Introduction:
Hospital-acquired infections (HAI) are infections that occur in hospitalized patients who are asymptomatic or incubate at the time of admission (1). Hospital-acquired infections are one of the major challenges and concerns in hospitals worldwide. Hospital-acquired infections cause severe consequences for patients such as prolonging treatment time, increasing health care costs, and increasing mortality rates (2). According to estimates by the World Health Organization, about 15% of hospitalized patients are at risk of hospital-acquired infections (3). The rate of hospital-acquired infections in European countries and the Western Pacific region ranges from 7.7% to 9%; 11.8% in the Middle East, and 10% in Southeast Asia (4). The prevalence of hospital-acquired infections in low- and middle-income countries ranges from 5.7% to 19.9% (5). In which, surgical site infection accounted for the highest rate (29.1%), following by urinary tract infection (23.9%), bacteremia (19.1%), respiratory tract (14.8%) and other infections (13.1%) (5).
Prevention and control of hospital-acquired infections are one of the top priorities due to the heavy consequences of this problem (6, 7). Hospital-acquired infection control is not only an indicator of hospital quality assurance, but also an indicator of patient safety, compliance with healthcare practices, and the effectiveness of management work (8, 9). Identifying the risk factors associated with hospital-acquired infections plays an important role in the development of interventions for the prevention and control of hospital-acquired infections (10). Studies have shown that patients' health conditions and interventional procedures are important risk factors for hospital-acquired infections (11-13). However, the factors vary in different places. Therefore, it is necessary to have additional studies to supplement practical evidence for this issue in each health facility.
In Vietnam, recent results showed that the rate of hospital-acquired infections was still high. A previous study in 3 intensive care units (ICUs) in 3 pediatric hospitals with 1363 cases (1143 children) showed a hospital infection rate of 33.1% including pneumonia (52.2%), sepsis (26.4%), surgical infection (2%), and necrotizing enterocolitis (2%) (14). Another study in 15 ICUs in Vietnam showed that among 3287 patients recorded, the hospital-acquired infection rate was 29.5% (15). The Vietnam Ministry of Health has issued a number of policies to control hospital-acquired infections in health facilities (16). However, the limited evidence on groups of patients at high risk for hospital-acquired infections is a major barrier to the development of intervention programs. Therefore, this study aimed to evaluate the point-prevalence of hospital-acquired infections among inpatients at a public hospital in Hanoi, Vietnam, and analyze the factors associated with this condition.
Methodology
Study design and participants
The study was conducted at Thanh Nhan Hospital, Hanoi, Vietnam. This is a general hospital of Hanoi, with the number of more than 1000 patients being cared for and treated every day. The hospital has more than 1100 medical staff and 51 departments with 1200 beds. Patients were selected if they used inpatient services and had a hospital stay >48 hours and were present at the time of the survey. Exclusion criteria included: 1) Patients with less than 48 hours of hospital stay or outpatients; 2) Patients had an infectious disease on admission, detected through laboratory tests, imaging, and clinical examination. Two cross-sectional surveys were conducted on 30 August 2018 and 29 September 2019. There were 712 patients in 2018 and 751 patients in 2019, for a total of 1463 patients. The Institutional Review Board of Thanh Nhan Hospital approved the study proposal (Code: 03/BVTN-HDDD).
Definition
Criteria for identifying patients with hospital-acquired infections: 1) The patient was infected 48 hours after admission and at the time of admission had no signs of incubation of a certain infection; 2) Patients with hospital-acquired infections, although no longer showing clinical signs on the date of investigation but are using antibiotics for treatment. Before being diagnosed with hospital-acquired infections, all patients were clinically examined, tested, discussed, and agreed upon between the doctors in the research group and the doctors in the treatment departments. Patients with hospital-acquired infections were diagnosed based on clinical and laboratory symptoms according to the guiding criteria of Decision 3961/QD-BYT dated August 28, 2017 (17).
Data collection and measurements
Initially, nurses listed all patients present in the department identified patients who were eligible for the study and patients discharged on the same day. The treating doctor and nurse reviewed the medical history, clinical symptoms, and subclinical conditions of these patients; and thereby detecting patients with suspected or confirmed hospital-acquired infections. After that, the patient's information was supplemented with necessary tests and procedures. Next, doctors and nurses filled in information about disease diagnoses, procedures, antibiotics in the monitoring sheet form and completed the monitoring form with discharged patients. The monitoring sheet form was attached to the medical record to supplement information during the monitoring period. Nurses also monitored, recorded signs of suspected infection in the daily patient monitoring sheet, and notified if patients had clinical symptoms of suspected hospital-acquired infection. The information collected in the medical records was checked and validated to ensure data quality.
The collected information included demographic information (age, gender), treatment department, comorbidities, interventional procedures, surgical status, type of surgery, number of antibiotics used before and after surgery, the status of hospital-acquired infection, type of hospital infection, and name of bacteria causing hospital-acquired infection. The treatment departments were divided into six main groups: emergency, multi-specialization, internal medicine, surgery, obstetrics and gynecology and pediatrics.
Statistics
Data were entered into Epidata software and analyzed using SPSS 20.0 software. Descriptive analysis with frequency and percentage was performed to describe the status of hospital-acquired infections. Chi-squared and Fisher's exact tests were performed to evaluate the differences in characteristics of patients with and without hospital-acquired infections. Univariate and multivariate logistic regression models were applied to identify factors related to hospital-acquired infections. P-value < 0.05 was used to evaluate the statistical significance.
Results
Among 1463 patients, 88 patients had hospital-acquired infections (6.0%), including 5.9% of patients in 2018 and 6.1% of patients in 2019. The difference between the two years was not statistically significant (p>0.05). All patients had one type of hospital-acquired infection (100%), with mainly surgical site infections (37.5%) and respiratory infections (37.5%). Bacterial cultures were performed in 36 patients. The negative rate was 50.0%. The most common bacteria were Pseudomonas aeruginosa (27.8%), followed by Klebsiella pneumoniae (13.9%) and Acinetobacter spp. (8.3%). (Table 1)
| Table 1: Point- Prevalence of hospital-acquired infection |
| Characteristics |
2018 |
2019 |
Total |
p-value |
N |
% |
N |
% |
N |
% |
Number of patients with infection |
42 |
5.9 |
46 |
6.1 |
88 |
6.0 |
0.86 |
Number of infections
|
One |
42 |
100.0 |
46 |
100.0 |
88 |
100.0 |
- |
Type of infection
|
Surgical site infections |
13 |
31.0 |
20 |
43.5 |
33 |
37.5 |
0.14 |
Septicemia |
1 |
2.4 |
5 |
10.9 |
6 |
6.8 |
|
Upper respiratory tract infection |
11 |
26.2 |
10 |
21.7 |
21 |
23.9 |
|
Pneumonia |
8 |
19.1 |
4 |
8.7 |
12 |
13.6 |
|
Urinary tract infections |
3 |
7.1 |
4 |
8.7 |
7 |
8.0 |
|
Soft tissue skin infections |
2 |
4.8 |
3 |
6.5 |
5 |
5.7 |
|
Others |
4 |
9.5 |
0 |
0.0 |
4 |
4.6 |
|
Bacterial culture outcome (n=36)
|
Negative |
6 |
50.0 |
12 |
50.0 |
18 |
50.0 |
0.29 |
Pseudomonas aeruginosa |
5 |
41.7 |
5 |
20.8 |
10 |
27.8 |
|
Klebsiella pneumoniae |
0 |
0.0 |
5 |
20.8 |
5 |
13.9 |
|
Acinetobacter spp. |
1 |
8.3 |
2 |
8.2 |
3 |
8.3 |
|
Table 2 shows the highest point-prevalence of hospital-acquired infections in the 40-49 age group (8.7%) and in women (7.3%). The rate of hospital-acquired infections was highest at the General surgery department (14.4%), following by the Intensive care unit department (11.6%) and Urology department (7.9%). Infection rates were highest in patients with multiple injuries (22.2%), followed by heart-related diseases (11.2%), chronic respiratory diseases (9.4%) and chronic liver diseases (7.9%). People having infection before admission had a significantly higher rate of HAI (8.3%) compared to those without infection before admission (5.0%) (p<0.05). In terms of intervention techniques, the rate of hospital-acquired infections was highest in the group of patients undergoing tracheostomy (3/13 = 23.1%), followed by stomach catheterization (10/62 = 16.1%), urinary catheter (15.8%) and central vascular catheter (6/43 = 14.0%). Patients with HAI had significantly higher days from hospitalization to HAI examination date (mean=12.7 days, SD=11.0) than those without HAI (mean=7.9 days, SD=6.1) (p<0.01).
| Table 2: Demographics, comorbidities, and intervention techniques |
Characteristics |
With HAI |
Without HAI |
Total |
p |
N |
% |
N |
% |
N |
% |
Age group (years)
|
≤17 |
5 |
5.7 |
83 |
94.3 |
88 |
6.1 |
0.39 |
18-29 |
3 |
2.2 |
134 |
97.8 |
137 |
9.5 |
|
30-39 |
5 |
6.7 |
70 |
93.3 |
75 |
5.2 |
|
40-49 |
10 |
8.7 |
105 |
91.3 |
115 |
8 |
|
50-59 |
16 |
6.5 |
231 |
93.5 |
247 |
17.1 |
|
≥60 |
49 |
6.3 |
734 |
93.7 |
783 |
54.2 |
|
Gender
|
Male |
30 |
4.5 |
633 |
95.5 |
663 |
45.4 |
0.03 |
Female |
58 |
7.3 |
740 |
92.7 |
798 |
54.6 |
|
Department group
|
Urology |
6 |
7.9 |
70 |
92.1 |
76 |
5.2 |
<0.01 |
Other internal medicines |
21 |
4.0 |
511 |
96.1 |
498 |
34.9 |
|
Surgical urology |
3 |
4.6 |
62 |
95.4 |
65 |
4.6 |
|
General surgery |
13 |
14.4 |
77 |
85.6 |
90 |
6.3 |
|
Surgical neurology |
5 |
5.2 |
91 |
94.8 |
96 |
6.7 |
|
Other surgery departments |
14 |
5.7 |
230 |
94.3 |
244 |
16.7 |
|
Emergency |
5 |
6.3 |
75 |
93.8 |
80 |
5.5 |
|
Intensive care unit |
14 |
11.6 |
107 |
88.4 |
121 |
8.3 |
|
Others |
7 |
4.4 |
152 |
95.6 |
159 |
10.9 |
|
Having infection before admission
|
No |
51 |
5.0 |
964 |
95.0 |
1015 |
69.5 |
0.02 |
Yes |
37 |
8.3 |
409 |
91.7 |
446 |
30.5 |
|
Comorbidities
|
Chronic respiratory diseases |
10 |
9.4 |
96 |
90.6 |
106 |
7.3 |
0.12 |
Chronic liver diseases |
6 |
7.9 |
70 |
92.1 |
76 |
5.2 |
0.48 |
Heart-related diseases |
35 |
11.2 |
277 |
88.8 |
312 |
21.3 |
<0.01 |
Cancer |
5 |
5.8 |
82 |
94.3 |
87 |
6.0 |
0.91 |
Diabetes |
7 |
4.3 |
155 |
95.7 |
162 |
11.1 |
0.34 |
Chronic kidney diseases |
6 |
6.3 |
90 |
93.7 |
96 |
6.6 |
0.92 |
Multiple injuries |
6 |
22.2 |
21 |
77.8 |
27 |
1.9 |
<0.01 |
High blood pressure |
16 |
7.6 |
194 |
92.4 |
210 |
14.4 |
<0.01 |
Intervention techniques
|
Intrusive mechanical ventilation |
3 |
8.8 |
31 |
91.2 |
34 |
2.3 |
0.49 |
Intubation |
4 |
7.4 |
50 |
92.6 |
54 |
3.7 |
0.66 |
Tracheostomy |
3 |
23.1 |
10 |
76.9 |
13 |
0.9 |
0.01 |
Urinary Catheter |
22 |
15.8 |
117 |
84.2 |
139 |
9.5 |
<0.01 |
Central vascular catheter |
6 |
14.0 |
37 |
86.0 |
43 |
2.9 |
0.03 |
Peripheral intravenous line |
46 |
6.4 |
677 |
93.6 |
723 |
49.4 |
0.58 |
Stomach Catheterization |
10 |
16.1 |
52 |
83.9 |
62 |
4.2 |
<0.01 |
Number of interventions
|
None |
34 |
5.0 |
653 |
95.1 |
687 |
47.0 |
<0.01 |
One intervention |
35 |
5.7 |
583 |
94.3 |
618 |
42.2 |
|
Two interventions |
11 |
11.5 |
85 |
88.5 |
96 |
6.6 |
|
Three interventions or more |
8 |
12.9 |
54 |
87.1 |
62 |
4.2 |
|
|
Mean |
SD |
Mean |
SD |
Mean |
SD |
|
Days from hospitalization to HAI examination date |
12.7 |
11.0 |
7.9 |
6.1 |
8.2 |
6.6 |
<0.01 |
| HAI: Hospital-acquired infection |
Table 3 illustrates that, among those with hospital-acquired infections, the proportion of patients undergoing surgery was 40.9%. The difference in surgery rate between the group with and without hospital-acquired infection was statistically significant (p<0.01). In which, among the group of patients with hospital-acquired infections and surgery, patients mainly underwent planned surgery (52.8%), had an American Society of Anaesthesiologists (ASA) score of 2 (63.9%), used one antibiotic before surgery (44.4%), and two antibiotics after surgery (41.7%).
| Table 3: Hospital-acquired infection according to surgical characteristics |
| Characteristics |
With HAI |
Without HAI |
Total |
p |
N |
% |
N |
% |
N |
% |
Having surgery (n=1463)
|
Yes |
36 |
40.9 |
207 |
15.1 |
243 |
16.6 |
<0.01 |
No |
52 |
59.1 |
1168 |
84.9 |
1220 |
83.4 |
|
Type of operation (n=243)
|
Emergency |
17 |
47.2 |
51 |
24.6 |
68 |
28.0 |
0.01 |
Planned |
19 |
52.8 |
156 |
75.4 |
175 |
72.0 |
|
ASA Score(n=243)
|
1 |
2 |
5.6 |
78 |
40.0 |
80 |
34.6 |
<0.01 |
2 |
23 |
63.9 |
69 |
35.4 |
92 |
39.8 |
|
3 |
4 |
11.1 |
23 |
11.8 |
27 |
11.7 |
|
4 |
7 |
19.4 |
25 |
12.8 |
32 |
13.9 |
|
Number of antibiotics before surgery (n=243)
|
0 |
15 |
41.7 |
87 |
42.0 |
102 |
42.0 |
0.03 |
1 |
16 |
44.4 |
99 |
47.8 |
115 |
47.3 |
|
2 |
1 |
2.8 |
17 |
8.2 |
18 |
7.4 |
|
3 |
4 |
11.1 |
4 |
1.9 |
8 |
3.3 |
|
Number of antibiotics after surgery (n=243)
|
0 |
4 |
11.1 |
7 |
3.4 |
11 |
4.5 |
<0.01 |
1 |
4 |
11.1 |
118 |
57.0 |
122 |
50.2 |
|
2 |
15 |
41.7 |
66 |
31.9 |
81 |
33.3 |
|
3 |
13 |
36.1 |
16 |
7.7 |
29 |
11.9 |
|
| ASA: American Society of Anaesthesiologists; HAI: Hospital-acquired infection |
In univariate regression analysis, Table 4 shows that being females, having infection before admission, having heart-related diseases, multiple injuries, undergoing tracheostomy, urinary catheter, central vascular catheter, stomach catheterization, having surgery, and days from hospitalization to HAI examination date were factors that increased the likelihood of hospital-acquired infections. The results of the multivariable regression model showed that being females (OR=2.01, 95%CI=1.17-3.45), having heart-related diseases (OR=3.60, 95%CI=1.96-6.63), having surgery (OR=7.82, 95%CI=3.80-16.09) and higher days from hospitalization to HAI examination date (OR=1.07, 95%CI=1.04-1.10) were factors associated with a higher likelihood of suffering from HAI. People aged 18-29 were less likely to have HAI compared to those aged below 18 years old (OR=0.17, 95%CI=0.03-0.99).
| Table 4: Associated factors with hospital-acquired infections. |
Characteristics |
Univariate logistic regression |
Multivariate logistic regression |
cOR |
p-value |
95%CI |
aOR |
p-value |
95%CI |
Age groups |
≤17 |
ref |
|
|
|
ref |
|
|
|
18-29 |
0.37 |
0.18 |
0.09 |
1.60 |
0.17 |
0.049 |
0.03 |
0.99 |
30-39 |
1.19 |
0.79 |
0.33 |
4.26 |
0.51 |
0.37 |
0.12 |
2.23 |
40-49 |
1.58 |
0.42 |
0.52 |
4.80 |
0.60 |
0.46 |
0.16 |
2.30 |
50-59 |
1.15 |
0.79 |
0.41 |
3.24 |
0.47 |
0.24 |
0.13 |
1.66 |
≥60 |
1.11 |
0.83 |
0.43 |
2.86 |
0.35 |
0.09 |
0.11 |
1.19 |
Gender |
Male |
ref |
|
|
|
ref |
|
|
|
Female |
1.65 |
0.03 |
1.05 |
2.60 |
2.01 |
0.01 |
1.17 |
3.45 |
Department group |
Other internal medicines |
ref |
|
|
|
ref |
|
|
|
Urology |
2.09 |
0.13 |
0.81 |
5.34 |
3.63 |
0.04 |
1.04 |
12.65 |
Surgical urology |
1.18 |
0.80 |
0.34 |
4.06 |
0.26 |
0.13 |
0.05 |
1.47 |
General surgery |
4.11 |
<0.01 |
1.98 |
8.54 |
2.89 |
0.05 |
0.98 |
8.52 |
Surgical neurology |
1.34 |
0.57 |
0.49 |
3.64 |
1.13 |
0.84 |
0.33 |
3.91 |
Other surgery departments |
1.48 |
0.27 |
0.74 |
2.96 |
0.59 |
0.28 |
0.22 |
1.54 |
Emergency |
1.62 |
0.35 |
0.74 |
2.96 |
0.89 |
0.84 |
0.28 |
2.81 |
Intensive care unit |
3.18 |
<0.01 |
3.57 |
6.46 |
1.33 |
0.55 |
0.52 |
3.41 |
Others |
1.12 |
0.80 |
0.47 |
2.69 |
0.69 |
0.53 |
0.22 |
2.21 |
Having infection before admission |
No |
ref |
|
|
|
ref |
|
|
|
Yes |
1.71 |
0.02 |
1.10 |
2.65 |
1.66 |
0.06 |
0.98 |
2.82 |
Comorbidities (Yes vs No-ref) |
Chronic respiratory diseases |
1.71 |
0.13 |
0.86 |
3.41 |
1.99 |
0.11 |
0.86 |
4.61 |
Chronic liver diseases |
1.36 |
0.48 |
0.58 |
3.23 |
2.71 |
0.05 |
1.01 |
7.29 |
Heart-related diseases |
2.62 |
<0.01 |
1.67 |
4.09 |
3.60 |
<0.01 |
1.96 |
6.63 |
Cancer |
0.95 |
0.91 |
0.37 |
2.41 |
1.04 |
0.94 |
0.34 |
3.24 |
Diabetes |
0.68 |
0.34 |
0.31 |
1.50 |
0.68 |
0.40 |
0.27 |
1.68 |
Chronic kidney diseases |
1.04 |
0.92 |
0.44 |
2.46 |
0.47 |
0.22 |
0.14 |
1.56 |
Multiple injuries |
4.72 |
<0.01 |
1.85 |
12.01 |
3.41 |
0.06 |
0.97 |
12.04 |
High blood pressure |
1.35 |
0.29 |
0.77 |
2.37 |
1.58 |
0.20 |
0.78 |
3.17 |
Intervention techniques (Yes vs No-ref) |
Intrusive mechanical ventilation |
1.53 |
0.49 |
0.46 |
5.11 |
0.45 |
0.48 |
0.05 |
4.16 |
Intubation |
1.26 |
0.66 |
0.45 |
3.58 |
0.19 |
0.07 |
0.03 |
1.15 |
Tracheostomy |
4.82 |
0.02 |
1.30 |
17.83 |
3.80 |
0.17 |
0.55 |
26.07 |
Urinary catheter |
3.58 |
<0.01 |
2.13 |
6.02 |
1.55 |
0.27 |
0.72 |
3.33 |
Central vascular catheter |
2.65 |
0.03 |
1.09 |
6.45 |
2.34 |
0.25 |
0.56 |
9.84 |
Peripheral intravenous line |
1.13 |
0.58 |
0.73 |
1.74 |
0.75 |
0.31 |
0.43 |
1.31 |
Stomach Catheterization |
3.26 |
<0.01 |
1.60 |
6.66 |
1.76 |
0.31 |
0.59 |
5.21 |
Having surgery |
No |
ref |
|
|
|
ref |
|
|
|
Yes |
3.91 |
<0.01 |
2.49 |
6.13 |
7.82 |
<0.01 |
3.80 |
16.09 |
Days from hospitalization to HAI examination date (per day) |
1.07 |
<0.01 |
1.05 |
1.10 |
1.07 |
<0.01 |
1.04 |
1.10 |
| HAI: Hospital-acquired infection; cOR: crude Odds Ratio; aOR: adjusted Odds Ratio; ref: Reference group |
Discussion
The results of the study showed that the hospital-acquired infection rate in the study hospital was low. Groups at high risk of infection included female patients, patients with heart-related diseases, patients undergoing surgery, and patients having higher days from hospitalization to HAI examination date. These results supported the development of appropriate intervention strategies for this hospital as well as for hospitals with similar characteristics.
In this study, the point-prevalence of hospital-acquired infection was 6.0%. Our results could be compared with other countries and regions in the world such as Europe (7.1% in 2010) (18), Japan (7.4% in 2018) (19), or the US (3.2% in 2015) (20). This result is significantly lower than other previous studies in Vietnam. A prior study in the ICUs of 3 pediatric hospitals showed that the hospital-acquired infection rate was 33.1% (14.8%-50.3%) (14). Another study in 15 ICUs at 15 hospitals found this rate to be 29.5% (5.6%-60.9%) (15). Such significant variation could be attributed to the study settings where these studies were conducted in ICUs, while our study carried out a hospital-wide assessment. This led to differences in patient characteristics, disease status, as well as different characteristics of hospitals. Even so, the hospital-acquired infection rate in ICUs in this study was 5.0%, which was also much lower than in those studies.
The infection rate in large hospitals (>1500 beds) in these previous studies was much higher than in this study (14, 15). This can be explained by the fact that these studies were conducted before 2016 when hospital-acquired infection control policies were not implemented systematically and rigorously. In 2017 and 2018, the Vietnam Ministry of Health issued guidelines and regulations for infection control in medical examination and treatment facilities (16, 17), creating detailed legal frameworks and guidelines for infection control implementation in hospitals. However, according to an internal hospital report, the hospital-acquired infection rate tended to increase from 3.6% in 2017 (unpublished document), 5.9% in 2018, and 6.1% in 2019. This might be explained by the matter that the hospital size increased during those years, resulting in the increasing number of inpatients and surgical patients, thereby increasing the number of patients with a high risk of hospital-acquired infections. In addition, the rate of hospital-acquired infections might be underestimated because the proportion of patients tested for bacterial cultures was not high. Notably, the results of this study showed no difference in the rate of nosocomial infections in different departments, suggesting that the risk of nosocomial infections is similar across departments and units; therefore, there is a need for a universal and hospital-wide hospital infection prevention strategy. Overall, although the rate of hospital-acquired infections was low, the increase in this rate over the years raised the need for other studies to develop and evaluate the effectiveness of interventions to limit the increasing prevalence of hospital-acquired infections.
Results in this study showed that surgical site infections and respiratory infections were the most common types of hospital-acquired infections. This result was similar to studies in Vietnam and around the world (14, 15, 18, 20, 21). In addition, this study found that gram-negative bacteria were the most common, including Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter spp., similar to other studies in developing countries (22-24). This suggests that future prevention strategies should focus on these two hospital-acquired infections.
The results of the multivariate regression analysis showed the groups of patients at high risk of hospital-acquired infections, thereby helping to determine the optimal intervention strategies in the prevention and control of hospital-acquired infections. This study was similar to previous studies in that in-patients undergoing surgery were among the patient groups at the highest risk of hospital-acquired infections (7, 18, 21, 25). This might be due to the nature of the treatment in these patients making them susceptible to exposure to hospital-acquired bacteria, which in turn lead to hospital-acquired infection through surgical sites.
The finding also indicated that prolonged hospital stay was associated with a higher likelihood of having HAI, which was in line with prior literature (26-28). Long-term hospital stays could be attributed to the severity of the disease as well as the complexity of the interventions, which were factors that are significantly associated with nosocomial infections. In addition, such a long hospital stay might increase the susceptibility of patients to hospital-acquired bacteria and put them at risk for nosocomial infections (29). Notably, the study found that people with heart-related diseases were at the highest risk of hospital-acquired infections compared to those with other medical conditions. The reason might be not clear; however, we suggest that this may be due to the fact that these patients often receive long-term hospital treatment, thereby increasing their risk of nosocomial infections. Indeed, these patients had a longer hospital stay than patients without this condition (data not shown).
This study has some limitations. Firstly, the study was conducted in one hospital in an urban area; hence, the study results might not be representative of other hospitals with different organizational characteristics and sizes. Second, this study assessed the point-prevalence through cross-sectional surveys; therefore, the results only reflected the prevalence of hospital-acquired infections at the time of the survey. Third, the study might under or overestimate the prevalence of hospital-acquired infections in patients with latent infections.
Conclusion
The study showed a low point-prevalence of hospital-acquired infections; however, this percentage gradually increased over the years. Future interventions should focus on the prevention and control of hospital-acquired infections in patients undergoing surgery or tracheostomy and in patients with hypertension, as well as infection control in medical devices.
Competing Interests: Authors declare no conflict of interest.
References
- Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. American Journal of Infection Control. 1988;16(3):128-40.
- Sheng WH, Chie WC, Chen YC, Hung CC, Wang JT, Chang SC. Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients. Journal of the Formosan Medical Association = Taiwan yi zhi. 2005;104(5):318-26.
- Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine. 2017;7(5):478-82.
- WHO. Guideline for the prevention of nosocomial infection in healthcare facilities in resource limited settings. Geneva, Switzerland; 1999.
- WHO. Report on the Burden of Endemic Health Care-Associated Infection Worldwide. Geneva, Switzerland; 2011.
- American TS. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416.
- Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate Point-Prevalence Survey of Health Care-Associated Infections. 2014;370(13):1198-208.
- French GL, Wong SL, Cheng AFB, Donnan S. Repeated Prevalence Surveys for Monitoring Effectiveness of Hospital Infection Control. The Lancet. 1989;334(8670):1021-3.
- Humphreys H, Smyth ET. Prevalence surveys of healthcare-associated infections: what do they tell us, if anything? Clinical Microbiology and Infection: The official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2006;12(1):2-4.
- Glenister HM, Taylor LJ, Bartlett CLR, Cooke EM, Sedgwick JA, Mackintosh CA. An evaluation of surveillance methods for detecting infections in hospital inpatients. Journal of Hospital Infection. 1993;23(3):229-42.
- NNISN. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 to June 2002, issued August 2002. American Journal of Infection Control. 2002;30(8):458-75.
- Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infection Control and Hospital Epidemiology. 2000;21(8):510-5.
- Eckmanns T, Bessert J, Behnke M, Gastmeier P, Ruden H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infection Control and Hospital Epidemiology. 2006;27(9):931-4.
- Le NK, HF W, Vu PD, Khu DTK, Le HT, Hoang BTN, et al. High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey. Medicine. 2016;95(27):e4099.
- Phu VD, Wertheim HF, Larsson M, Nadjm B, Dinh QD, Nilsson LE, et al. Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units. PLoS ONE. 2016;11(1):e0147544.
- Circular 16/2018/TT-BYT dated July 20, 2018 regulating infection control in medical examination and treatment establishments. 2018.
- Decision No. 3916/QD-BYT dated August 28, 2017 approving the Guidelines for infection control in medical examination and treatment facilities. 2017.
- Zarb P, Coignard B, Griskeviciene J, Muller A, Vankerckhoven V, Weist K, et al. The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. Euro surveillance: Bulletin Europeen sur les maladies transmissibles = European Communicable Disease Bulletin. 2012;17(46).
- Komagamine J, Yabuki T, Kobayashi M, Okabe T. Prevalence of antimicrobial use and active healthcare-associated infections in acute care hospitals: a multicentre prevalence survey in Japan. BMJ Open. 2019;9(6):e027604.
- Magill SS, O'Leary E, Janelle SJ, Thompson DL, Dumyati G, Nadle J, et al. Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. New England Journal of Medicine. 2018;379(18):1732-44.
- Chen Y, Zhao JY, Shan X, Han XL, Tian SG, Chen FY, et al. A point-prevalence survey of healthcare-associated infection in fifty-two Chinese hospitals. The Journal of Hospital Infection. 2017;95(1):105-11.
- Allegranzi B, Bagheri NS, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet (London, England). 2011;377(9761):228-41.
- Erdem H, Inan A, Altındis S, Carevic B, Askarian M, Cottle L, et al. Surveillance, control and management of infections in intensive care units in Southern Europe, Turkey and Iran- a prospective multicenter point prevalence study. The Journal of Infection. 2014;68(2):131-40.
- Barrera L, Zingg W, Mendez F, Pittet D. Effectiveness of a hand hygiene promotion strategy using alcohol-based hand rub in 6 intensive care units in Colombia. American Journal of Infection Control. 2011;39(8):633-9.
- Huang G, Huang Q, Zhang G, Jiang H, Lin Z. Point-prevalence surveys of hospital-acquired infections in a Chinese cancer hospital: From 2014 to 2018. Journal of Infection and Public Health. 2020;13(12):1981-7.
- Ali S, Birhane M, Bekele S, Kibru G, Teshager L, Yilma Y, et al. Healthcare associated infection and its risk factors among patients admitted to a tertiary hospital in Ethiopia: longitudinal study. Antimicrobial Resistance & Infection Control. 2018;7(1):2.
- Askarian M, Yadollahi M, Assadian O. Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, Iran. Journal of Infection and Public Health. 2012;5(2):169-76.
- Zhao X, Li S, Sun X, Liu S, Duan F. Risk factors for hospital-acquired infection in cancer patients in a central Chinese hospital. American Journal of Infection Control. 2016;44(9):e163-5.
- Monegro AF, Muppidi V, Regunath H. Hospital Acquired Infections. StatPearls. Treasure Island (FL): StatPearls Publishing LLC. 2021.
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