Surveillance of Healthcare-Associated Infections (HAI) in an Adult Surgical Intensive Care Unit (ICU) in the Republic of South Africa

Abstract

Background: Patients being treated in ICUs are at high risk of developing infection due to invasive procedures, frequent underlying health problems and immunosuppression resulting from their critical illness and co-morbidities. This project aimed to assess the incidence of HAI in A1 Adults Surgical ICU at Tygerberg Hospital and to improve infection prevention and control practices. Methods: This was a prospective observational study conducted during a period of 5 weeks, starting from 08 September to 15 October 2014. During the first four weeks, all new bacterial positive isolates from A1 Surgical ICU were collected daily, and then patient clinical data collected from patient files and from clinician’s interactive (doctors and nurses). The diagnosis of HAI was made based on the NHSN definitions. Wound contamination class used is the one described by Altemeier. Direct observation on hand hygiene practice was done to check whether any correlation between hand hygiene compliance and HAI rate. Data was analysed using Ms Excel. Results: There was a very high LRTI with 81.8 infections per 1000 IP-Days per month, followed by SSI with 31.7 infections per 1000 IP-Days and BSI with 26.4 infections per 1000 IP-Days per month. Acinetobacter baumannii was the most common organism representing 31% of all infections. VAP incidence density was 12.3 infections per 1000 ventilator-days per month, while CAUTI incidence density was 7.9 infections per 1000 catheter-days per month. There was no case of CLABSI during the surveillance period. Multidrug resistant organisms represented 65.4% of all isolated organisms causing HAI. Conclusion: HAI rates were very high for LRTI (81.8/1000 IP-Days), SSI (31.7/1000 IP-Days) and BSI (26.4/1000 IP-Days). MDR is very high (65.4%). HH compliance was very scared (29.3%). Only CLABSI bundle was implemented in A1 Surgical ICU. Bundles of care other than CLABSI such as VAP, CAUTI should be implemented to reduce HAIs. The clinical staff should comply with IPC precautions, especially standard precautions to reduce the risk of patients from getting HAIs.