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Ssekitoleko RT, Oshabaheebwa S, Munabi IG, Tusabe MS, Namayega C, Ngabirano BA, Matovu B, Mugaga J, Reichert WM, Joloba ML. The role of medical equipment in the spread of nosocomial infections: a cross-sectional study in four tertiary public health facilities in Uganda. BMC Public Health 2020; 20:1561. [PMID: 33066745 PMCID: PMC7562759 DOI: 10.1186/s12889-020-09662-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 10/08/2020] [Indexed: 11/11/2022] Open
Abstract
Background With many medical equipment in hospitals coming in direct contact with healthcare workers, patients, technicians, cleaners and sometimes care givers, it is important to pay close attention to their capacity in harboring potentially harmful pathogens. The goal of this study was to assess the role that medical equipment may potentially play in hospital acquired infections in four public health facilities in Uganda. Methods A cross-sectional study was conducted from December 2017 to January 2018 in four public health facilities in Uganda. Each piece of equipment from the neonatal department, imaging department or operating theatre were swabbed at three distinct points: a location in contact with the patient, a location in contact with the user, and a remote location unlikely to be contacted by either the patient or the user. The swabs were analyzed for bacterial growth using standard microbiological methods. Seventeen bacterial isolates were randomly selected and tested for susceptibility/resistance to common antibiotics. The data collected analyzed in STATA version 14. Results A total of 192 locations on 65 equipment were swabbed, with 60.4% of these locations testing positive (116/192). Nearly nine of ten equipment (57/65) tested positive for contamination in at least one location, and two out of three equipment (67.7%) tested positive in two or more locations. Of the 116 contaminated locations 52.6% were positive for Bacillus Species, 14.7% were positive for coagulase negative staphylococcus, 12.9% (15/116) were positive for E. coli, while all other bacterial species had a pooled prevalence of 19.8%. Interestingly, 55% of the remote locations were contaminated compared to 66% of the user contacted locations and 60% of the patient contacted locations. Further, 5/17 samples were resistant to at least three of the classes of antibiotics tested including penicillin, glycylcycline, tetracycline, trimethoprim sulfamethoxazole and urinary anti-infectives. Conclusion These results provides strong support for strengthening overall disinfection/sterilization practices around medical equipment use in public health facilities in Uganda. There’s also need for further research to make a direct link to the bacterial isolates identified and cases of infections recorded among patients in similar settings.
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Affiliation(s)
- Robert T Ssekitoleko
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Solomon Oshabaheebwa
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ian G Munabi
- Department of Anatomy, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha S Tusabe
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - C Namayega
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Beryl A Ngabirano
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Brian Matovu
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Julius Mugaga
- Biomedical Engineering Unit, Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Moses L Joloba
- Department of Microbiology, School of Biomedical Sciences, Makerere University college of Health Sciences, Kampala, Uganda
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Ayed HB, Yaich S, Trigui M, Jemaa MB, Hmida MB, Karray R, Kassis M, Mejdoub Y, Feki H, Jedidi J, Damak J. Prevalence and risk factors of health care-associated infections in a limited resources country: A cross-sectional study. Am J Infect Control 2019; 47:945-950. [PMID: 30777390 DOI: 10.1016/j.ajic.2019.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Houda Ben Ayed
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029.
| | - Sourour Yaich
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Maroua Trigui
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Maissa Ben Jemaa
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Mariem Ben Hmida
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Raouf Karray
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Mondher Kassis
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Yosra Mejdoub
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Habib Feki
- Preventive Medicine and Hygiene Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Jihène Jedidi
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
| | - Jamel Damak
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Ain Street Km 1, Sfax, Tunisia 3029
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Wasswa P, Nalwadda CK, Buregyeya E, Gitta SN, Anguzu P, Nuwaha F. Implementation of infection control in health facilities in Arua district, Uganda: a cross-sectional study. BMC Infect Dis 2015; 15:268. [PMID: 26170127 PMCID: PMC4501062 DOI: 10.1186/s12879-015-0999-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 06/25/2015] [Indexed: 11/10/2022] Open
Abstract
Background At least 1.4 million people are affected globally by nosocomial infections at any one time, the vast majority of these occurring in low-income countries. Most of these infections can be prevented by adopting inexpensive infection prevention and control measures such as hand washing. We assessed the implementation of infection control in health facilities and determined predictors of hand washing among healthcare workers (HCWs) in Arua district, Uganda. Methods We interviewed 202 HCWs that included 186 randomly selected and 16 purposively selected key informants in this cross-sectional study. We also conducted observations in 32 health facilities for compliance with infection control measures and availability of relevant supplies for their implementation. Quantitative data underwent descriptive analysis and multiple logistic regressions at 95 % confidence interval while qualitative data was coded and thematically analysed. Results Most respondents (95/186, 51 %) were aware of at least six of the eight major infection control measures assessed. Most facilities (93.8 %, 30/32) lacked infection control committees and adequate supplies or equipment for infection control. Respondents were more likely to wash their hands if they had prior training on infection control (AOR = 2.71, 95 % CI: 1.03–7.16), had obtained at least 11 years of formal education (AOR = 3.30, 95 % CI: 1.44–7.54) and had reported to have acquired a nosocomial infection (AOR = 2.84, 95 % CI: 1.03–7.84). Conclusions Healthcare workers are more likely to wash their hands if they have ever suffered from a nosocomial infection, received in-service training on infection control, were educated beyond ordinary level, or knew hand washing as one of the infection control measures. The Uganda Ministry of Health should provide regular in-service training in infection control measures and adequate necessary materials. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0999-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peter Wasswa
- African Field Epidemiology Network, Kampala, Uganda.
| | - Christine K Nalwadda
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Esther Buregyeya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Sheba N Gitta
- African Field Epidemiology Network, Kampala, Uganda.
| | | | - Fred Nuwaha
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
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Mamoudou S, Lassina D, Fla K. [Pseudomonas aeruginosa infections in the service of infectious diseases at CHU YO, Burkina Faso: about two cases]. Pan Afr Med J 2015; 21:78. [PMID: 26491521 PMCID: PMC4594982 DOI: 10.11604/pamj.2015.21.78.4739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 03/12/2015] [Indexed: 11/30/2022] Open
Abstract
Nous rapportons deux cas d'infection à Pseudomonas aeruginosa : un cas de méningite et un cas d'infection urinaire. Les auteurs rappellent qu’à côté des étiologies classiques des méningites et des infections urinaires, des germes résistants comme Pseudomonas aeruginosa peuvent être responsables d'infections à localisation méningées et urinaires et dont il faut connaître pour une bonne prise en charge. Le traitement de ces infections requiert un antibiogramme au regard de la grande capacité de résistance de Pseudomonas aeruginosa en milieu hospitalier. La limitation des gestes invasifs et l'application rigoureuse des mesures de prévention des infections en milieu hospitalier contribueront à lutter efficacement contre ces infections en milieu de soins.
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Affiliation(s)
| | - Dao Lassina
- CHU Pédiatrique Charles De Gaulle, Ouagadougou, Burkina Faso
| | - Koueta Fla
- CHU Pédiatrique Charles De Gaulle, Ouagadougou, Burkina Faso
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Mahjoub M, Bouafia N, Bannour W, Masmoudi T, Bouriga R, Hellali R, Ben Cheikh A, Ezzi O, Ben Abdeljellil A, Mansour N. Healthcare-associated infections in a Tunisian university hospital: from analysis to action. Pan Afr Med J 2015; 20:197. [PMID: 26113928 PMCID: PMC4469509 DOI: 10.11604/pamj.2015.20.197.4062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 01/26/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Our study was conducted, in university hospital center (UHC) Farhat Hached of Sousse (city in Tunisian center-east), within healthcare-associated infections (HAI) epidemiological surveillance (ES) program, based, among others, on HAI regular prevalence surveys. Our objectives are to resituate HAI prevalence rate and to identify their risk factors (RF) in order to adjust, in our hospital, prevention programs. METHODS It is a transversal descriptive study, including all patients who had been hospitalized for at least 48 hours, measuring prevalence of HAI a "given day", with only one passage by service. Risk factors were determined using Epiinfo 6.0, by uni-varied analysis, then, logistic regression stepwise descending for the variables whose p. RESULTS The study focused on 312 patients. Infected patients prevalence was 12.5% and that of HAI was 14.5%. Infections on peripheral venous catheter (PVC) dominated (42.2%) among all HAI identified. HAI significant RF were neutropenia (p < 10(-4)) for intrinsic factors, and PVC for extrinsic factors (p = 0,003). CONCLUSION Predominance of infections on PVC should be subject of specific prevention actions, including retro-information strategy, prospective ES, professional practices evaluation and finally training and increasing awareness of health personnel with hygiene measures. Finally, development of a patient safety culture with personnel ensures best adherence to hygiene measures and HAI prevention.
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Affiliation(s)
- Mohamed Mahjoub
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Nebiha Bouafia
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Waadia Bannour
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Tasnim Masmoudi
- Forensic Medical Service, University Hospital Centre Farhat Hached, Sousse Tunisia
| | - Rym Bouriga
- Hematology Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Radhia Hellali
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Asma Ben Cheikh
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Olfa Ezzi
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Amel Ben Abdeljellil
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
| | - Njah Mansour
- Hospital Hygiene Service, University Hospital Centre Farhat Hached, Sousse, Tunisia
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Razine R, Azzouzi A, Barkat A, Khoudri I, Hassouni F, Chefchaouni AC, Abouqal R. Prevalence of hospital-acquired infections in the university medical center of Rabat, Morocco. Int Arch Med 2012; 5:26. [PMID: 23031793 PMCID: PMC3515421 DOI: 10.1186/1755-7682-5-26] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 09/25/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND The aims of this study were to determine the hospital-acquired infections (HAI) prevalence in all institutions of Rabat University Medical Center, to ascertain risk factors, to describe the pathogens associated with HAI and their susceptibility profile to antibiotics. MATERIALS AND METHODS Point-prevalence survey in January 2010 concerning all patients who had been in the hospital for at least 48 hours. At bedside, 27 investigators filled a standardized questionnaire from medical records, temperature charts, radiographs, laboratory reports and by consultation with the ward's collaborating health professionals. Risk factors were determined using logistic regression. RESULTS 1195 patients involved, occupancy rate was 51%. The prevalence of HAI was 10.3%. Intensive care units were the most affected wards (34.5%). Urinary tract infection was the most common infected site (35%). Microbiological documentation was available in 61% of HAI. Staphylococcus was the organism most commonly isolated (18.7%) and was methicillin-resistant in 50% of cases. In multivariate analysis, risk factors associated with HAI were advanced age, longer length of hospital stay, presence of comorbidity, invasive devices and use of antibiotic use. CONCLUSION HAI prevalence was high in this study. Future prevention program should focus on patients with longer length of stay, invasive devices, and overprescribing antibiotics.
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Affiliation(s)
- Rachid Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco.
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Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ 2011; 89:757-65. [PMID: 22084514 DOI: 10.2471/blt.11.088179] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 07/05/2011] [Accepted: 07/08/2011] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess the epidemiology of endemic health-care-associated infection (HAI) in Africa. METHODS Three databases (PubMed, the Cochrane Library, and the WHO regional medical database for Africa) were searched to identify studies published from 1995 to 2009 on the epidemiology of HAI in African countries. No language restriction was applied. Available abstract books of leading international infection control conferences were also searched from 2004 to 2009. FINDINGS The eligibility criteria for inclusion in the review were met by 19 articles, only 2 of which met the criterion of high quality. Four relevant abstracts were retrieved from the international conference literature. The hospital-wide prevalence of HAI varied between 2.5% and 14.8%; in surgical wards, the cumulative incidence ranged from 5.7% to 45.8%. The largest number of studies focused on surgical site infection, whose cumulative incidence ranged from 2.5% to 30.9%. Data on causative pathogens were available from a few studies only and highlighted the importance of gram-negative rods, particularly in surgical site infection and ventilator-associated pneumonia. CONCLUSION Limited information is available on the endemic burden of HAI in Africa, but our review reveals that its frequency is much higher than in developed countries. There is an urgent need to identify and implement feasible and sustainable approaches to strengthen HAI prevention, surveillance and control in Africa.
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Affiliation(s)
- Sepideh Bagheri Nejad
- Clean Care is Safer Care, World Health Organization Patient Safety, Geneva, Switzerland
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Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377:228-41. [PMID: 21146207 DOI: 10.1016/s0140-6736(10)61458-4] [Citation(s) in RCA: 1267] [Impact Index Per Article: 97.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries. METHODS We searched electronic databases and reference lists of relevant papers for articles published 1995-2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence-including overall health-care-associated infection and major infection sites, and their microbiological cause-were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis. FINDINGS Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6-18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7-59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance. INTERPRETATION The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices. FUNDING World Health Organization.
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