Epidemiology Of Hospital-acquired Infections Research Articles

Characteristics of Airborne Particles and Bacteria in Hospital Indoor and Outdoor Air

Introduction: Given that hospital air is one of the important environmental sources for transmission of microorganisms, the importance of airborne transmission in the epidemiology of hospital-acquired infections (HAIs) has gained attention in the past two decades. Therefore, the present study aims to determine the concentration of bacteria in association with airborne particulate matter (PM) in the outdoor and indoor air of two hospital wards.
 Materials and methods: The GRIMM 1.109 dust monitor and the Andersen one-stage viable impactor were used for particle counting and bioaerosol sampling, respectively.
 Results: The average levels of airborne bacteria sampled from outdoor air were 33 colony-forming units (CFU/m3), and in the air samples of medical and infectious disease wards, they were 76 and 85 CFU/m3, respectively. Staphylococcus spp. and Acinetobacter spp. were the most prevalent bacteria in the samples. Statistical analysis showed a significant association between PM2.5, and PM10 particle mass concentrations and airborne bacteria concentrations in indoor air samples (P-value < 0.05).
 Conclusion: Some bacterial agents of HAIs existed in hospital air and may be problematic for immunocompromised patients. Higher levels of bacteria in indoor air compared to outdoor air may indicate that the bacteria were of indoor origin, such as the presence and activities of people. Moreover, the results showed that particle counting may be a useful tool for airborne bacteria monitoring.

Risk factors for and incidence of hospital-acquired infections after cardiac surgery in children with congenital heart disease: a single center experience.

The epidemiology of hospital-acquired infections (HAIs) has been less well studied in critically ill children in pediatric cardiothoracic intensive care units. This study aimed to investigate independent risk factors for and incidence of HAIs after cardiac surgery in children with congenital heart disease (CHD). Our study included 574 patients who underwent congenital heart surgery and were followed up in the cardiothoracic intensive care unit between September 2016 and December 2020. All patients were divided into four groups according to age: 0-1 months, 1-6 months, 6-12 months, and 1-18 years, and into two subgroups according to HAI development. The patients` median age and weight at surgery were 3.28 (interquartile range [IQR]): 0.43-8.1) months and 4.34 (IQR: 4.34-6.69) kg, respectively. HAIs and infection-related deaths were observed in 223 and 21 patients, respectively. Age at surgery, weight at surgery, concomitant syndromes and immunodeficiency status, presence of cyanotic heart disease, intubation, and use of antibiotics during hospitalization were statistically significant between the two groups with and without infection (p < 0.05). In logistic regression analysis, surgical weight < 5 kg (odds ratio [OR]: 2.55; 95% confidence interval [CI]: 1.56-4.17; p < 0.001), preoperative mechanical ventilation (OR: 2.0; 95% CI: 1.26-3.12; p=0.003), complexity of cardiac surgery according to the risk-adjusted congenital heart surgery classification score 3 (OR: 3.13; 95% CI: 1.24-7.92; p=0.016), presence of an concomitant syndrome (OR: 1.56; 95% CI: 1.02-2.88; p=0.040), age (OR: 1.01; 95% CI: 1.01-1.04; p=0.044) were independent risk factors for HAIs after cardiac surgery in children with CHD. In this study, younger age, presence of an associated syndrome, preoperative mechanical ventilation, and weight less than 5 kg were found to be independent risk factors for HAI after cardiac surgery in children with CHD.

Epidemiology of hospital-acquired infections in a tertiary care teaching hospital in India: a cross-sectional study of 79401 inpatients

Background: Healthcare-associated infections are those infections that the patients develop during the course of receiving healthcare treatment for other conditions, which are not incubating at the time of admission. Health care associated infections are the major concerns in the developing countries commonly affecting the ill patients. The purpose of the study is to assess the epidemiology of health care associated infections (HAI) in a tertiary care teaching hospital.Methods: Cross sectional retrospective data was collected for all inpatients from January 2013 to December 2015 covering 79401 inpatients. Data was collected as per ICD – 10 coding, analyzed using SPSS software ver.16.Results: Overall Percentage of different types of HAI calculated, UTI- 1318 (1.66%) more among females and 51.7 %, highest rate in general ward. BSI -360 (0.45%) with 54% male patients, 79.7% medical related type of diagnosis, 66.9% cases from ICU. VAP 148 (0.19%), 62.1% male patients, 94.8%- medical related type of diagnosis. SSI – 30 (0.04%) 65.5% male patients , General Ward 86.2% , 65.5% male patients. Mortality analysis reveal maximum number of deaths was due to BSI contributing to 27.22 % as case fatality rate and 60.12 % proportional mortality rate.Conclusions: Occurrence of hospital acquired infections pose a grave threat to patients as well as health care personnel. Tertiary care centers require a multi-pronged approach to tackle these infections. HAIs lead long term disability, increase in hospital stay, financial burden to the family members. Many a times health care associated infections can be prevented by using standard guidelines, precautions, correct protective measures by health care workers.

Epidemiology of Hospital-Acquired Infections and Related Anti-Microbial Resistance Patterns in a Tertiary-Care Teaching Hospital in Zahedan, Southeast Iran

Background: Healthcare-acquired infections (HAIs) that patients develop during the course of healthcare treatment are important causes of morbidity and mortality worldwide. Objectives: The aim of this study was to determine the epidemiology of HAIs in a tertiary-care teaching hospital in Zahedan, southeast Iran. Patients and Methods: This was a cross-sectional study of patients admitted to Ali-Ibn-Abitalib Hospital, a tertiary-care teaching center, from March 2013 through March 2014. All patients admitted during this study period were examined by head nurses on a daily basis for detecting four types of HAIs: surgical site infection, urinary tract infection, pneumonia, and bloodstream infection. All the identified HAIs were registered into the Iranian National Nosocomial Infections Surveillance System Software. Pathogens were identified using standard microbiological methods, and antimicrobial susceptibility was determined by disk diffusion tests according to the Clinical and Laboratory Standards Institute guidelines. Descriptive statistics were used for data analysis. Results: A total of 16,140 patients were admitted to the hospital during the study period, including 162 found to have HAIs (approximately 1%). The majority (79.6%) of the HAIs were reported from the intensive care units (n = 129), followed by the medical wards (10.5%, n = 17) and obstetrics/gynecology ward (7.4%, n = 12). The most common site of infection was the respiratory tract (67.9%) followed by the urinary tract (13.6%). Among the pathogens isolated, Acinetobacter and Enterobacter were the most common (17.6%) followed by Escherichia coli (11%). Overall, multidrug resistance was observed in 95% of the isolates. Conclusions: The HAI prevalence found in this study was lower than HAI rates reported in some other studies from Iran. The isolates showed high resistance to common antibiotics. Guidelines for improving HAI surveillance and stringent measures to reduce the prevalence of multidrug-resistant HAIs must be implemented to reduce the rate and the consequences of HAIs.

Health care-associated infections in the intensive care unit of Saqr Hospital, Ras Al Khaimah, in 2013

Introduction: Heath care-associated infections are a major threat to patients in the intensive care unit (ICU). Owing to the difficulty in gathering reliable data, evidence regarding ICU-acquired infections in the developing world is limited. This study aimed to assess the epidemiology of hospital-acquired infections in ICU patients in Saqr Hospital, Ras Al-Khaimah, United Arab Emirates. Material and methods: A retrospective review of nosocomial infections in the ICU of Saqr Hospital between 2013 and 2014 was performed. Nosocomial infections were defined according to the definitions outlined by the Centers for Disease Control and Prevention. The incidence of patient nosocomial infection, the excess length of stay, causative agents and the distribution of nosocomial infection sites were determined, then pathogen and antimicrobial susceptibility profiles were further investigated. Results: The study included 364 patients admitted to the ICU in the years 2013 and 2014. The overall patient nosocomial infection rate was 20.9%. Lower respiratory tract infections (LRTIs) accounted for half of the infections (50%), followed by bloodstream (24%) and urinary tract (UTI, 18%) infections. In addition, Acinetobacter baumannii, Pseudomonas aeruginosa and Candida albicans were the most frequent pathogens isolated in patients with LRTIs, bloodstream infections and UTIs, respectively. The average length of stay for infected patients was 15.5 days, which was 10 days more than the average for non-infected patients. Empirical antibiotics were used to treat these patients and antimicrobial susceptibility results were positive for all organisms except C. albicans. The overall mortality rate among patients admitted during 2013 to the ICU of Saqr Hospital was 27.7%. The mortality rate of patients admitted to the ICU with positive culture results was 26%. Conclusion: Guidelines for surveillance and prevention of nosocomial infections must be implemented in order to reduce the rate of infection. Acknowledgements: We would like to thank Dr Rasha A Salama for supervising and supporting our research and Dr James Donato for his help.

Infecciones en los niños quemados: análisis epidemiológico y de los factores de riesgo

Burns are the third cause of accidental deaths among children. Approximately 50-60% of these deaths are the result of an infection.To determine infection related risk factors in burned children.All patients admitted to the Burn Unit of Hospital "Prof. Dr. Juan P. Garrahan" between June 2007 and December 2009 were included. The epidemiology of hospital-acquired infections and the associated outcome measures were determined. Groups of infected and non-infected children were compared using Student's t test or the Mann-Whitney Rank Sum test, as applicable. Dichotomous outcome measures were analyzed with the X2 test using Yates' correction. In order to assess the predictive value of independent outcome measures, the multiple logistic regression model was applied.In this cohort of 110 children, 128 hospital-acquired infections were recorded in 84 patients. There were 17 deaths (15%); 14 out of these 17 (82%) were related to infection. Infection-related factors included the percentage of burned body surface area; the highest Garces' index; burn depth; antibiotic prophylaxis; the use of topical antibiotics; the presence of a central venous line, an arterial line, a urinary catheter, mechanical ventilation support, escharotomy, and the need of a graft. The multivariate analysis showed a higher risk of infection with the use of central venous lines (RR: 5.15; 95% CI: 1.44-18.46), antibiotic prophylaxis (RR: 5.22; 95% CI: 1.26-21.63), and graft requirement (RR: 3.65; 95% CI: 1.08-12.37).The presence of lines or catheters, antibiotic prophylaxis, and graft requirement were independent risk factors for infection in burned children.

Epidemiology of hospital-acquired infections in an adult intensive care unit: results of a prospective cohort study

We aimed to describe the pattern of nosocomial infections in an adult medical-surgical intensive care unit (ICU). A 2-year prospective cohort study of nosocomial infection surveillance in a 12 - bed adult medical and surgical ICU of the Federico II University Hospital in Naples, was carried out. Data were collected between January 2009 and December 2010 using the standard surveillance protocols and nosocomial infection site definitions of the National Healthcare Safety Network's ICU surveillance component. Out of 768 patients hospitalized during this period, 434 with an ICU stay longer than 48 h were included in the study. Fifty-three patients acquired a total of 71 nosocomial infections; 55 (77,5%) ventilatorassociated pneumonia (VAP), 10 (14,1%), central-line-associated bloodstream infection (CLA-BSI) and 6 (8,4%) catheter-associated urinary tract infection (CA-UTI). The overall patient day rate was 12,9 patient days. The patient infection rate was 16,3 patients at risk. The mean VAP rate was 15,0/1.000 ventilator days, the CLA-BSI rate 2,9/1.000 central line days and the CA-UTI rate 1,2/1.000 catheter days. Of the nosocomial infections, 65 were Gram-negative, 6 Gram-positive and 5 fungal. The most frequent organism was Acinetobacter baumannii (61,9%), followed by Pseudomonas aeruginosa (22,5%), Enterococcus fecalis (4,2%) and Candida albicans (4,2%). The crude mortality was 35% among ICU-infected patients. VAP was the most common nosocomial infection in our ICU. Gram-negative organisms were more commonly reported as etiologic agents of ICU infections.

Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, Iran

Hospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region. The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60-700 beds. The study was conducted during all four season of 2008-2009. All of the patients admitted for ≥48h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance (NNIS) guidelines. Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections (2.5%), surgical site infections (2.4%), urinary tract infections (1.4%), and pneumonia (1.3%). A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 (95% confidence interval [CI] 1.21-2.02). Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 (95% CI 2.38-6.26), and using an urinary catheter, adjusted OR of 3.06 (95% CI 2.19-4.28). Being admitted to an ICU was not an independent HAI risk factor. For all HAIs, the OR of acquiring infection was 3.24 (95% CI 2.34-4.47) in the patients with hospital stays longer than eight days. A high discrepancy between HAIs and antibiotic use was observed. Antibiotics were administered to 71% of the patients, but only 9.4% of the patients also had at least one documented infection. This point prevalence study showed that HAIs are frequent in Shiraz university hospitals, and that the proportion of patients receiving antibiotics is high. The results imply that more primary prevention efforts are necessary to address HAIs associated with using indwelling devices and to prevent surgical site infections.

Point prevalence and risk ractors of hospital acquired infections in a cluster of university affiliated hospitals in Shirz, Iran

Summary Background: Hospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region. Methods: The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60—700 beds. The study was conducted during all four season of 2008—2009. All of the patients admitted for ≥48 h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance (NNIS) guidelines. Results: Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections (2.5%), surgical site infections (2.4%), urinary tract infections (1.4%), and pneumonia (1.3%). A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 (95% confidence interval [CI] 1.21—2.02). Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 (95% CI 2.38—6.26), and using an urinary catheter, adjusted OR

Epidemiology of Hospital-Acquired Infections in a Tertiary Care Center in Lebanon

Epidemiology of Hospital-Acquired Infections in a Tertiary Care Center in Lebanon

Antimicrobial surfaces and their potential in reducing the role of the inanimate environment in the incidence of hospital-acquired infections

Environmental surfaces and their role in the epidemiology of hospital-acquired infections (HAIs) have become an area of great scientific interest, particularly in light of the much publicised cases of infections due to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile in UK hospitals. This feature article sets out to examine the role of surfaces and the inanimate environment in the spread of HAIs, and looks at various antimicrobial techniques being researched to reduce microbial contamination of surfaces. Preventative measures such as coatings which reduce initial microbial adhesion to surfaces will be considered alongside actively antimicrobial measures which inactivate microorganisms already adherent to a surface. The principal focus of this feature article will be given to light-activated antimicrobial surfaces such as the photocatalyst TiO2 and surfaces with embedded photosensitisers. Surfaces which release antimicrobial compounds or metal ions such as silver and copper are also examined, alongside materials which kill microbes upon contact. The widespread research and development of these antimicrobial surfaces is of great importance in maintaining acceptable levels of hygiene in hospitals and will help to fight the spread of HAIs via the contamination of inanimate surfaces in the healthcare environment.

Surveillance of hospital-acquired infections in Liguria, Italy: results from a regional prevalence study in adult and paediatric acute-care hospitals

A multi-hospital prevalence study of hospital-acquired infections (HAIs) was carried out between 19 March and 6 April 2007 in Liguria, Italy, being the first to be performed in this region. Of the 29 existing public acute hospitals, 25 took part in the investigation (86.2%). In total, 3176 patients were enrolled in the study, representing a regional average bed-occupancy rate of nearly 70%. Three-hundred and ten HAIs were diagnosed from 283 patients, with an overall prevalence of infections and cases of 9.8% and 8.9%, respectively. Prevalence varied considerably between hospitals, ranging from 0 to 24.4% [95% confidence interval (CI): 15.53-33.27]. Urinary tract infections (UTIs) (30.0%) and respiratory tract infections (RTIs) (26.1%) presented the highest relative frequency, followed by bloodstream infections (BSIs) (14.8%), surgical site infections (11.6%) and gastrointestinal infections (6.5%). Intensive care units (ICUs) and haemato-oncological units showed the highest specific prevalence of HAI, respectively 42.5% (95% CI: 34.48-50.52) and 13.3% (6.28-20.32), with RTI and BSI as the predominant infections. Spinal units (33.3%; 13.14-53.46) and functional-rehabilitation units (18.9%; 17.75-24.06) demonstrated a high rate of urinary tract infections. Uni- and multivariate analyses were performed to assess the main risk factors and conditions associated with HAI, both overall and by site. Our study provides an overall picture of the epidemiology of HAI in Liguria, which may be usefully employed as a starting point to plan and organise future surveillance and control programmes.

Hospital-Acquired Infections in the Surgical Intensive Care: Epidemiology and Prevention

Hospital-acquired infections affect 7% to 10% of hospitalized patients and account for approximately 80,000 deaths per year in the United States. Of all infections acquired in the hospital, more than 20% occur in intensive care unit patients. As the number of ICU beds increases, the proportion of ICU infections is likely to increase. The focus of this paper is to review the epidemiology of hospital-acquired infections that occur in the surgical ICU, particularly ventilator associated pneumonia, catheter-associated urinary tract infection, and catheter-related bloodstream infection, and to discuss ICU-related prevention strategies. By implementing effective preventative measures and maintaining strict surveillance of ICU infections, we hope to affect the associated morbidity, mortality, and cost that our patients and society bare.

Etiología de las infecciones hospitalarias en España (EPINE, 1990–1999)

Clinical and demographic characteristics of patients, their interaction with pathogens and antimicrobial therapies are prompting changes in the epidemiology of hospital-acquired infections (HI). The knowledge of the etiology of hospital-acquired infections is valuable for the treatment of infected patients and for the prevention of HI. We analyzed a series of 10 annual prevalence studies during the period 1990-1999 (EPINE project) in Spanish hospitals. Estimate of prevalence of infection was calculated by means of the percent distribution of every organism regarding overall identified organisms and infections. 40,550 HI were identified among 484,013 patients (HI prevalence = 8.4%; 95% CI, 8.3-8.5%). Gram-positive organism predominated steadily in bloodstream and surgical wound infections, while gram-negative bacilli predominated in respiratory and urinary tract infections. There was an increase in HI infections by Acinetobacter baumannii (from 1.9% in 1990 to 3.6% in 1999; P < 0.001) and Candida albicans (from 2.4 to 3.2%; P < 0.001), as well as an increase in both HI and community-acquired infections by methicillin-resistant Staphylococcus aureus [HI: from 4.7 to 40.2% (P < 0.001); community-acquired: from 2.7 to 15.6% (P < 0.001)]. We observed some changes in the etiology of infections over the last decade: rates of methicillin-resistant S. aureus hospital-acquired and community-acquired infections increased steadily and their initial rates multiplied by 8 and 6, respectively. Rates of HI caused by yeasts and A. baumannii increased also.

Special article: Benchmarking in pediatric infection control: Results from the National Nosocomial Infections Surveillance (NNIS) system and the pediatric prevention network

The Institute of Medicine's 1999 report on medical errors stated that 44,000 to 98,000 deaths occur annually because of adverse patient events, at a national cost of $17 to $29 billion. Hospital-acquired infections (HAIs) are estimated to represent 50 percent of this human and economic burden. Surveillance in combination with infection control programs can prevent up to one third of HAIs by organizing and implementing focused prevention interventions. The National Nosocomial Infections Surveillance (NNIS) system, created by the Centers for Disease Control and Prevention in 1970, establishes and monitors national benchmarks for HAI rates based on standardized definitions and validated methodology and facilitates comparative quality assessments for individual hospitals. Estimates of the burden of HAIs on hospitalized children can vary widely from less than 1 percent to greater than 20 percent, depending on the patient's host factors or extrinsic exposures, the methodology used to ascertain infections, and the denominator used to calculate rates. It is useful to have benchmark rates, such as those determined through the NNIS system, that reflect consistently collected data over time and for large populations of patients. In 1999, the Pediatric Prevention Network, a collaboration between the National Association of Children's Hospitals and Related Institutions and the Hospital Infections Program, Centers for Disease Control and Prevention, conducted the first national point prevalence surveys of HAIs in neonatal and pediatric intensive care units. The data provided by the NNIS system (incidence data) and the Pediatric Prevention Network (prevalence data) surveys are important contributors to our understanding of the epidemiology of HAIs in pediatric patients. Copyright © 2001 by W.B. Saunders Company

Is Streptococcus pneumoniae a nosocomially acquired pathogen?

Streptococcus pneumoniae is most prominently a major cause of community-acquired infections of the respiratory tract, central nervous system, and bloodstream, but there is an increasing interest in its role in the epidemiology of hospital-acquired infections. Penicillin-resistant pneumococcal strains appeared 3 decades ago and now are present worldwide, often displaying multiple resistance due to antibiotic selective pressure. Horizontal spread can cause either sporadic cases or hospital outbreaks, primarily in younger children and elderly patients. Pneumococcal transmission from one patient to another can be documented by polymerase chain reaction or pulsed-field gel electrophoresis typing. Nosocomial acquisition of infection, along with pediatric age, previous hospitalization, and previous beta-lactam therapy, are the main risk factors significantly associated with penicillin-resistant pneumococcal infections. Nosocomial acquisition also is associated with higher mortality from pneumococcal disease. The importance of penicillin resistance as a risk factor significantly associated with higher mortality from pneumococcal infection is found in some studies, but not in others. Mortality from pneumococcal pneumonia is approximately the same for human immunodeficiency virus (HIV)-infected patients without acquired immunodeficiency syndrome (AIDS) as for HIV-negative subjects, but it is significantly higher in AIDS patients. Penicillin-resistant strains are involved in the vast majority of hospital outbreaks, whether presenting as clinically manifest infection or a simple colonization. Pneumococcal vaccination is recommended universally in order to lower the incidence of invasive infection, although a number of problems can limit its effectiveness.

Nosocomial infections in human immunodeficiency virus-infected patients in a long-term-care setting.

To our knowledge, the epidemiology of hospital-acquired infections in human immunodeficiency virus (HIV)-infected patients during long-term care has not been reported. For 13 months, we observed HIV-infected patients (50 men and 15 women) in a dedicated 21-bed unit in a long-term-care facility to determine the rate of nosocomial infections. The mean age of the patients was 39 years (range, 22-78 years); 74% of the patients had CD4 cell counts of < 200/mm3. There was a total of 152 infections (24 infections per 1,000 long-term-care days). The factors associated with the occurrence of a nosocomial infection were low CD4 cell counts, poor functional status, and longer duration of stays at the facility. The three most common infections were Clostridium difficile-associated diarrhea, primary bacteremia, and urinary tract infection. Eighteen hospital-manifested opportunistic infections occurred. More than 50% of the cases of bacteremia were due to multidrug-resistant organisms. Nosocomial infections occur commonly in HIV-infected patients in long-term care and thus are important considerations in patient management.