Highest Prevalence Of Healthcare-associated Infection Research Articles

Healthcare-associated infections among neonates and children in Pakistan: findings and the implications from a point prevalence survey

Health-care associated infections (HAIs) increase morbidity, mortality and costs. The overall prevalence of HAIs is greater in low and middle income countries due to poor resources and infrastructure, with the incidence of HAIs greater among neonates and children. There is a need to understand the current situation in Pakistan including key drivers to improve future care. Point prevalence survey (PPS) of HAIs in the children wards of 19 public sector secondary and tertiary care hospitals of Pakistan and associated key drivers. 1147 children were included in the PPS. 35.7% were neonates with 32.8% aged >1 to 5 years. 35.2% were admitted in the ICU. Peripheral, central venous and urinary catheters were present in 48%, 2.9% and 5.6% of the patients respectively. 161 HAIs from various pathogens were observed in 153 cases, giving a prevalence of 13.3%. The majority of HAIs were caused by S. aureus (31.7%) followed by K. pneumoniae (22.9%) and E. coli (17.4%). Blood stream infections were identified in 42 cases followed by lower respiratory tract infections in 35. Increased length of hospital stays and being admitted to the ICU, "rapidly fatal" patients under the McCabe and Jackson criteria, central and peripheral catheterization, and invasive mechanical ventilation were associated with higher HAIs (p < 0.001). 99.7% HAIs patients fully recovered and were discharged from the hospital. There is a high prevalence of HAIs among neonates and children admitted to health facilities in Pakistan. Infection prevention and control measures should be implemented to help prevent future HAIs.

The Effect of Healthcare Infection Control Application Committee in Patients Using Urine Cateters on Cost Containtment

The high prevalence of HAIs (Healthcare-associated Infections) is a threat to hospital services. Implementation of infection prevention and control is the biggest challenge in the arrangement of health services, especially in hospitals. HICPAC is one of the CDC guidelines that is quite recommended in reducing the incidence of infections in hospitals. This study aims to assess the effect of implementing HICPAC with a reduction in hospital costs in patients using a urine catheter at Delia Hospital in Langkat District in 2019. The type of research is quantitative with a quasi-experimental approach conducted at Delia General Hospital in Langkat District with a population of 30 patients and analyzed using Paired T Test analysis. The analysis found that there were differences in treatment costs based on secondary diagnoses before and after the HICPAC guidelines were applied. This shows that the HICPAC guidelines can significantly reduce the cost of care for patients who use urine catheters at Delia Hospital in Langkat District. So it is recommended that the HICPAC guidelines can be used integrated with the medical record so that it is easily implemented by all medical personnel in the hospital.

Point prevalence survey is useful for introducing effective surveillance of healthcare-associated infections

SummaryBackgroundIn Finland, the surveillance of healthcare-associated infections (HAI) became obligatory by the renewed Communicable Diseases Act on the 1st March 2017.AimTo introduce HAI surveillance protocol (HALT-2 by ECDC) in primary care hospitals in the largest hospital district in Finland, and to measure the burden of HAIs and antimicrobial use patterns for improvement.MethodsTwo identical point prevalence surveys (PPS) were organized in autumn 2015 and in spring 2017. The infection control persons (ICP) in the hospitals were inducted to the HAI definitions and the study protocol to collect the data with questionnaires on the study days. The data were checked and analyzed by the areal infection control unit. The hospitals were provided feedback of the results and HAI prevention methods.FindingsIn 2015, 2218 patients from 22 hospitals and in 2017, 2343 patients from 25 hospitals were studied. The prevalence of HAI was 11% in both surveys (ranges per hospital 4–24% and 4–31%, respectively). Of all HAIs, 37% originated from referring hospitals. Respiratory tract, urinary tract and skin were the most frequent sites of infection. One fourth of all patients received at least one systemic antimicrobial. The process showed that recognition of HAIs may be difficult for non-experienced ICPs.ConclusionsThe HALT-2 protocol proved useful in introducing HAI surveillance and prevention in primary care hospitals with active patient transfer from other hospitals and relatively high prevalence of HAI and antimicrobial use. For annually repeated surveys, slightly shorter electronic questionnaires are essential.

Analysis of Continuous Prevalence Survey of Healthcare-Associated Infections Based on the Real-Time Monitoring System in 2018 in Shandong in China

Background Healthcare-associated infection (HAI) is a serious threat to the safety of patients worldwide. The prevalence survey is widely used to explore and study the characteristics of HAI. However, the annual continuous prevalence survey of hospital-acquired infections has not been reported so far. Aim This study is aimed at examining the occurrence and development trend of HAIs dynamically and accurately. Methods An annual continuous HAI prevalence survey based on the real-time monitoring system was conducted in representative hospitals from different regions in Shandong in China. Findings. A total of 64 hospitals participated in the survey, and 2,741,433 patients were monitored in 2018. The highest prevalence of HAIs in Shandong was 3.83% (February 15), the lowest was 1.85% (February 28), and the average was 2.45%. The percentile distribution of prevalence of HAIs in this study was as follows: P10, 2.23%; P25, 2.31%; P50, 2.41%; P75, 2.55%; and P90, 2.73%. Conclusion This study dynamically and accurately showed the occurrence and development trend of HAIs in Shandong in 2018. The results of this study can be used as a reference for the HAI prevalence survey in various medical institutions in Shandong and provide the basis for the regional HAI prevention and control strategy.

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis.

Healthcare-associated infection is a global threat in healthcare which increases the emergence of multiple drug-resistant microbial infections. Hence, continuous surveillance data is required before or after patient discharge from health institutions though such data is scarce in developing countries. Similarly, ongoing infection surveillance data are not available in Ethiopia. However, various primary studies conducted in the country showed different magnitude and determinants of healthcare-associated infection from 1983 to 2017. Therefore, this systematic review and meta-analysis aimed to estimate the national pooled prevalence and determinants of healthcare-associated infection in Ethiopia. We searched PubMed, Science Direct, Google Scholar, and grey literature deposited at Addis Ababa University online repository. The quality of studies was checked using Joanna Brigg's Institute quality assessment scale. Then, the funnel plot and Egger's regression test were used to assess publication bias. The pooled prevalence of healthcare-associated infection was estimated using a weighted-inverse random-effects model meta-analysis. Finally, the subgroup analysis was done to resolve the cause of statistical heterogeneity. A total of 19 studies that satisfy the quality assessment criteria were considered in the final meta-analysis. The pooled prevalence of healthcare-associated infection in Ethiopia as estimated from 18 studies was 16.96% (95% CI: 14.10%-19.82%). In the subgroup analysis, the highest prevalence of healthcare-associated infection was in the intensive care unit 25.8% (95% CI: 3.55%-40.06%) followed by pediatrics ward 24.16% (95% CI: 12.76%-35.57%), surgical ward 23.78% (95% CI: 18.87%-29.69%) and obstetrics ward 22.25% (95% CI: 19.71%-24.80%). The pooled effect of two or more studies in this meta-analysis also showed that patients who had surgical procedures (AOR = 3.37; 95% CI: 1.85-4.89) and underlying non-communicable disease (AOR = 2.81; 95% CI: 1.39-4.22) were at increased risk of healthcare-associated infection. The nationwide prevalence of healthcare-associated infection has remained a problem of public health importance in Ethiopia. The highest prevalence was observed in intensive care units followed by the pediatric ward, surgical ward and obstetrics ward. Thus, policymakers and program officers should give due emphasis on healthcare-associated infection preventive strategies at all levels. Essentially, the existing infection prevention and control practices in Ethiopia should be strengthened with special emphasis for patients admitted to intensive care units. Moreover, patients who had surgical procedures and underlying non-communicable diseases should be given more due attention.

Implementation of the policy protocol for management of surgical and non-surgical wounds in selected public health facilities in Ghana: An analytic case study.

BackgroundIt is estimated that millions of patients are affected by healthcare associated infections (HAIs) each year. In Ghana, high prevalence of HAIs in relation to non-surgical (also called contaminated wounds) and surgical wounds (also called sterile wounds) is largely attributed to poor adherence to policy protocols for wound management by frontline clinical staff especially nurses.ObjectiveInvestigate the extent to which nursing staff adhere to the policy protocol for management of non-surgical and surgical wounds in selected public health facilities in Ghana.MethodologyThis is an analytic case study among nursing staff (n = 140) in three government facilities in the Volta region of Ghana. Subjective and objective performance scores of staff on adherence proxies were compared using the Wilcoxon Signed-rank test, and univariate ordered logistic regression analysis used to predict staff likelihood of adherence to policy protocols on non-surgical and surgical wound management.FindingsOverall, staff self-rated themselves higher on subjective performance proxies relative to their objective scores (p<0.05). Staff with more years of work experience did not translate into a higher likelihood of adhering to standard protocol on wound management (Coef. = -0.49, CI = -0.93–0.05, p = 0.036). Being a senior nursing officer relative to lower nursing ranks increased staff likelihood of complying particularly with standard policy protocol for management of non-surgical wounds (Coef. 5.27, CI = 0.59 9.95, p = 0.027).ConclusionThere is the need for accelerated in-service training for staff on standard protocols for wound management coupled with supportive supervisions. Staff adherence to standard quality care protocols should be a pre-requisite for licensing of health facilities by regulatory bodies like Health Facilities Regulatory Agency and National Health Insurance Authority.

Healthcare-associated infections and compliance of hand hygiene among healthcare workers in a tertiary health facility, southwest Nigeria.

Healthcare-associated infections (HAIs) are threats in healthcare settings contributing to increased morbidity, mortality and antimicrobial resistance worldwide. Hand hygiene (HH) is the simplest and most important single intervention to reduce HAIs. This study sought to determine rates of HAIs as well as compliance of HH among healthcare workers (HCWs) in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). A cross-sectional study was conducted among 227 HCWs (59 doctors, 129 nurses and 39 ward attendants) selected by multistage sampling across 10 hospital wards. Electronic interviewer-administered questionnaire, HH compliance checklist and point prevalence of HAI were done using World Health Organization and Centers for Disease Control and Prevention toolkits, respectively. Only 20.33% (n = 12) of doctors, 3.88% (n = 5) of nurses and 2.56% (n = 1) of ward attendants had good knowledge of HH (χ2 = 22.22, P value = 0.01). Among doctors, 11.86% (n = 7), 6.98% (n = 9) of nurses and 2.56% (n = 1) of ward attendants had positive perception towards HH (χ2 = 7.87, P value = 0.25). Of the 174 opportunities for HH observed, compliance rates were 42.37%, 55.81% and 68.97% among doctors, nurses and ward attendants, respectively. Point prevalence of HAI was 16.38%. Good knowledge and positive perception about HH were uncommon among doctors, nurses and ward attendants. However, ward attendants had the highest compliance to HH. There was a high prevalence of HAIs in this institution.

Prevalence of Healthcare-Associated Infections in Pediatric Wards of Nemazee Teaching Hospital in Shiraz: A Comparison with the Whole Hospital

Background: The risk of healthcare-associated infections (HAIs) in the developing countries can be up to 20 times greater than the developed countries. Objectives: As the prevalence of HAIs varies even in different wards of a hospital, this study aimed to estimate the prevalence of HAIs in pediatric wards and to compare it with the whole hospital. Methods: This cross-sectional study was conducted in Nemazee Teaching Hospital in Shiraz. We used registered data that was reported monthly during a one-year period (March 20, 2016 to March 20, 2017). Statistical analysis was performed using SPSS software. Results: The average prevalence of HAIs in pediatric wards was 7.77%, while it was 11.38% for the whole hospital. The most prevalent HAIs in the whole hospital and in pediatric wards were urinary tract and blood stream infections, respectively. The mean rate of HAIs was significantly different between various pediatric wards (F = 29.50, P = 0.0001) and all wards of the hospital (F = 27.16, P = 0.0001) (P < 0.05). Investigation of the prevalence of HAIs in the critical, medical, and surgical wards showed the highest prevalence in the critical care ward (13.22% in pediatric wards vs. 17.45% in the whole hospital). Acinetobacter was the most common microorganism causing HAIs in the whole hospital. Conclusions: Considering the prevalence of urinary tract infections in the whole hospital and blood stream infections in pediatric wards, preventive strategies to reduce the infections should be adopted. The high prevalence of HAIs in critical care wards even in pediatric wards compared to medical and surgical wards indicates the importance of interventions in such wards, especially for children with a weak immune system.

Prevalence and antimicrobial susceptibility profile of microorganisms in a university hospital from Vitória (ES), Brazil

ABSTRACT INTRODUCTION: Healthcare associated infections (HAIs) occur during the hospital stay as a result of underlying morbidity, invasive procedures, acute pathology or medical treatment. They lead prolonged stay and, consequently, to an increase in financial charges. The main tool to control these infections is the use of antimicrobials. However, the increase in resistance and the low frequency of discovery of new drugs justify the research that evaluates the resistance profile of microorganisms to antimicrobials. OBJECTIVE: To evaluate the prevalence and antimicrobial susceptibility profile of HAIs at a philanthropic reference hospital in Espirito Santo, Brazil. METHODS: Observational, retrospective and cross-sectional study, between July 2014 and June 2016. Data on blood, urine and corporal secretions culture were collected from the data base of the Hospital Infection Control Commission. RESULTS: There was a high prevalence of HAIs in patients older than 60 years. Two hundred and forty three (47.55%) patients were female. The four most prevalent bacteria were: Acinetobacter spp., Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Polymyxin was the drug which presented the best antimicrobial effects. CONCLUSION: Polymyxin was active in vitro against all isolates of Acinetobacter spp. Regarding K. pneumoniae, both polymyxin and amikacin showed a significant effectiveness. Regarding Pseudomonas aeruginosa, polymyxin was effective in all samples. Regarding S. aureus, teicoplanin, daptomycin and vancomycin were effective in all samples. Polymyxin showed a good overall in vitro activity.

Risk factors for healthcare-associated infection in light of two years of experience with the ECDC point prevalence survey of healthcare-associated infection and antimicrobial use in Poland

Healthcare-associated infection (HAI) and antimicrobial resistance are two of the most important threats in contemporary medicine. The aim of this study was to evaluate independent risk factors associated with higher prevalence of HAI in a population of patients hospitalized in acute care hospitals in Poland. This study was conducted in accordance with the protocol of the European Centre for Disease Prevention and Control (ECDC) point prevalence survey of HAI and antimicrobial use. Data for 16,598 patients were collected from 50 hospitals. Independent risk factors assessed included: hospital size and type; consumption of alcohol hand rub; isolation capacity; number of beds per full-time-equivalent (FTE) infection control doctor/nurse; sex; age; hospitalization specialty; exposure to invasive procedures; and McCabe score. The highest prevalence of HAI was observed in large and teaching hospitals (6.7% and 7.4%, respectively), in children aged less than one (13.3%) and among males (7.2%). With regard to invasive procedures, the strongest association was observed for central venous catheterization (30.2%), intubation (41.6%) and urinary catheterization (17.5%). The highest prevalence of HAI was observed among patients in intensive care units (adult 39.8%, paediatric 30.8%). The lowest prevalence of HAI was observed in hospitals with one FTE infection control nurse per <200 beds (4.1%). A high prevalence of HAI combined with high exposure to risk factors among patients in paediatric and adult ICUs should result in the introduction of an HAI prevention programme across Poland.

Integrating intensive care unit (ICU) surveillance into an ICU clinical care electronic system

The intensive care unit (ICU) is the specialty with the highest prevalence of healthcare-associated infection (HCAI) in European hospitals and therefore a priority for surveillance of HCAI. Whereas surveillance is an essential part of an effective infection prevention and control (IPC) programme, all too often it consumes too much clinician and IPC team time, limiting the time available for quality improvement. The case for electronic surveillance is made in the literature from several countries on this basis. These studies indicate that electronic surveillance can improve validity, reduce time spent on surveillance, and provide opportunities for improvement in clinical decision-making and IPC action arising from surveillance. The Scottish ICU HAI surveillance system was established as part of an integrated audit and clinical care system. Investment in this technology infrastructure reduced the burden of data collection and has resulted in a focus on driving improvement in all Scottish ICUs. The experience in Scotland indicates that several critical components are necessary to optimize ICU HCAI surveillance, including: nationally agreed definitions and methods; national investment in information technology infrastructure to make it easier to follow clinical care pathways; leadership of surveillance by intensivists; piloting and validation to ensure confidence in the system; and strategic integration of national and local programmes. These elements have helped improve surveillance data locally, nationally, and at a European level, allowing clinical attention to be focused on the data rather than on the process of data collection.

The Prevalence of Health Care–Associated Infection in Older People in Acute Care Hospitals

To determine the prevalence of health care-associated infection (HAI) in older people in acute care hospitals, detailing the specific types of HAI and specialties in which these are most prevalent. Secondary analysis of the Scottish National Healthcare Associated Infection Prevalence Survey data set. All inpatients in acute care (n = 11,090) in all acute care hospitals in Scotland (n = 45). The study found a linear relationship between prevalence of HAI and increasing age (P<.0001) in hospital inpatients in Scotland. Urinary tract infections and gastrointestinal infections represented the largest burden of HAI in the 75-84- and over-85-year age groups, and surgical-site infections represented the largest burden in inpatients under 75 years of age. The prevalence of urinary catheterization was higher in each of the over-65 age groups (P<.0001). Importantly, this study reveals that a high prevalence of HAI in inpatients over the age of 65 years is found across a range of specialties within acute hospital care. An increased prevalence of HAI was observed in medical, orthopedic, and surgical specialties. HAI is an important outcome indicator of acute inpatient hospital care, and our analysis demonstrates that HAI prevalence increases linearly with increasing age (P<.0001). Focusing interventions on preventing urinary tract infection and gastrointestinal infections would have the biggest public health benefit. To ensure patient safety, the importance of age as a risk factor for HAI cannot be overemphasized to those working in all areas of acute care.

Evidence-Based Infection Control Planning Based on National Healthcare-Associated Infection Prevalence Data

This study identifies factors associated with a high prevalence of healthcare-associated infection (HAI) in the Scottish inpatient population, on the basis of the Scotland National HAI Prevalence Survey data set. The multivariate models developed can be used to predict HAI prevalence in specific patient groups to help with planning and policy in infection control.

Four Country Healthcare Associated Infection Prevalence Survey 2006: risk factor analysis

Point prevalence surveys are useful in detecting changes in the pattern of healthcare-associated infection (HCAI). In 2004 the Hospital Infection Society was asked to conduct a third national prevalence survey, which included England, Wales, Northern Ireland and the Republic of Ireland. A similar but not identical survey was carried out in Scotland. Data were collected on standardised forms using Centres for Disease Control and Prevention definitions. This report considers associations with a wide range of risk factors for all HCAI and for four main categories. The overall prevalence rate of HCAI was 7.6% and increased significantly with age. All risk factors considered were associated with highly significantly increased risk of HCAI, except recent peripheral IV catheter and other bladder instrumentation use. Primary bloodstream infection (PBSI) was associated with antibiotic, central intravenous catheter and parenteral nutrition use. Pneumonia was associated with antibiotic, central catheter, parenteral nutrition use, mechanical ventilation and current peripheral catheter use. Surgical site infection was associated with recent surgery, antibiotic and central catheter use, mechanical ventilation and parenteral nutrition. Urinary instrumentation and antibiotic use were associated with urinary tract infection. Patients under a critical care medicine consultant had the highest prevalence of HCAI (23.2%). This report highlights those areas requiring attention to prevent HCAI, i.e. device-related infections such as PBSI (e.g. central catheters) and pneumonia (e.g. mechanical ventilation) and should influence protocols for future prevalence surveys of HCAI, e.g. the recording of risk factors at the time of assessment only is sufficient.

Results from the Scottish National HAI Prevalence Survey

A national point prevalence survey was undertaken over the period of one calendar year in Scotland from October 2005 to October 2006. The prevalence of healthcare-associated infection (HAI) was 9.5% in acute hospitals and 7.3% in non-acute hospitals. The highest prevalence of HAI in acute hospital inpatients was found in the following specialties: care of the elderly (11.9%), surgery (11.2%), medicine (9.6%) and orthopaedics (9.2%). The lowest prevalence was found in obstetrics (0.9%). The most common types of HAI in acute hospital inpatients were: urinary tract infections (17.9% of all HAI), surgical site infections (15.9%) and gastrointestinal infections (15.4%). In non-acute hospitals one in ten inpatients in two specialties (combined) - medicine (11.4%) and care of the elderly (7.8%) - was found to have HAI, and one in 20 inpatients in psychiatry (5.0%) had HAI. In non-acute hospital patients, urinary tract infections were frequent (28.1% of all HAI) and similarly skin and soft tissue infection (26.8% of all HAI). When combined, these two HAI types affected 4% of all the inpatients in non-acute hospitals. This is the first survey of its kind in Scotland and describes the burden of HAI at a national level.