Risk Factors For Healthcare-associated Infections Research Articles

Characterization of Potential Pathogenic Bacteria Isolated in High-Risk Infectious Services at the University Hospital Center of Suru-Léré in Benin

Healthcare-associated infections (HCAIs) remain a major public health concern. The aim of this study was to characterize potential pathogenic bacteria isolated in high-risk infectious services at the University Hospital Center of Suru-Léré in Benin. A cross-sectional, descriptive study was carried out on 215 samples with 8 air samples, 20 hand samples and 187 samples of medical-technical material. Genes for resistance to β-lactam antibiotics (blaTEM, blaSHV, blaCTX-M and blaOXA-1) were sought. The data were processed and analyzed using EPI Info version 3.5.4 software. A total of 10 bacterial species were identified. Of the 319 bacterial strains identified, Staphylococcus saprophyticus, Staphylococcus aureus and Enterococcus faecalis were predominant at 20.06%, 17.87% and 11.28% respectively. Antibiotic susceptibility showed that the majority of bacterial strains were multidrug-resistant. Of the 4 resistance genes sought, only the blaTEM and blaSHV genes were found. The poor microbiological quality observed in high-risk infectious services could be a risk factor for healthcare-associated infections. It is therefore useful to implement preventive measures in order to prevent or reduce the risk of healthcare-associated infections.

The risk factors analysis and establishment of an early warning model for healthcare-associated infections after pediatric cardiac surgery

The aim of this study was to identify the main risk factors for health-care-associated infections (HAIs) following cardiac surgery and to establish an effective early warning model for HAIs to enable intervention in an earlier stage.In total, 2227 patients, including 222 patients with postoperative diagnosis of HAIs and 2005 patients with no-HAIs, were continuously enrolled in Beijing Anzhen Hospital, Beijing, China. Propensity score matching was used and 222 matched pairs were created. The risk factors were analyzed with the methods of univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to test the accuracy of the HAIs early warning model.After propensity score matching, operation time, clamping time, intubation time, urinary catheter time, central venous catheter time, ≥3 blood transfusions, re-endotracheal intubation, length of hospital stay, and length of intensive care unit stay, still showed significant differences between the 2 groups. After logistic model analysis, the independent risk factors for HAIs were medium to high complexity, intubation time, urinary catheter time, and central venous catheter time. The ROC showed the area under curve was 0.985 (confidence interval: 0.975–0.996). When the probability was 0.529, the model had the highest prediction rate, the corresponding sensitivity was 0.946, and the specificity was 0.968.According to the results, the early warning model containing medium to high complexity, intubation time, urinary catheter time, and central venous catheter time enables more accurate predictions and can be used to guide early intervention after pediatric cardiac surgery.

The burden of healthcare-associated infections among pediatrics: a repeated point prevalence survey from Pakistan

ABSTRACT Background Healthcare-associated infections (HAIs) are considered a major threat to public health resulting in significant morbidity, mortality, and additional costs. The present study aimed to assess the current patterns and risk factors of HAIs among hospitalized children. Materials and methods Three repeated point prevalence surveys were conducted in the pediatric inpatients of four hospitals by using the methodology developed by the European Center for Disease Prevention and Control. All patients present in the ward at 8:00 AM on the survey day and not discharged from the hospital on the same day were included. A standardized data collection form containing information on the presence of HAIs and the associated risk factors was completed for the patients. Findings Out of 888 hospitalized patients, 116 (13.1%) had the symptoms of HAIs. Most common infections were bloodstream infections (BSIs) (32.8%), pneumonia (21.0%), ear, eyes, nose and throat infections (11.8%), and skin and soft tissue infections (SSTs) (19.0%). Factors significantly associated with infections were the length of hospital stay (p = 0.000), admission to the medicine ward (p = 0.034), and male gender (p = 0.010). BSIs were most common in children belonging to the age group of less than one month (78.9%), who were admitted to intensive care units (73.7%). SSTs including surgical site infections were more prevalent in surgery wards (78.3%). Conclusions A high rate of HAIs among pediatrics was found in Pakistan. Infection control and prevention strategies are needed with a major focus on interventions to prevent the spread of most prevalent HAIs.

Exploring rural patients' understanding of the types, risk factors and measures to prevent healthcare-associated infections in Australia.

In Australia, there are approximately 165,000 healthcare-associated infections (HAIs) per year. Improving patient knowledge on HAIs and actively involving them in infection prevention is essential. This study assessed patient knowledge on types of and risk factors for HAIs and their perceptions of HAI information provision and hospital infection control practices in rural New South Wales, Australia. Medical and surgical ward patients in three rural hospitals completed a questionnaire between February and March 2019. Open ended responses were grouped under categories, decided upon by two researchers, one of which is an infection prevention and control nurse. Descriptive analysis was completed. A total of 153 patients completed the survey. Most (n=126, 82%) participants were previously aware of HAIs, with common sources of education/information being family/friends (n=55, 36%), television (n=28, 18%), newspapers (n=27, 18%), and previous experience of a HAI (n=20, 13%). Satisfaction with infection control measures and hospital cleanliness was high. Over half (n=83, 54%) of participants thought they received too little information on HAIs, and only 35% (n=21) of those that had surgery reported receiving information. Participants suggested that more education for the general public (n=117, 76%) and patients (n=110, 72%) in both written form and verbally from hospital staff, and education outside of the hospital in various mediums, could help reduce the risk and rates of HAI. Awareness of HAIs amongst respondents was high, however, education appeared to be lacking. More can be done to inform patient, family and general public education programs in rural and regional Australian hospitals.

Appropriateness of Anti-MRSA Therapy in Hospitalized Patients With Suspected Community-Onset Infections

Background: Inappropriate use of MRSA-spectrum antibiotics is an important antimicrobial stewardship target. Contributors to inappropriate use include empiric treatment of patients who are determined to not be infected or who are infected but lack MRSA risk factors, and by excessive treatment duration when suspected MRSA infection is disproven. To characterize opportunities for improvement, we conducted a medical use evaluation (MUE) in 27 VA medical centers. The primary objectives were to assess the following proportions: (1) courses of unjustified empiric vancomycin therapy (patients in whom all antibacterials were halted within 2 days or without a principal or secondary discharge infection diagnosis); (2) courses of unjustified continuation of anti-MRSA therapy beyond day 4 (no MRSA risk factors or proven MRSA infection); and (3) excess anti-MRSA days of therapy (DOT), that is, DOT in unjustified empiric courses plus DOT after day 4 in unjustified continued courses. Methods: Clinical pharmacists performed retrospective, structured, manual record reviews of patients started on intravenous vancomycin on day 1 or 2 of hospitalization from June 2017 to May 2018. Exclusion criteria included surgical prophylaxis, recent MRSA infection, β-lactam allergy, renal insufficiency, severe immunosuppression, or infection that warranted anti-MRSA therapy other than vancomycin. Results: Of 2,493 evaluated patients, 1,320 met the inclusion criteria. Among them, 44% of courses were initiated in the emergency department, 37% of patients had ≥1 risk factor for healthcare-associated infections, and 50% of patients had ≥2 SIRS criteria or required vasopressor support. The most common admission diagnoses were skin and soft-tissue infection (SSTI, 40%; 68% nonpurulent) and pneumonia (27%; 46% without healthcare risk factors). Clinical cultures recovered MRSA from 8% of patients. Empiric therapy was not justified in 342 patients (26%; 57% were clinically stable). Continued therapy was unjustified in 46% of the 320 patients who received >4 days of anti-MRSA therapy. Of all days of anti-MRSA therapy, 23% were unjustified; 65% of these were due to unjustified empiric therapy. Site-specific variations in unjustified empiric therapy better correlated with the proportion of unjustified DOT than did unjustified continuation of therapy (Pearson correlation coefficients [PCC], 0.75 and 0.54, respectively) (Fig. 1). Facility-specific proportions of unjustified DOT modestly correlated with anti-MRSA DOT (PCC, 0.45; n = 27) (Fig. 2) but not the anti-MRSA standardized antimicrobial administration ratio (PCC, 0.15; n = 21). Conclusions: In this multicenter MUE, 26% of all days of anti-MRSA therapy lacked justification; this rate correlated with total facility-specific anti-MRSA DOT. Unnecessary empiric therapy, largely in the ED and for nonpurulent SSTIs and pneumonia without risk factors, was the principal contributor to unjustified DOT.Funding: NoneDisclosures: None

Using Machine Learning to Detect Hospital-Specific Risk Factors of Surgical Site Infections

Background: Identification of healthcare-associated infections (HAIs) is just a first step in the surveillance of HAIs. The other part is the analysis and interpretation of collected data, which should help to set up effective preventive measures targeted where they are needed the most. General risk factors of HAIs are mostly well known, but how do the environment and processes of each hospital affect risks of HAI? Can advanced methods of data analytics reveal hidden hospital-specific risk factors of surgical site infections (SSIs)? Methods: We analyzed data from electronic health records stored in the clinical information system of Hospital Jihlava, Czech Republic, with 650 beds and 7,500 surgeries performed annually. For each inpatient stay with a surgical procedure, we automatically observed almost 1,500 features that could lead to a higher incidence of SSIs. These features consist of patient demographic data, information from structured data (eg, patient diagnoses, departments, specific rooms, operating theaters, surgeons and other hospital staff participating in the surgery), and information extracted from clinical notes using natural language processing (eg, procedures, invasive devices, and comorbidities). We used a model based on survival analysis to reveal the risk factors that can increase the probability of SSI during the inpatient stay or outpatient care after discharge. Results: We automatically evaluated risk factors weekly for 4 months (July 2019–October 2019). We detected 16 distinct significant risk factors during this period—between 2 and 6 active risk factors each week. For example, patients visiting a specific department were up to 5 times more likely to develop an HAI than the rest of the patients (P < .001). Some of the risk factors revealed were significant only within a short time, and some of them occurred perpetually. When a feature became significant, it was considered an early warning of a problem that should be addressed by the infection prevention and control team. Trends in risk factors coefficients can also help in assessing the performance of the launched preventive measures. Conclusions: Advanced data analytics can effectively uncover hospital-specific risk factors affecting surgical site infections. Such systems can automatically deliver results that can be further explored and used as a basis for targeted preventive measures.Funding: Datlowe provided support for this study.Disclosures: Jakub Kozák reports salary from and ownership of Datlowe.

Epidemiology and risk factors for healthcare-associated infections caused by Pseudomonas aeruginosa

Pseudomonas aeruginosa (PA) is a globally recognized cause of healthcare-associated infections (HAIs). The aim of our cross-sectional study, conducted in a Serbian tertiary care hospital, was to investigate clinical characteristics of HAIs caused by the PA, the prevalence of various drug-resistant phenotypes of this pathogen, and risk factors for their occurrence. Prolonged ICU stay and previous carbapenem administration were independent risk factors for HAIs caused by carbapenem-resistant PA, while HAIs caused by multidrug-resistant PA were more frequent in patients with prolonged stay in an ICU, who were previously hospitalized at another department and previously treated with aminoglycosides, fluoroquinolones or glycopeptides. The prolonged ICU stay was the only significant risk factor for HAIs caused by extensively drug-resistant PA. To decrease the incidence of HAIs caused by drug-resistant PA, a multifaceted approach is necessary, including staff education, antibiotic stewardship, improving hygiene, shortening hospitalization, and minimizing exposure to invasive medical procedures/devices.

Risk factors for Healthcare-Associated Infections caused by KPC-producing Enterobacteriaceae: a case-control study

Objetivo: Evaluar los factores de riesgo para infecciones relacionadas con la asistencia sanitaria causadas por Enterobacteriaceae productoras de carbapenemas.Método: Este es un estudio retrospectivo de casos y controles que consistió en una muestra de 82 pacientes infectados y 164 controles, totalizando 246 pacientes. La recopilación de datos se realizó entre enero y mayo de 2017 mediante la búsqueda en el Sistema Automatizado de Control de Infecciones Hospitalarias y en los registros electrónicos de pacientes.Resultados: Pacientes previamente colonizados con microorganismos gramnegativos (OR: 10.7, 95% CI: 2-60, p=0.007), con cáncer (OR: 20.8, 95% CI: 4-120, p<0.001), utilizando una catéter de doble luz (OR: 30.5, 95% CI: 2-382, p=0.008), con lesión por presión (OR: 136.2, 95% CI: 11- 1623, p<0.001) y permanecer en la Unidad de Cuidados Intensivos (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) fueron más propensos a desarrollar infecciones causadas por Enterobacteriaceae productoras de carbapenemas que el grupo control. El área bajo la curva ROC mostró un buen rendimiento general (0,99; IC 95%: 0,992-0,998) del modelo de regresión logística final.Conclusión: La colonización previa, el cáncer, el uso de catéteres de doble luz, la lesión por presión y la estadía en la UCI fueron factores de riesgo muy importantes para la adquisición de infecciones en el entorno hospitalario. Objective: To evaluate the risk factors for healthcare-associated infections caused by Klebsiella pneumoniae carbapenemase producing Enterobacteriaceae. Method: This is a retrospective case-control study that consisted of a sample of 82 infected patients and 164 controls, totaling 246 patients. Data collection was performed between January and May 2017 through search in the Automated Hospital Infection Control System and in the electronic patient records.Results: Patients previously colonized with gram-negative microorganisms (OR: 10.7, 95% CI: 2-60, p=0.007), with cancer (OR: 20.8, 95% CI: 4-120, p<0.001), using a double lumen catheter (OR: 30.5, 95% CI: 2-382, p=0.008), with pressure injury (OR: 136.2, 95% CI: 11- 1623, p<0.001) and Intensive Care Unit stay (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) had a greater chance of developing Healthcare-associated Infections caused by KPC-producing Enterobacteriaceae than the control group. The area under the ROC curve showed a good overall performance (0.99, 95% CI: 0.992-0.998) of the final logistic regression model. Conclusion: Previous colonization, cancer, double lumen catheter use, pressure injury and ICU stay were very important risk factors for the acquisition of infections in the hospital environment.

Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

BackgroundAvailable data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs.MethodologyWe conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018.ResultsOver the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively.The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus.ConclusionWe demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.

Faktori rizika za nastanak bolničkih infekcija uzrokovanih Pseudomonas aeruginosa rezistentnim na cefepim

Introduction: The increasing resistance of Pseudomonas aeruginosa against cefepime requires a better understanding of hospital epidemiology in order to retain this drug as a therapeutic option. Aim: The aim of this study was to identify risk factors associated with healthcare associated infections (HAIs) caused by cefepime-resistant P. aeruginosa (CRPA), both in all patients with HAIs and in the subgroups of patients who died or who acquired infection with carbapenem-resistant P. aeruginosa. Methods: The academic study was designed as a combination of three nested case/ control studies within the cohort of patients with HAIs caused by P. aeruginosa regardless of localization, prospectively followed from January 2009 to December 2017 in a tertiary care hospital. The influence of risk factors on specific outcomes was estimated by adjusted odds ratios calculated from multivariate logistic regressions. Results: Our study showed that there are independent risk factors for CRPA infections: the existence of another HAI (p=0.001), hospitalization in ICU longer than one month (p=0.007), a longer stay in hospital prior to infection (p=0.004), longer use of mechanical ventilation (p=0.036), administration of antibiotics before infection (p<0.001) and previous use of fluoroquinolones (p=0.030), while traumatic injury (p=0.020), the existence of another HAI (p=0.001) and long-term use of antibiotics before HAI (p=0.034) were related to mortality. Further, independent risk factors for HAIs caused by carbapenem-resistant CRPA are the existence of another HAI (p=0.011), transfer from another facility (p=0.023), more days spent in hospital (p=0.006) and ICU (p=0.004), and administration of antibiotics before infection (p<0.001). Conclusion: Risk factors for HAIs with CRPA are primarily linked to pre-infection use of systemic antibiotics, which is a common pathway for selection of multi, extensive or pan-resistant strains of P. aeruginosa that invade tissues and cause infection.

Çocuk cerrahisi yenidoğan yoğun bakım ünitesinde sağlık bakımı ilişkili enfeksiyonlar ve risk faktörleri

Purpose: The purpose of this study is to investigate the infectious agents, risk factors and prevalance of the healthcare-associated infections (HAIs) in patients treated at surgical neonatal intensive care unit. Materials and Methods: Patients were examined for application date, sex, mode of delivery, birth weight, gestation age, age at admission, hospital stay, hospitalization at another center, the provinces they come, surgery, developement of sepsis, use of TPN (Total parenteral nutrition), application of chest tube, endotracheal intubation, urinary catheter use, nasal or oral catheter use, application of abdominal drains, central catheter application, oral feeding time, laboratory parameters, degree of surgical stress and the nature of wounds. Results: Low birth weight, prior hospitalisation at another center, high degree of surgical stres, TPN use and duration, chest tube application and duration, endotracheal intubation and duration, urinary catheterisation and duration, central cathetery, application of abdominal drains at surgery, duration of nasal-oral catheterisation and the duration of nonenteral feding were found as risk factors of HAIs. Sepsis was detected at 57 of HAIs patients and 35 of them died. Conclusion: Decreasing the number and duration of invasive procedures, shorten the duration of hospital stay, special measures for the epidemic microorganisms can reduce the HAIs and the related deaths.

Infections caused by extended-spectrum β-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae

ObjectivesInfections as a result of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP). MethodsThis prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks. ResultsAmong all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16–3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17–6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62–5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64–6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068–2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses. ConclusionsClinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.

High rate of neonates colonized by methicillin-resistant Staphylococcus species in an Intensive Care Unit.

Staphylococcal colonization is a risk factor for healthcare-associated infections, which are frequent in Neonatal Intensive Care Units (NICU). This study analyzed microbiology, epidemiology and clinical aspects of Staphylococcus spp. colonizing neonates. Nasal or periumbilical swabs were evaluated from 175 newborns admitted to a NICU of a Rio de Janeiro hospital from March to September 2009. Clinical data were obtained from the medical records. SCCmec typing and the mecA and Panton-Valentine Leukocidin (PVL) genes were detected by PCR. Clonal diversity was evaluated by pulsed-field gel electrophoresis. Staphylococcus spp. isolates were detected in 98 (56%) neonates, 66.3% of them had birth weight ≤ 2500 g, 62.2% were preterm (˂ 37 weeks) and the mean length of hospitalization was 14.9 days. Among the 133 isolates identified, 48.1% were S. epidermidis, 23.3% S. haemolyticus and 13.5% S. aureus. Methicillin-resistant Staphylococcus isolate was detected in 77.6% of neonates. The methicillin-resistant S. aureus isolates carried the SCCmec type IV, while 94.6% of S. epidermidis and 85.7% of S. haemolyticus presented non-typeable cassettes. Among the S. aureus, 55.6% had PVL genes and the USA800 genotype was prevalent. Two genotypes of S. epidermidis and one of S. haemolyticus clustered 42.2% and 25.8% of the isolates, respectively. S haemolyticus colonization was associated with the use of parenteral nutrition and mechanical ventilation. High rate of neonates colonized by methicillin-resistant Staphylococcus species and the permanence of clones circulating in the NICU highlight the importance for continuous and preventive surveillance in this high-risk population.

Prevalence and risk factors of health care–associated infections in a limited resources country: A cross-sectional study

The aim of this study was to determine the prevalence of health care-associated infections (HAI) in our university hospitals (UH) and to delineate the risk factors associated with HAI. We conducted a cross-sectional study in the 2 UH of Sfax, Tunisia on July 2017, including all patients hospitalized for at least 48 hours. It was a 1-day pass per department and a 1-week prevalence survey per UH. Of 752 patients eligible for the study, the total number of HAI was 82, representing an overall prevalence of HAI of 10.9%. Respiratory tract infections were the most prevalent HAI (36.6%). In multivariate analysis, intrinsic risk factors independently associated with HAI were immune-suppression (adjusted odds ratio (AOR) = 2.8; P < .001), diabetes (AOR = 2.2; P = .008), and malnutrition (AOR = 2.2; P = .019). Extrinsic risk factors were endotracheal intubation (AOR = 17; P = .01), transfer to another department (AOR = 9; P = .019), parental feeding (AOR = 7.2; P = .014), tobacco use (AOR = 6.3; P = .004), as well as surgical wound class contaminated or dirty (AOR = 6.3; P = .002), and peripheral venous catheter(AOR = 4.7; P = .006). Our study highlighted the magnitude of the HAI problem threatening the quality of care in Southern Tunisia. A wise identification of HAI risk factors may help health care workers to ascertain the avoidability of these infections.

Prospective surveillance of hospital associated infections epidemiology in a haematology-oncology department

In haematology-oncology, intensified procedures have been associated with higher risk of healthcare associated infections (HAIs).This study aimed to estimate the incidence and to identify risk factors of HAIs in a haematology-oncology unit in a Tunisian university hospital. We conducted a prospective study, during 06 months from Mars through September 2016 in the department of hematology- oncology in a tertiary teaching hospital in Tunisia. Patients, admitted for ≥48 h, were followed until hospital discharge. The (CDC) criteria for site-specific infections were used to define HAIs. Bivariate and multivariate analyses were performed to identify risk factors of HAIs. P

Perceptions of Healthcare-Associated Infection and Antibiotic Resistance among Physicians Treating Syrian Patients with War-Related Injuries.

Healthcare-associated infections (HAIs) constitute a major contributor to morbidity and mortality worldwide, with a greater burden on low- and middle-income countries. War-related injuries generally lead to large tissue defects, with a high risk of infection. The aim of this study was to explore how physicians in a middle-income country in an emergency setting perceive HAI and antibiotic resistance (ABR). Ten physicians at a Jordanian hospital supported by Médecins Sans Frontières were interviewed face-to-face. The recorded interviews were transcribed verbatim and analyzed by qualitative content analysis with an inductive and deductive approach. The participants acknowledged risk factors of HAI and ABR development, such as patient behavior, high numbers of injured patients, limited space, and non-compliance with hygiene protocols, but did not express a sense of urgency or any course of action. Overuse and misuse of antibiotics were reported as main contributors to ABR development, but participants expressed no direct interrelationship between ABR and HAI. We conclude that due to high patient load and limited resources, physicians do not see HAI as a problem they can prioritize. The knowledge gained by this study could provide insights for the allocation of resources and development of hygiene and wound treatment protocols in resource-limited settings.

Vacuum-assisted closure (VAC\xae) systems and microbiological isolation of infected wounds

BackgroundNegative pressure wound therapy is now largely used to treat infected wounds. The prevention and reduction of healthcare-associated infections is a high priority for any Department of Health and great efforts are spent to improve infection control systems. It is assumed that vacuum-assisted closure (VAC®) dressings should be watertight and that all the secretions are gathered in a single container but there is no consistent data on air leakage and possible dispersion of bacteria from the machine.MethodsWe have conducted a prospective experimental study on 10 patients with diagnosis of wound infection to verify whether the filtration process is microbiologically efficient. We compared the bacteria population present in the wound to the one present in the air discharged by the VAC® machine.ResultsThis study shows that the contamination of the VAC® machine is considerably lower than the environment or wound contamination.ConclusionsNegative pressure wound therapy system does not represent a risk factor for healthcare-associated infections.

Acinetobacter Infections in Neonates

MDR-Gram-negative bacteria are a great concern in the neonatal population, with a worldwide rise in the reported incidence and with very limited therapeutic options. Acinetobacter baumannii is responsible for many infections in neonates and outbreaks in neonatal intensive care unit (NICU); also, outbreaks caused by other Acinetobacter species have been reported. The aim of this review is to document the epidemiology of Acinetobacter spp. infections in neonates and risk factors for acquisition of Acinetobacter spp. in the NICU using data from published studies. Acinetobacter spp. infections are increasing in neonates in NICU. Outbreak caused by multidrug resistant (MDR) or extensively drug resistant (XDR) A. baumannii but also outbreak caused by susceptible A. soli and A. septicus sp. nov., were reported in neonates. Acinetobacter spp. were responsible for bloodstream infections and respiratory tract infections in neonates. Risk factors for A. baumannii acquisition in neonates were low birthweight, length of NICU stay, umbilical catheterization, central-venous catheterization, assisted ventilation, and prior antibiotic use. This review highlights the importance of surveillance of risk factors for healthcare-associated infections in NICU to control MDR and XDR A. baumannii infections in neonates.

Prevalence and risk factors of healthcare-associated infections in an Algerian Teaching Hospital

Introduction/aim Healthcare-associated infections are a major public health problem worldwide. The objective of our work was to determine the prevalence of these infections and the main risk factors in the University Hospital Establishment of Oran. Methodology A cross-sectional descriptive study was conducted at the EHUO from April 27, 2014 to May 6, 2014. The study included all patients hospitalized on the day of the survey. All infectious sites were considered. Results Five hundred (500) patients were included in the study. Forty-eight (48) healthcare-associated infections were recorded that is to say a rate of 9.6% [8.8 to 10.4] for healthcare-associated infections. Urinary tract infections represented 47.9% of documented infections sites followed by pneumonia (18.8%). Exposure to certain medical invasive devices were significantly associated with the occurrence of healthcare-associated infections: intubation and/or tracheotomy (OR = 10.3 [4.5 to 23.8], P Conclusion The prevalence rate recorded in our study does not deviate too much from the range found in the majority of studies in Europe. Periodically conducting prevalence surveys allows us to track annual trends of healthcare-associated infections and bacterial resistance to antibiotics.

Healthcare-associated infections in a Tunisian University Hospital in 2017: Prevalence and risk factors

Introduction Healthcare-associated infections (HAI) represent a major public health problem. Our study aimed to determine prevalence of HAI in Sahloul University Hospital, and their risk factors in order to redirect preventive measures and improve the quality of care. Methods A cross-sectional study of one-day prevalence with a single pathway was carried out in 2017. All services were included in the survey, except emergency and hemodialysis services due to their very short length of stay. We used a questionnaire, NosoTun plug (national HAI prevalence survey), filled beside all hospitalized patients, since at least 48 h. HAI risk factors were analyzed by step by step descendant logistic regression with a signification degree P Results In total, 307 patients were included. The mean age was 49 ± 22.16 years. The prevalence rate of infected patients was 10.4% (n = 32). The prevalence of nosocomial infections was 11.4% (n = 35). This prevalence was most frequent in intensive care units (40%). Infections on surgical site infections were the most frequent (n = 9; 25.71%), followed by respiratory infections (n = 8; 22.85%). In total, 26 germs were identified, the most frequent were Gram Negative Bacilli (53.8%). Retained HAI risk factors after univariate and multivariate analysis were obesity (P = 0.034), prosthesis placement (P = 0.020), central venous catheter (P = 0.000) and surgery (P = 0.006). Conclusion the present study showed that HAI are more frequent among patients who are exposed to invasive healthcare procedures. So, the results of this study should be considered in our strategy for preventing HAI.