culture, antimicrobial susceptibility testing, and logistic regression analyses. Findings: The study included 206 participants who were screened infection-free at admission, predominantly from Southern Province (85%) and female (56%), with a median hospital stay of 3 days. Most were admitted from Kabutare District Hospital (22%) to Internal Medicine (90%). Age distribution peaked at 61 years and above (38.8%) and 60 years and below (61.2%). Unemployment was high (83%), especially among females (60%) and those with low education. Prior 30-day hospitalization occurred in 34%, mainly for non-communicable diseases (41%) and infections (20%). Chronic conditions were reported by 41%, commonly hypertension (37%), other non-communicable diseases (14%), and diabetes (10%). Recent antibiotic use was 23%, primarily ceftriaxone (54%). Urine samples dominated (55%), with prevalent pathogens like Escherichia coli and Staphylococcus species. But more importantly this study demonstrated a strong association between nosocomial infection level and some predictors with significant P values as follows: time of stay (P=0.002), Health Care providers following WHO 5 Moments of hand hygiene (P=0.005), disinfection of medical devices by Health Care providers (P=0.036) and hands washing before taking medicines (P=0.047). Unique Contribution to Theory, Practice and Policy: The environmental decontamination and antibiotic rotation policies should be implemented to manage Acinetobacter spp. infections. As well hand hygiene adherence and preventive measures for urinary tract infections will address Escherichia Coli infections. Efforts to mitigate the burden of nosocomial infections should prioritize the enhanced surveillance, establishing robust infection tracking systems across healthcare facilities, invest in antimicrobial stewardship and targeted interventions tailoring infection control practices to high-risk groups like geriatric patients.