Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital

Pasco Hearn,Nicholas P J Day,Paul Turner,Claudia Turner,Chanpheaktra Ngoun,Soklin Seng,Yoel Lubell,Thyl Miliya

doi:10.1186/s13756-017-0172-5

Abstract

BackgroundHealthcare associated infections (HAI) are the most common preventable adverse events following admission to healthcare facilities. Data from low-income countries are scarce. We sought to prospectively define HAI incidence at Angkor Hospital for Children (AHC), a Cambodian pediatric referral hospital.MethodsProspective HAI surveillance was introduced for medical admissions to AHC. Cases were identified on daily ward rounds and confirmed using locally adapted Centers for Disease Control and Prevention (CDC) definitions. During the surveillance period, established infection prevention and control (IPC) activities continued, including hand hygiene surveillance. In addition, antimicrobial stewardship practices such as the creation of an antimicrobial guideline smartphone app were introduced.ResultsBetween 1st January and 31st December 2015 there were 3,263 medical admissions and 102 HAI cases. The incidence of HAI was 4.6/1,000 patient-days (95% confidence interval 3.8–5.6) and rates were highest amongst neonates. Median length of stay was significantly longer in HAI cases: 25 days versus 5 days for non-HAI cases (p < 0.0001). All-cause in-hospital mortality increased from 2.0 to 16.1% with HAI (p < 0.0001). Respiratory infections were the most common HAI (54/102; 52.9%). Amongst culture positive infections, Gram-negative organisms predominated (13/16; 81.3%). Resistance to third generation cephalosporins was common, supporting the use of more expensive carbapenem drugs empirically in HAI cases. The total cost of treatment for all 102 HCAI cases combined, based on additional inpatient days, was estimated to be $299,608.ConclusionsProspective HAI surveillance can form part of routine practice in low-income healthcare settings. HAI incidence at AHC was relatively low, but human and financial costs remained high due to increased carbapenem use, prolonged admissions and higher mortality rates.

Highlights

Healthcare associated infections (HAI) are the most common preventable adverse events following admission to healthcare facilities
Admissions are often prolonged by HAI, whilst their association with increasingly resistant bacteria requires that more expensive antimicrobials are often employed
One hundred two HAI episodes were identified from 93 separate admissions, resulting in an annual HAI incidence of 4.6 per 1,000 patient-days (95% confidence interval (CI) 3.8–5.6) and an attack rate of 3.1 per 100 admissions

Summary

Introduction

Healthcare associated infections (HAI) are the most common preventable adverse events following admission to healthcare facilities. The most common, preventable adverse event following admission to a healthcare facility is a healthcare associated infection (HAI). Such infections are a major cause of morbidity and mortality worldwide [1, 2]. Pooled information from high-income countries suggested an overall HAI prevalence of 7.6 per 100 admissions and an incidence of 17.0 per 1,000 patient-days [3]. Few middle and low-income countries carry out HAI surveillance, but pooled data from such

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