Prevalence Of Hospital-acquired Infections Research Articles

Molecular characterization of Staphylococcus aureus isolated from hospital-acquired infections in Ilam, Iran.

This research study was undertaken to investigate antimicrobial resistance patterns and the prevalence of hospital-acquired infections (HAIs). The study focuses on common microorganisms responsible for HAIs and explores emerging challenges posed by antimicrobial drug-resistant isolates. A comprehensive analysis of 123 patients with HAIs, hospitalized in surgical department and intensive care unit (ICU) at Imam Khomeini Hospital, Ilam, Iran, was conducted over a six-month period. Pathogenic bacterial isolates, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Staphylococcus aureus (VRSA), were isolated and subjected to antibiotic susceptibility testing. The study findings revealed a significant prevalence of multidrug-resistant (MDR) isolates, of which 73.3% were MRSA. Notably, 6.7% of S. aureus isolates exhibited resistance to vancomycin, indicating the emergence of VRSA. Respiratory infections were identified as the most prevalent HAI, constituting 34.67% of cases, often arising from extended ICU stays and invasive surgical procedures. Furthermore, patients aged 60 and above, particularly those associated with MDR, exhibited higher vulnerability to HAI. This research sheds light on the intricate interplay between drug resistance and HAI, highlighting the imperative role of rational antibiotic use and infection control in addressing this critical healthcare challenge.

The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: a systematic review and meta-analysis

Hospital-acquired infections (HAI) are a leading cause of morbidity and mortality globally. These infections are diverse, but the majority are lower respiratory tract infection (LRTI), surgical site infection (SSI), bloodstream infection (BSI), and urinary tract infection (UTI). For most sub-Saharan African countries, studies revealing the burden and impact of HAI are scarce, and few systematic reviews and meta-analysis have been attempted. We sought to fill this gap by reporting recent trends in HAI in sub-Saharan Africa (SSA) with attention to key patient populations, geographic variation, and associated mortality. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search of six electronic databases (Web of Science, Pubmed, APA PsycInfo, CINAHL, Embase, and the Cochrane Library) to identify studies assessing the prevalence of HAI in SSA countries. Studies published between 01 January 2014 and 31 December 2023 were included. We applied no language or publication restrictions. Record screening and data extractions were independently conducted by teams of two or more reviewers. Using the R software (version 4.3.1) meta and metafor packages, we calculated the pooled prevalence estimates from random-effect meta-analysis, and further explored sources of heterogeneity through subgroup analyses and meta-regression. This study is registered with PROSPERO, CRD42023433271. Forty-one relevant studies were identified for analysis, consisting of 15 from West Africa (n=2107), 12 from Southern Africa (n=2963), 11 from East Africa (n=2142), and 3 from Central Africa (n=124). A total of 59.4% of the patient population were associated with paediatric admissions. The pooled prevalence of HAI was estimated at 12.9% (95% CI: 8.9-17.4; n=7336; number of included estimates [k]=41, p<0.001). By subregions, the pooled current prevalence of HAI in the West Africa, Southern Africa, East Africa and Central Africa were estimated at 15.5% (95% CI: 8.3-24.4; n=2107; k=15), 6.5% (95% CI: 3.3-10.7; n=2963; k=12), 19.7% (95% CI: 10.8-30.5; n=2142; k=11) and 10.3% (95% CI: 1.1-27.0; n=124; k=3) of the patient populations respectively. We estimated mortality resulting from HAI in SSA at 22.2% (95% CI: 14.2-31.4; n=1118; k=9). Our estimates reveal a high burden of HAI in SSA with significant heterogeneity between regions. Variations in HAI distribution highlight the need for infection prevention and surveillance strategies specifically tailored to enhance prevention and management with special focus on West and East Africa, as part of the broader global control effort. No funding was received for this study.

Prevalence of antimicrobial use and healthcare-associated infections in the UAE: Results from the first nationwide point-prevalence survey

ObjectivesThe WHO’s Global Antimicrobial Resistance Surveillance System (GLASS) 2017–2018 reported a significant increase in antimicrobial resistance among nosocomial pathogens. This was the first national point of prevalence survey in United Arab Emirates. MethodsA one-day multicenter cross-sectional survey using a unified web-based platform was conducted in forty-four hospitals across the country from 3 to 23 November 2019 to estimate the prevalence of antimicrobial use and healthcare-associated infections among both governmental and private sectors. ResultsAll in all, 3657 inpatients in the 44 participating hospitals were surveyed; 51.4 % were on at least one antibiotic at that time. Pneumonia was the most frequently reported hospital-acquired (47 %), followed by intra-abdominal sepsis (10.9 %), upper respiratory tract infections (10.6 %), and urinary tract infections (9.9 %). Ceftriaxone and piperacillin/Tazobactam were the most frequently used antibiotics (13.5 %, 9.6 %). Compliance with guidelines was reported in 70.3 % of prescriptions. Only 11.4 % of patients received a single dose of surgical prophylaxis. ConclusionOur results on antimicrobial use and hospital-acquired infection prevalence are comparable to other regional and international findings. Local guidelines are needed to reduce the excessive use of Watch and Reserve antibiotics, reduce prolonged antibiotic use after surgery, and decrease hospital-acquired infections.

Assessment of nursing knowledge and practice toward prevention of acquired infections in the emergency department of King Faisal Medical Complex in Taif.

Hospital-acquired infections constitute a significant source of morbidity and mortality for both patients and healthcare professionals. Nursing professionals constitute an integral component of any quality-related program in a hospital, given their oversight and provision of nearly all healthcare services. Nurses' knowledge and attitudes play a significant role in healthcare delivery. Within Saudi Arabia, the prevalence of hospital-acquired infections in hospital settings has prompted a growing emphasis on evaluating nursing knowledge and adherence to practice standards aimed at hospital-acquired infection prevention. This single-center cross-sectional study was conducted at the emergency department of King Faisal Medical Complex, Taif, between October and December 2022, involving 168 nurses. The study utilized a pre-validated structured online questionnaire comprising three sections: demographics, knowledge assessment, and practice evaluation. Knowledge and practice levels were categorized as good, moderate, and poor using quartiles. The study encompassed 168 nurses employed in the emergency department of the hospital, revealing their proficiency in standard practices for preventing hospital-acquired infections. Notably, 63.8% of participants demonstrated a commendable "Good" level of knowledge, while 10.6% exhibited a "Moderate" level and 25.5% manifested a "Poor" level in terms of knowledge. Similarly, concerning practice levels, 56.4% showcased a commendable "Good" practice level, 22.3% maintained a "Moderate" practice level, and 21.3% presented a "Poor" practice level. Chi-square analysis unveiled a significant association between age and knowledge levels (p = 0.000). In addition, age (p = 0.000) and years of clinical experience (p = 0.000) were significantly linked to nurses' practice levels The nurses aged 40-50 years (82%) and those with 10-15 years of clinical experience (83.3%) showed good levels of knowledge and practice, respectively. Overall, most of the nurses demonstrated effective knowledge and compliance with infection prevention practices. Sociodemographic factors such as age and clinical experience exert a notable impact on nurses' knowledge and practices regarding hospital-acquired infections.

Evaluating Healthcare-Associated Infections in Public Hospitals: A Cross-Sectional Study.

Hospital-acquired infections (HAIs) pose a significant danger to global public health, mainly because their numbers are growing exponentially each year. Additionally, the rise of bacterial strains resistant to current treatment options further exacerbates this threat. This study aimed to examine the occurrences of HAIs identified in public hospitals at the county level. We conducted a cross-sectional study utilizing data provided to the Mures Public Health Directorate from all the public hospitals within the studied county. We examined HAIs reported during the period spanning from 2017 to 2021, which amounted to a total of 4603 cases. The medical departments reported the highest prevalence of HAIs at 48.25%. The most common infections included enterocolitis with Clostridioides difficile (32.61%), COVID-19 (19.83%), bronchopneumonia (16.90%), sepsis, surgical wound infections, and urinary tract infections. The five most frequently identified pathogens were Clostridioides difficile (32.61%), SARS-CoV-2 (19.83%), Acinetobacter baumannii (11.82%), Klebsiella pneumoniae (9.58%), and Pseudomonas aeruginosa (7.95%). Acinetobacter baumannii was the predominant agent causing bronchopneumonia, while Klebsiella pneumoniae was the leading cause of sepsis cases. Escherichia coli was the primary agent behind the urinary tract infections, and Staphylococcus aureus MRSA was identified as the main etiology for wound infections and central catheter infections. Throughout the study period, there was a significant rise in Clostridioides difficile and Gram-negative bacteria prevalence rates. This study identified increased Clostridioides difficile in HAI cases during COVID-19, highlighting the need for careful antibiotic use and emphasizing the growing challenge of multi-resistant strains in post-pandemic state hospitals.

A comprehensive review on prevention and management of hospital-acquired infections: Current strategies and best practices

Hospital-acquired infections (HAIs) are a significant global public health issue, impacting millions of patients annually. Another name for HAIs is nosocomial infections (NI).These infections arise from illnesses that patients contract while they are in the hospital and can have major negative effects on their health, such as increased morbidity, prolonged hospital stays, or even death. The rise of antibiotic-resistant pathogens has only added to the complexity and severity of HAIs. Healthcare facilities need to take a thorough, evidence-based strategy to HAI prevention and control in order to solve this issue. This entails carrying out evidence-based procedures, like cleaning the environment, using the proper antimicrobial agents, and practicing hand hygiene, in addition to continuously assessing and evaluating their HAI prevention program. Improving patient outcomes, cutting healthcare costs, and preserving public confidence in the healthcare system all depend on lowering the prevalence of HAIs. Improvements in hospital epidemiological surveillance, infection control practices, and the implementation of HAI prevention guidelines should lead to a decrease in the frequency of morbidity and mortality. Nonetheless, HAIs continue to be a major worry for high-risk populations.

Incidence of Drug-Resistant Hospital-Associated Gram-Negative Bacterial Infections, the Accompanying Risk Factors, and Clinical Outcomes with Treatment.

Extensive drug resistance to bacterial infections in hospitalised patients is accompanied by high morbidity and mortality rates due to limited treatment options. This study investigated the clinical outcomes of single and combined antibiotic therapies in extensive (XDR), multidrug-resistant (MDR) and susceptible strains (SS) of hospital-acquired infections (HAIs). Cases of hospital-associated drug-resistant infections (HADRIs) and a few susceptible strains from hospital wards were selected for this study. Bacteria identifications (IDs) and antimicrobial susceptibility tests (ASTs) were performed with a Vitek 2 Compact Automated System. Patients' treatment types and clinical outcomes were classified as alive improved (AI), alive not improved (ANI), or died. The length of hospital stay (LOHS) was acquired from hospital records. The HAI pathogens were Acinetobacter baumannii (28%), Escherichia coli (26%), Klebsiella pneumoniae (22%), Klebsiella (2%) species, Pseudomonas aeruginosa (12%), Proteus mirabilis (4%), and other Enterobacteriaceae. They were MDR (40.59%), XDR (24.75%), carbapenem-resistant Enterobacteriaceae (CRE, 21.78%) and susceptible (12%) strains. The treatments were either monotherapy or combined therapy with different outcomes. Monotherapy produced positive significant outcomes with E. coli infections, while for P. aeruginosa, there were no differences between the number of infections treated with either mono/combined therapies (50% each). Nonetheless, combined therapy had significant effects (p < 0.05) as a treatment for A. baumannii and K. pneumoniae infections. Clinical outcomes and LOHS varied with infecting bacteria. The prevalence of XDR and MDR HAIs was found to be significantly high, with no association with treatment type, LOHS, or outcome.

Point-Prevalence Survey for the Hospital-Acquired Infections and Infection Prevention and Control Status of Different Wards of Rajshahi Medical College Hospital

Introduction: Healthcare-associated infections represent significant obstacles to providing high-quality healthcare and have been directly linked to ineffective infection control procedures. There is currently a shortage of trustworthy data in Bangladesh describing the epidemiology of hospital-acquired infections (HAIs), which is necessary for the development of effective infection prevention and control measures. This study's goal was to assess the frequency, nature, and risk factors of HAIs in acute care hospitals in Northern Bangladesh.&#x0D; Methods: This was a pilot point prevalent survey conducted in the medicine, surgery, gynecology, and obstetrics departments of Rajshahi Medical College Hospital between August 2022 to September 2022. Data were collected by two questionnaires for disease profile and hospital-acquired infection. In addition, a checklist was used for the observation of the infection prevention and control (IPC) status of different wards.&#x0D; Result: Approximately 900 patients' data were collected during this time period. The overall prevalence of HAI was found to be 3.7%. The prevalence of HAI, especially surgical site Infection (SSI), in the obstetrics ward, was 4.2%, and the Medicine ward was 3.9%, respectively. The prevalence of hospital-acquired infection in the surgery ward is 7.7%. Approximately 41.7% of patients developed SSI on the 6th post operative day (POD). The Infection prevention and control status of different wards was similar, which was not satisfactory.&#x0D; Conclusion: This surveillance might help concerned authorities and policymakers by making some crucial steps to monitor and reduce hospital-acquired infections and HAIs in hospitals.&#x0D; TAJ 2022; 36: No-1: 9-15

Risk factors for lower respiratory tract infections in a psychiatric hospital: a retrospective study.

Locked pediatric inpatient psychiatric units are vulnerable to the emergence and spread of infections, and nosocomial infection, especially respiratory tract infection is potentially a major problem. This study aimed to explore the risk factors for lower respiratory tract infection (LRI), in particular, pneumonia. We conducted a retrospective study comprising 4643 patients with schizophrenia (SZ) and 1826 patients with major depressive disorder (MDD), and the chi-square test was performed to analyze the categorical variables. The risk ratio for LRI, including pneumonia, in intensive care unit (ICU) was higher than in the general ward, and electroconvulsive therapy (ECT) increased the patients' susceptibility to LRI and pneumonia. Our data have revealed that patients treated with restraint or clozapine showed a higher prevalence of LRI and pneumonia, and the results indicated that the increased risk of LRI, not pneumonia, was dose-dependently observed in patients with clozapine treatment. Our study shows that ICU and ECT treatment were risk factors for LRI and pneumonia in patients with SZ or MDD, and patients with SZ has a prevalence of hospital-acquired infection because of restraint and clozapine treatments.

Global prevalence of nosocomial infection: A systematic review and meta-analysis.

Hospital-acquired infections (HAIs) are significant problems as public health issues which need attention. Such infections are significant problems for society and healthcare organizations. This study aimed to carry out a systematic review and a meta-analysis to analyze the prevalence of HAIs globally. We conducted a comprehensive search of electronic databases including EMBASE, Scopus, PubMed and Web of Science between 2000 and June 2021. We found 7031 articles. After removing the duplicates, 5430 studies were screened based on the titles/ abstracts. Then, we systematically evaluated the full texts of the 1909 remaining studies and selected 400 records with 29,159,630 participants for meta-analysis. Random-effects model was used for the analysis, and heterogeneity analysis and publication bias test were conducted. The rate of universal HAIs was 0.14 percent. The rate of HAIs is increasing by 0.06 percent annually. The highest rate of HAIs was in the AFR, while the lowest prevalence were in AMR and WPR. Besides, AFR prevalence in central Africa is higher than in other parts of the world by 0.27 (95% CI, 0.22-0.34). Besides, E. coli infected patients more than other micro-organisms such as Coagulase-negative staphylococci, Staphylococcus spp. and Pseudomonas aeruginosa. In hospital wards, Transplant, and Neonatal wards and ICU had the highest rates. The prevalence of HAIs was higher in men than in women. We identified several essential details about the rate of HAIs in various parts of the world. The HAIs rate and the most common micro-organism were different in various contexts. However, several essential gaps were also identified. The study findings can help hospital managers and health policy makers identify the reason for HAIs and apply effective control programs to implement different plans to reduce the HAIs rate and the financial costs of such infections and save resources.

Isolation of Methicillin-Resistant Staphylococcus aureus from Wound Samples during the COVID-19 Pandemic: A Retrospective Study

Introduction: On March 11th, 2020, the World Health Organisation (WHO) declared the outbreak of the novel coronavirus disease caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARSCoV-2) virus as a pandemic. This recently discovered β-coronavirus spread instantaneously across mainland China due to human-tohuman transmission and crossed international borders aided by intercontinental travel. In most nations, the logarithmic growth of the cases very quickly overwhelmed the healthcare system which led to the overcrowding of the hospitals and led to a sudden surge in Hospital-Acquired Infections (HAIs). Implementation of contact precautions was implemented to control cross-infection. Aim: To determine the effect of Coronavirus Disease-2019 (COVID-19) on the prevalence of HAIs with special emphasis on Staphylococcus aureus (S. aureus). Materials and Methods: This three-year retrospective study (September 2018-August 2021) was undertaken at an apex tertiary care institute in Northern India. Wound swabs were collected and processed in the laboratory for the presence of aerobic bacterial isolates. S. aureus was identified using conventional methods and antimicrobial sensitivity was performed by the Kirby-Bauer disc diffusion method. Data was entered in Microsoft Excel and later analysed in International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A steady increase in the isolation of MethicillinResistant Staphylococcus aureus (MRSA) was noted during the study period (60.5% in 2018 to 78.1% in 2021). A statistically significant increase was noted in the detection of MRSA after the onset of the COVID-19 pandemic (p=0.018) despite the reduced number of surgeries conducted in the institution and rigorous execution of contact precautions. Conclusion: There was an increase in the rate of MRSA isolation during the study period. The increase was significantly affected by the onset of COVID-19. To contain the spread of MRSA, novel methods including preoperative screening of patients undergoing elective surgeries and periodic screening of hospital staff need to be implemented along with standard infection control precautions at all times.

The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay.

Background and objectives: The prognoses of patients experiencing a prolonged stay in the intensive care unit (ICU) are often significantly altered by hospital-acquired infections (HAIs), the early detection of which might be cumbersome. The aim of this study was to investigate the roles of the neutrophil-to-lymphocyte (NLR), derived-NRL (d-NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-C-reactive protein (LCR) ratios in predicting the progression to septic shock and death. Materials and Methods: A retrospective analysis of a consecutive series of ninety COVID-19 patients with prolonged hospitalization (exceeding 15 days) admitted to the ICU was conducted. The prevalence of culture-proven HAIs throughout their hospital stays was documented. NLR, dNLR, PLR, and LCR were recorded on admission, day 7, and day 14 to assess their discriminative prowess for detecting further progression to septic shock or death. Results: The prevalence of HAIs was 76.6%, 50% of patients met the criteria for septic shock, and 50% died. The median time to the first positive culture was 13.5 days and 20.5 days for developing septic shock. Mechanical ventilation was a key contributing factor to HAI, septic shock, and mortality. On admission and day 7 NLR, dNLR, PLR, and LCR values had no prognostic relevance for events occurring late during hospitalization. However, day-14 NLR, dNLR, and PLR were independent predictors for progression to septic shock and mortality and have shown good discriminative capabilities. The AUCs for septic shock were 0.762, 0.764, and 0.716, while the values for predicting in-hospital death were 0.782, 0.778, and 0.758, respectively. Conclusions: NLR, dNLR, and PLR are quick, easy-to-use, cheap, effective biomarkers for the detection of a more severe disease course, of the late development of HAIs, and of the risk of death in critically ill patients requiring a prolonged ICU stay.

Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

Background: Although the current literature suggests the significant impact of the COVID-19 pandemic on nosocomial infections, evidence is still scarce in this regard. Objectives: The present study aimed to systematically review the current literature to estimate the prevalence of hospital-acquired infections (HAIs) and their determinants during the COVID-19 pandemic. Methods: A comprehensive search was conducted via electronic databases such as EMBASE, Google Scholar, Scopus, PubMed, and Web of Science from the onset of the COVID-19 pandemic until the end of June 2021. To estimate the pooled prevalence of nosocomial infections, the random effects model was used. Results: The prevalence of HAIs during the COVID-19 pandemic was estimated at 15% (95% CI: 9 - 24). COVID-19 infection accounted for the highest infection rate in patients with HAIs (63%; 95% CI: 43 - 75), followed by bloodstream infections (39%; 95% CI: 56 - 24). Among the common organisms that infected patients with HAIs, coronavirus had the highest rate (63%; 95% CI: 43 - 75), followed by Enterococci and Enterococcus, respectively. In addition, positive significant correlations were observed between the prevalence of nosocomial infections, age, and length of hospital stay (P &lt; 0.05). Conclusions: According to the results, nosocomial infections are an important consequence of the COVID-19 pandemic, particularly in the elderly and high-risk populations with prolonged hospital stay. Therefore, the early detection of infected individuals could be a key step toward improving the quality of response to the current pandemic.

Prevalence of Nosocomial Infections During the COVID-19 Pandemic: A Systematic Review and Meta-analysis

Context: Although the current literature suggests the significant impact of the COVID-19 pandemic on nosocomial infections, evidence is still scarce in this regard. Objectives: The present study aimed to systematically review the current literature to estimate the prevalence of hospital-acquired infections (HAIs) and their determinants during the COVID-19 pandemic. Methods: A comprehensive search was conducted via electronic databases such as EMBASE, Google Scholar, Scopus, PubMed, and Web of Science from the onset of the COVID-19 pandemic until the end of June 2021. To estimate the pooled prevalence of nosocomial infections, the random effects model was used. Results: The prevalence of HAIs during the COVID-19 pandemic was estimated at 15% (95% CI: 9 - 24). COVID-19 infection accounted for the highest infection rate in patients with HAIs (63%; 95% CI: 43 - 75), followed by bloodstream infections (39%; 95% CI: 56 - 24). Among the common organisms that infected patients with HAIs, coronavirus had the highest rate (63%; 95% CI: 43 - 75), followed by Enterococci and Enterococcus, respectively. In addition, positive significant correlations were observed between the prevalence of nosocomial infections, age, and length of hospital stay (P &lt; 0.05). Conclusions: According to the results, nosocomial infections are an important consequence of the COVID-19 pandemic, particularly in the elderly and high-risk populations with prolonged hospital stay. Therefore, the early detection of infected individuals could be a key step toward improving the quality of response to the current pandemic.

Hospital-acquired infection rates in patients receiving extracorporeal membrane oxygenation across Australia and New Zealand

Introduction: Extracorporeal membrane oxygenation (ECMO) is a highly invasive method of cardiac and/or pulmonary support for critically ill patients where less invasive therapies have failed. Hospital-acquired infection (HAI) is a frequent and serious complication of ECMO and is reported in up to 64% of patients. Limited data on HAI exists in these patients in Australia and New Zealand. We aim to determine HAI prevalence in patients receiving ECMO.

Point-Prevalence Survey for the Hospital-Acquired Infections in Intensive Care Units of Trauma Center in a Tertiary Care Hospital of Northern India.

Background The burden of hospital-acquired infections (HAIs) is all assumption based, and the true burden remains unknown in most countries, particularly in the developing countries where healthcare facilities are suboptimal and knowledge is limited. Methodology This cross-sectional study was conducted at the trauma center of a tertiary care institute from August to September 2019, to assess the burden of HAI and antibiotic resistance pattern of HAI. The total sample size in our study was 105. Our objective was to estimate the point prevalence of HAI and study the associated factors in a tertiary care hospital. Result In this study, the point prevalence of HAI was five to six times higher when compared with that of developed countries. Gram-negative organisms were the predominant bacteria; with Acinetobacter baumannii the most common among them. Conclusion Point-prevalence survey is an important objective of the antimicrobial stewardship program; it will be helpful in controlling antimicrobial resistance and this tool plays a significant role in hospital settings. Our study is quite pertinent to assess the point prevalence of HAI. It will help in knowing the current prevalence and pattern of the HAI. Therefore, as healthcare administrators, we can further decrease the HAI for better patient outcomes in the future.

Systematic review and meta-analysis of hospital acquired infections rate in a middle east country (1995-2020)

Background: Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh] OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis. Results: A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively. Conclusion: The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

Antimicrobial Resistance Patterns and Antibiotic Use during Hospital Conversion in the COVID-19 Pandemic.

Objective: To describe empirical antimicrobial prescription on admission in patients with severe COVID-19, the prevalence of Hospital-Acquired Infections, and the susceptibility patterns of the causing organisms. Methods: In this prospective cohort study in a tertiary care center in Mexico City, we included consecutive patients admitted with severe COVID-19 between March 20th and June 10th and evaluated empirical antimicrobial prescription and the occurrence of HAI. Results: 794 patients with severe COVID-19 were admitted during the study period. Empiric antibiotic treatment was started in 92% of patients (731/794); the most frequent regimes were amoxicillin-clavulanate plus atypical coverage in 341 (46.6%) and ceftriaxone plus atypical coverage in 213 (29.1%). We identified 110 HAI episodes in 74/656 patients (11.3%). Ventilator-associated pneumonia (VAP) was the most frequent HAI, in 56/110 (50.9%), followed by bloodstream infections (BSI), in 32/110 (29.1%). The most frequent cause of VAP were Enterobacteriaceae in 48/69 (69.6%), followed by non-fermenter gram-negative bacilli in 18/69 (26.1%). The most frequent cause of BSI was coagulase negative staphylococci, in 14/35 (40.0%), followed by Enterobacter complex in 7/35 (20%). Death occurred in 30/74 (40.5%) patients with one or more HAI episodes and in 193/584 (33.0%) patients without any HAI episode (p < 0.05). Conclusion: A high frequency of empiric antibiotic treatment in patients admitted with COVID-19 was seen. VAP and BSI were the most frequent hospital-acquired infections, due to Enterobacteriaceae and coagulase negative staphylococci, respectively.

Point-prevalence survey of hospital acquired infections in three acute care hospitals in Northern Nigeria

BackgroundEffective infection prevention and control strategies require reliable data describing the epidemiology of hospital acquired infections (HAIs), and this is currently lacking in Nigeria. The objective of this study was to evaluate the prevalence, types and risk factors associated with HAIs in acute care hospitals in Northern Nigeria.MethodsA pilot point-prevalence survey was conducted in three acute care hospitals in Northern Nigeria between April and May 2019 using a protocol developed by the European Centre for Disease Prevention and Control. Patients admitted into the wards at or before 8.00 am on the survey date were included. Patients’ medical records were reviewed by a clinical pharmacist with the support of the attending physician and nurse to identify HAIs.ResultsOf the 321 patients surveyed, 50 HAIs were identified among 46 patients translating into a point-prevalence of 14.3%. The most common HAIs were bloodstream infection (38.0%), surgical site infections (32.0%) and pneumonia (12.0%). Neonatal (53.0%), pediatric surgical (26.7%) and surgical (10.1%) specialties had the highest prevalence. Device associated infections represented 16% of all HAIs including bloodstream infections and pneumonia. Of all the HAIs, 15 (30.0%) were present at the time of admission while 75.5% originated from the current hospitals. Univariate analysis showed that newborn (less than 1 month old) (OR: 4.687 95% CI: 1.298–16.927), intubation (OR: 3.966, 95% CI: 1.698–9.261), and neonatal (OR: 41.538 95% CI: 4.980–346.5) and pediatric surgical (OR: 13.091 95% CI: 1.532–111.874) specialties were significantly associated with HAI.ConclusionThe prevalence of HAI was relatively high compared to other developing countries and was significantly associated with neonatal and pediatric surgical specialties. Hospital infection control strategies should be strengthened to reduce the burden of HAIs.

Effectiveness of commonly used high level disinfectants on bacteria responsible for hospital acquired infections in Sri Jayewardenepura General Hospital, Sri Lanka

Introduction: Hospital-acquired infections (HAIs) cause high morbidity and mortality in patients throughout the world. Nosocomial pathogens can be transmitted through contaminated instruments and surfaces. Disinfectants play a crucial role in preventing HAIs. This study focuses on two high level disinfectants designated ‘disinfectant 1’ which contains primarily peracetic acid and ‘disinfectant 2’ which contains primarily didecyldimethylammonium chloride. Objective: To determine the effectiveness of commonly used high level disinfectants on bacteria responsible for causing HAIs in Sri Jayewardenepura General Hospital, Sri Lanka (SJGH), on different surfaces. Method: Data of the Infection Prevention and Control (IPC) unit of SJGH was traced back to identify bacteria causing HAIs from 1st January to 31st July 2018. This experimental study was conducted for disinfectant 1 and 2 according to the quantitative carrier test (European Standard EN 14561:2006). Disinfectants were tested at three different concentrations on glass, stainless steel and rexine surfaces against the commonest three bacteria responsible for causing HAIs in SJGH. Results: Coliforms, Acinetobacter species and Staphylococcus aureus were the three most common bacteria responsible for causing HAIs in SGJH. Surgical site infections were the predominant type of HAI and Intensive Care Units (ICUs) were identified as having the highest prevalence of HAIs. Both high level disinfectants achieved a Microbicidal Effect (ME) value of 5 as per ‘clean disinfectants’ in manufacturer recommended dilutions and passed the test against Escherichia coli, Acinetobacter spp. and S. aureus under both clean and dirty condition on all three tested surfaces. However, bacterial colonies of all 3 test organisms were detected after both disinfectant 1 and 2 use . Effect of disinfectant 1 was poor in manufacturer recommended concentrations on glass, stainless steel and rexine surfaces. ME of disinfectant 2 was considerably higher when compared to disinfectant 1. Conclusion: Although the manufacturer stated test standard was achieved for both disinfectants, the presence of residual bacteria after high level disinfectant use on different surfaces is not acceptable.