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Published in: Antimicrobial Resistance & Infection Control 1/2018

Open Access 01-12-2018 | Research

Healthcare associated infection and its risk factors among patients admitted to a tertiary hospital in Ethiopia: longitudinal study

Authors: Solomon Ali, Melkamu Birhane, Sisay Bekele, Gebre Kibru, Lule Teshager, Yonas Yilma, Yesuf Ahmed, Netsanet Fentahun, Henok Assefa, Mulatu Gashaw, Esayas Kebede Gudina

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2018

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Abstract

Background

Healthcare associated infection (HAI) is alarmingly increasing in low income settings. In Ethiopia, the burden of HAI is still not well described.

Methods

Longitudinal study was conducted from May to September, 2016. All wards of Jimma University Medical Centre were included. The incidence, prevalence and risk factors of healthcare associated infection were determined. A total of 1015 admitted patients were followed throughout their hospital stay. Biological specimens were collected from all patients suspected to have hospital aquired infection. The specimens were processed by standard microbiological methods to isolate and identify bacteria etiology. Clinical and laboratory data were collected using structured case report formats.

Results

The incidence rate of hospital acquired infection was 28.15 [95% C.I:24.40,32.30] per 1000 patient days while the overall prevalence was 19.41% (95% C.I: (16.97–21.85). The highest incidence of HAI was seen in intensive care unit [207.55 (95% C.I:133.40,309.1) per 1000 patient days] and the lowest incidence was reported from ophthalmology ward [0.98 (95% C.I: 0.05,4.90) per 1000patient days]. Among patients who underwent surgical procedure, the risk of HAI was found to be high in those with history of previous hospitalization (ARR = 1.65, 95% C.I:1.07, 2.54). On the other hand, young adults (18 to 30-year-old) had lower risk of developing HAI (ARR = 0.54 95% C.I: 0.32,0.93) Likewise, among non-surgical care groups, the risk of HAI was found to be high in patients with chest tube (ARR = 4.14, 95% C.I: 2.30,7.46), on mechanical ventilation (ARR = 1.99, 95% C.I: 1.06,3.74) and with underlying disease (ARR = 2.01, 95% C.I: 1.33,3.04). Furthermore, hospital aquired infection at the hosoital was associated with prolonged hospital stay [6.3 more days, 95% C.I: (5.16,7.48), t = 0.000] and increased in hospital mortality (AOR, 2.23, 95% CI:1.15,4.29).

Conclusion

This study revealed high burden and poor discharge outcomes of healthcare associated infection at Jimma University Medical Centre. There is a difference in risk factors between patients with and without surgery. Hence, any effort to control the observed high burden of HAI at the hospital should consider these differences for better positive out put.
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Literature
1.
go back to reference Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–32.CrossRefPubMed Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36(5):309–32.CrossRefPubMed
2.
go back to reference Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II. N Engl J Med. 1991;324(6):377–84.CrossRefPubMed Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard medical practice study II. N Engl J Med. 1991;324(6):377–84.CrossRefPubMed
3.
go back to reference Hauri AM, Armstrong GL, Hutin YJ. The global burden of disease attributable to contaminated injections given in health care settings. Int J STD AIDS. 2004;15(1):7–16.CrossRefPubMed Hauri AM, Armstrong GL, Hutin YJ. The global burden of disease attributable to contaminated injections given in health care settings. Int J STD AIDS. 2004;15(1):7–16.CrossRefPubMed
5.
go back to reference Rosenthal VD, Maki DG, Mehta Y, et al. International Nosocomial infection control consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control. 2014;42(9):942–56.CrossRefPubMed Rosenthal VD, Maki DG, Mehta Y, et al. International Nosocomial infection control consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control. 2014;42(9):942–56.CrossRefPubMed
6.
go back to reference Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The first global patient safety challenge “clean care is safer care”: from launch to current progress and achievements. J Hosp Infect. 2007;65(Suppl 2):115–23.CrossRefPubMed Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The first global patient safety challenge “clean care is safer care”: from launch to current progress and achievements. J Hosp Infect. 2007;65(Suppl 2):115–23.CrossRefPubMed
7.
go back to reference Schumacher M, Wangler M, Wolkewitz M, Beyersmann J. Attributable mortality due to nosocomial infections. A simple and useful application of multistate models. Methods Inf Med. 2007;46(5):595–600.CrossRefPubMed Schumacher M, Wangler M, Wolkewitz M, Beyersmann J. Attributable mortality due to nosocomial infections. A simple and useful application of multistate models. Methods Inf Med. 2007;46(5):595–600.CrossRefPubMed
8.
go back to reference Dramowski A, Whitelaw A, Cotton MF. Burden, spectrum, and impact of healthcare-associated infection at a south African children's hospital. J Hosp Infect. 2016;94(4):364–72.CrossRefPubMedPubMedCentral Dramowski A, Whitelaw A, Cotton MF. Burden, spectrum, and impact of healthcare-associated infection at a south African children's hospital. J Hosp Infect. 2016;94(4):364–72.CrossRefPubMedPubMedCentral
9.
go back to reference Nero DC, Lipp MJ, Callahan MA. The financial impact of hospital-acquired conditions. J Health Care Finance. 2012;38(3):40–9.PubMed Nero DC, Lipp MJ, Callahan MA. The financial impact of hospital-acquired conditions. J Health Care Finance. 2012;38(3):40–9.PubMed
10.
go back to reference Fuller RL, McCullough EC, Bao MZ, Averill RF. Estimating the costs of potentially preventable hospital acquired complications. Health Care Financ Rev. 2009;30(4):17–32.PubMedPubMedCentral Fuller RL, McCullough EC, Bao MZ, Averill RF. Estimating the costs of potentially preventable hospital acquired complications. Health Care Financ Rev. 2009;30(4):17–32.PubMedPubMedCentral
11.
go back to reference Forster AJ, Taljaard M, Oake N, Wilson K, Roth V, van Walraven C. The effect of hospital-acquired infection with Clostridium Difficile on length of stay in hospital. CMAJ. 2012;184(1):37–42.CrossRefPubMedPubMedCentral Forster AJ, Taljaard M, Oake N, Wilson K, Roth V, van Walraven C. The effect of hospital-acquired infection with Clostridium Difficile on length of stay in hospital. CMAJ. 2012;184(1):37–42.CrossRefPubMedPubMedCentral
12.
go back to reference Gandhi NR, Weissman D, Moodley P, et al. Nosocomial transmission of extensively drug-resistant tuberculosis in a rural hospital in South Africa. J Infect Dis. 2013;207(1):9–17.CrossRefPubMed Gandhi NR, Weissman D, Moodley P, et al. Nosocomial transmission of extensively drug-resistant tuberculosis in a rural hospital in South Africa. J Infect Dis. 2013;207(1):9–17.CrossRefPubMed
13.
go back to reference Struelens MJ. The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions. BMJ. 1998;317(7159):652–4.CrossRefPubMedPubMedCentral Struelens MJ. The epidemiology of antimicrobial resistance in hospital acquired infections: problems and possible solutions. BMJ. 1998;317(7159):652–4.CrossRefPubMedPubMedCentral
14.
go back to reference Shears P, O'Dempsey TJ. Ebola virus disease in Africa: epidemiology and nosocomial transmission. J Hosp Infect. 2015;90(1):1–9.CrossRefPubMed Shears P, O'Dempsey TJ. Ebola virus disease in Africa: epidemiology and nosocomial transmission. J Hosp Infect. 2015;90(1):1–9.CrossRefPubMed
15.
16.
go back to reference Allegranzi B, Nejad SB, Castillejos GG, Kilpatrick C, Kelley E, Mathai E. Report on the burden of endemic health care–associated infection worldwide. Geneva, Switzerland: World Health Organization; 2011. Allegranzi B, Nejad SB, Castillejos GG, Kilpatrick C, Kelley E, Mathai E. Report on the burden of endemic health care–associated infection worldwide. Geneva, Switzerland: World Health Organization; 2011.
17.
go back to reference Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.CrossRefPubMed Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.CrossRefPubMed
18.
go back to reference Allegranzi B, Bagheri Nejad S, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–41.CrossRefPubMed Allegranzi B, Bagheri Nejad S, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761):228–41.CrossRefPubMed
19.
go back to reference 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(10):757–65.CrossRefPubMedPubMedCentral 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(10):757–65.CrossRefPubMedPubMedCentral
20.
go back to reference Marschang S, Bernardo G. Prevention and control of healthcare-associated infection in Europe: a review of patients’ perspectives and existing differences. J Hosp Infect. 2015;89(4):357–62.CrossRefPubMed Marschang S, Bernardo G. Prevention and control of healthcare-associated infection in Europe: a review of patients’ perspectives and existing differences. J Hosp Infect. 2015;89(4):357–62.CrossRefPubMed
21.
go back to reference Klevens RM, Edwards JR, Richards CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160–6.CrossRefPubMedPubMedCentral Klevens RM, Edwards JR, Richards CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160–6.CrossRefPubMedPubMedCentral
22.
go back to reference Gedebou M, Habte-Gabr E, Kronvall G, Yoseph S. Hospital-acquired infections among obstetric and gynaecological patients at Tikur Anbessa hospital, Addis Ababa. J Hosp Infect. 1988;11(1):50–9.CrossRefPubMed Gedebou M, Habte-Gabr E, Kronvall G, Yoseph S. Hospital-acquired infections among obstetric and gynaecological patients at Tikur Anbessa hospital, Addis Ababa. J Hosp Infect. 1988;11(1):50–9.CrossRefPubMed
23.
go back to reference Habte-Gabr E, Gedebou M, Kronvall G. Hospital-acquired infections among surgical patients in Tikur Anbessa hospital, Addis Ababa, Ethiopia. Am J Infect Control. 1988;16(1):7–13.CrossRefPubMed Habte-Gabr E, Gedebou M, Kronvall G. Hospital-acquired infections among surgical patients in Tikur Anbessa hospital, Addis Ababa, Ethiopia. Am J Infect Control. 1988;16(1):7–13.CrossRefPubMed
24.
go back to reference Endalafer N, Gebre-Selassie S, Kotiso B. Nosocomial bacterial infections in a tertiary hospital in Ethiopia. J Infect Prev. 2011;12(1):38–43.CrossRef Endalafer N, Gebre-Selassie S, Kotiso B. Nosocomial bacterial infections in a tertiary hospital in Ethiopia. J Infect Prev. 2011;12(1):38–43.CrossRef
25.
go back to reference Mulu W, Kibru G, Beyene G, Damtie M. Postoperative Nosocomial infections and antimicrobial resistance pattern of bacteria isolates among patients admitted at Felege Hiwot referral hospital, Bahirdar, Ethiopia. Ethiop J Health Sci. 2012;22(1):7–18.PubMedPubMedCentral Mulu W, Kibru G, Beyene G, Damtie M. Postoperative Nosocomial infections and antimicrobial resistance pattern of bacteria isolates among patients admitted at Felege Hiwot referral hospital, Bahirdar, Ethiopia. Ethiop J Health Sci. 2012;22(1):7–18.PubMedPubMedCentral
26.
go back to reference Yallew WW, Kumie A, Yehuala FM. Point prevalence of hospital-acquired infections in two teaching hospitals of Amhara region in Ethiopia. Drug Healthc Patient Saf. 2016;8:71–6.CrossRefPubMedPubMedCentral Yallew WW, Kumie A, Yehuala FM. Point prevalence of hospital-acquired infections in two teaching hospitals of Amhara region in Ethiopia. Drug Healthc Patient Saf. 2016;8:71–6.CrossRefPubMedPubMedCentral
27.
go back to reference Tesfahunegn Z, Asrat D, Woldeamanuel Y, Estifanos K. Bacteriology of surgical site and catheter related urinary tract infections among patients admitted in Mekelle hospital, Mekelle, Tigray. Ethiopia Ethiop Med J. 2009;47(2):117–27.PubMed Tesfahunegn Z, Asrat D, Woldeamanuel Y, Estifanos K. Bacteriology of surgical site and catheter related urinary tract infections among patients admitted in Mekelle hospital, Mekelle, Tigray. Ethiopia Ethiop Med J. 2009;47(2):117–27.PubMed
28.
go back to reference Melaku S, Gebre-Selassie S, Damtie M, Alamrew K. Hospital acquired infections among surgical, gynaecology and obstetrics patients in Felege-Hiwot referral hospital, Bahir Dar, northwest Ethiopia. Ethiop Med J. 2012;50(2):135–44.PubMed Melaku S, Gebre-Selassie S, Damtie M, Alamrew K. Hospital acquired infections among surgical, gynaecology and obstetrics patients in Felege-Hiwot referral hospital, Bahir Dar, northwest Ethiopia. Ethiop Med J. 2012;50(2):135–44.PubMed
29.
go back to reference Amenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of jimma university specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):91–100.CrossRefPubMedPubMedCentral Amenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of jimma university specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):91–100.CrossRefPubMedPubMedCentral
30.
go back to reference Zimlichman E, Henderson D, Tamir O, et al. Health care–associated infections:AMeta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039–46.CrossRefPubMed Zimlichman E, Henderson D, Tamir O, et al. Health care–associated infections:AMeta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039–46.CrossRefPubMed
31.
go back to reference Vandepitte J, Verhaegen J, Engbaek K, Rohner P, Piot P, Heuck CC. Basic laboratory procedures in clinical bacteriology. Second ed. Geneva, Switzerland: World Health Organization; 2003. Vandepitte J, Verhaegen J, Engbaek K, Rohner P, Piot P, Heuck CC. Basic laboratory procedures in clinical bacteriology. Second ed. Geneva, Switzerland: World Health Organization; 2003.
32.
go back to reference Petersen MH, Holm MO, Pedersen SS, Lassen AT, Pedersen C. Incidence and prevalence of hospital-acquired infections in a cohort of patients admitted to medical departments. Dan Med Bul. 2010;57(11):A4210. Petersen MH, Holm MO, Pedersen SS, Lassen AT, Pedersen C. Incidence and prevalence of hospital-acquired infections in a cohort of patients admitted to medical departments. Dan Med Bul. 2010;57(11):A4210.
33.
go back to reference Ige OK, Adesanmi AA, Asuzu MC. Hospital-acquired infections in a Nigerian tertiary health facility: an audit of surveillance reports. Niger Med J. 2011;52(4):239–43.CrossRefPubMedPubMedCentral Ige OK, Adesanmi AA, Asuzu MC. Hospital-acquired infections in a Nigerian tertiary health facility: an audit of surveillance reports. Niger Med J. 2011;52(4):239–43.CrossRefPubMedPubMedCentral
34.
go back to reference Razine R, Azzouzi A, Barkat A, et al. Prevalence of hospital-acquired infections in the university medical center of Rabat. Morocco Int Arch Med. 2012;5(1):26.CrossRefPubMed Razine R, Azzouzi A, Barkat A, et al. Prevalence of hospital-acquired infections in the university medical center of Rabat. Morocco Int Arch Med. 2012;5(1):26.CrossRefPubMed
35.
go back to reference Gosling R, Mbatia R, Savage A, Mulligan JA, Reyburn H. Prevalence of hospital-acquired infections in a tertiary referral hospital in northern Tanzania. Ann Trop Med Parasitol. 2003;97(1):69–73.CrossRefPubMed Gosling R, Mbatia R, Savage A, Mulligan JA, Reyburn H. Prevalence of hospital-acquired infections in a tertiary referral hospital in northern Tanzania. Ann Trop Med Parasitol. 2003;97(1):69–73.CrossRefPubMed
36.
go back to reference Haile TG, Engeda EH, Abdo AA. Compliance with standard precautions and associated factors among healthcare Workers in Gondar University Comprehensive Specialized Hospital, Northwest Ethiopia. J Environ Public Health. 2017;2017:2050635.CrossRefPubMedPubMedCentral Haile TG, Engeda EH, Abdo AA. Compliance with standard precautions and associated factors among healthcare Workers in Gondar University Comprehensive Specialized Hospital, Northwest Ethiopia. J Environ Public Health. 2017;2017:2050635.CrossRefPubMedPubMedCentral
37.
go back to reference Balkhy HH, Cunningham G, Chew FK, et al. Hospital- and community-acquired infections: a point prevalence and risk factors survey in a tertiary care center in Saudi Arabia. Int J Infect Dis. 2006;10(4):326–33.CrossRefPubMed Balkhy HH, Cunningham G, Chew FK, et al. Hospital- and community-acquired infections: a point prevalence and risk factors survey in a tertiary care center in Saudi Arabia. Int J Infect Dis. 2006;10(4):326–33.CrossRefPubMed
38.
go back to reference Durando P, Bassetti M, Orengo G, et al. Hospital-acquired infections and leading pathogens detected in a regional university adult acute-care hospital in Genoa, Liguria, Italy: results from a prevalence study. J Prev Med Hyg. 2010;51(2):80–6.PubMed Durando P, Bassetti M, Orengo G, et al. Hospital-acquired infections and leading pathogens detected in a regional university adult acute-care hospital in Genoa, Liguria, Italy: results from a prevalence study. J Prev Med Hyg. 2010;51(2):80–6.PubMed
39.
go back to reference Kibret M, Abera B. Prevalence and antibiogram of bacterial isolates from urinary tract infections at Dessie Health Research Laboratory, Ethiopia. Asian Pac J Trop Biomed. 2014;4(2):164–8.CrossRefPubMedPubMedCentral Kibret M, Abera B. Prevalence and antibiogram of bacterial isolates from urinary tract infections at Dessie Health Research Laboratory, Ethiopia. Asian Pac J Trop Biomed. 2014;4(2):164–8.CrossRefPubMedPubMedCentral
40.
go back to reference Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):141–6.CrossRefPubMedPubMedCentral Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):141–6.CrossRefPubMedPubMedCentral
Metadata
Title
Healthcare associated infection and its risk factors among patients admitted to a tertiary hospital in Ethiopia: longitudinal study
Authors
Solomon Ali
Melkamu Birhane
Sisay Bekele
Gebre Kibru
Lule Teshager
Yonas Yilma
Yesuf Ahmed
Netsanet Fentahun
Henok Assefa
Mulatu Gashaw
Esayas Kebede Gudina
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2018
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0298-5

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