Incidence and risk factors for hospital-acquired infection among paediatric patients in a teaching hospital: a prospective study in southeast Ethiopia.
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ABSTRACT: Objectives
In order to maximise the prevention of hospital-acquired infections (HAIs) and antimicrobial resistance, data on the incidence of HAIs are crucial. In Ethiopia, data about the occurrence of HAIs among hospitalised paediatric patients are lacking. We aim to determine the incidence and risk factors of HAIs among paediatric patients in Ethiopia.Design
A prospective cohort study.Setting
A teaching hospital in southeast Ethiopia.Participants
448 hospitalised paediatric patients admitted between 1 November 2018 and 30 June 2019.Primary and secondary outcome measures
Incidence and risk factors of hospital-acquired infections.Results
A total of 448 paediatric patients were followed for 3227 patient days. The median age of the patients was 8 months (IQR: 2-26 months). The incidence rate of HAIs was 17.7 per 1000 paediatric days of follow-up; while the overall cumulative incidence was 12.7% (95% CI 9.8% to 15.8%) over 8 months. Children who stayed greater than 6 days in the hospital (median day) (adjusted risk ratio (RR): 2.58, 95% CI 1.52 to 4.38), and children with underlying disease conditions of severe acute malnutrition (adjusted RR: 2.83, 95% CI 1.61 to 4.97) had higher risks of developing HAIs.Conclusions
The overall cumulative incidence of HAIs was about 13 per 100 admitted children. Length of stay in the hospital and underlying conditions of severe acute malnutrition were found to be important factors associated with increased risk of HAIs.
SUBMITTER: Sahiledengle B
PROVIDER: S-EPMC7747586 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundHospital-acquired infection affects hundreds of millions of people worldwide. It is a major global issue for patient safety. Understanding the potential risk factors is important to appreciate the local context. A matched case control study design, which is the first of its kind in the study region, was undertaken to identify risk factors in teaching hospitals of Amhara regional state, Ethiopia.MethodA matched case control study design matched with age and hospital type was used. The study was conducted in University of Gondar and Felege-Hiwot medical teaching hospital. Cases were patients who fulfilled the criteria based on CDC definition of hospital-acquired infection and controls were patients admitted to the hospital that stayed for more than 48 hours in the ward in the study period, but who did not develop infection. For one case, four controls were selected. Of 545 patients, 109 were cases and 436 were controls. Conditional logistic regression using STATA 13 was used for data analysis.ResultThe median length of stay for cases and controls was 7 and 8 days, respectively. Patients admitted in wards with the presence of medical waste container in the room had 82% less chance of developing hospital-acquired infection (AOR 0.18; 95% CI, 0.03-0.98). The odds of developing hospital-acquired infection among immune deficient patients were 2.34 times higher than their counterparts (95% CI; 1.17-4.69). Patients received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively.ConclusionHealth providers and mangers should consider the provision and availability of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients, and give attention to the immunocompromised patients for the prevention and control of hospital-acquired infections.
| S-EPMC5515417 | biostudies-literature
Project description:BackgroundIn sub-Saharan Africa, community-acquired bacteraemia is an important cause of illness and death in children. Our aim was to establish the magnitude and causes of hospital-acquired (nosocomial) bacteraemia in African children.MethodsWe reviewed prospectively collected surveillance data of 33,188 admissions to Kilifi District Hospital, Kenya, between April 16, 2002, and Sept 30, 2009. We defined bacteraemia as nosocomial if it occurred 48 h or more after admission. We estimated the per-admission risk, daily rate, effect on mortality, and microbial cause of nosocomial bacteraemia and analysed risk factors by multivariable Cox regression. The effect on morbidity was measured as the increase in hospital stay by comparison with time-matched patients without bacteraemia.FindingsThe overall risk of nosocomial bacteraemia during this period was 5·9/1000 admissions (95% CI 5·2-6·9) but we recorded an underlying rise in risk of 27% per year. The incidence was 1·0/1000 days in hospital (0·87-1·14), which is about 40 times higher than that of community-acquired bacteraemia in the same region. Mortality in patients with nosocomial bacteraemia was 53%, compared with 24% in community-acquired bacteraemia and 6% in patients without bacteraemia. In survivors, nosocomial bacteraemia lengthened hospital stay by 10·1 days (3·0-17·2). Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter spp, group D streptococci, and Pseudomonas aeruginosa accounted for three-quarters of nosocomial infections. Nosocomial bacteraemia was significantly associated with severe malnutrition (hazard ratio 2·52, 95% CI 1·79-3·57) and blood transfusion in children without severe anaemia (4·99; 3·39-7·37).InterpretationOur findings show that although nosocomial bacteraemia is rare, it has serious effects on morbidity and mortality, and the microbiological causes are distinct from those of community-acquired bacteraemia. Nosocomial infections are largely unrecognised or undocumented as a health risk in low-income countries, but they are likely to become public health priorities as awareness of their occurrence increases and as other prominent childhood diseases are progressively controlled.FundingWellcome Trust.
| S-EPMC3242162 | biostudies-literature
Project description:BackgroundSocial and hospital environmental factors that may be associated with hospital-acquired pneumonia (HAP) have not been evaluated. Comprehensive risk assessment for the incidence of HAP including sociodemographic, clinical, and hospital environmental factors was conducted using national health insurance claims data.MethodsThis is a population-based retrospective cohort study of adult patients who were hospitalized for more than 3 days from the Health Insurance Review and Assessment Service-National Inpatient Sample data between January 1, 2016 and December 31, 2018 in South Korea. Multivariable logistic regression analyses were conducted to identify the factors associated with the incidence of HAP.ResultsAmong the 512,278 hospitalizations, we identified 25,369 (5.0%) HAP cases. In multivariable analysis, well-known risk factors associated with HAP such as older age (over 70 vs. 20-29; adjusted odds ratio [aOR], 3.66; 95% confidence interval [CI] 3.36-3.99), male sex (aOR, 1.35; 95% CI 1.32-1.39), pre-existing lung diseases (asthma [aOR, 1.73; 95% CI 1.66-1.80]; chronic obstructive pulmonary disease [aOR, 1.62; 95% CI 1.53-1.71]; chronic lower airway disease [aOR, 1.79; 95% CI 1.73-1.85]), tube feeding (aOR, 3.32; 95% CI 3.16-3.50), suctioning (aOR, 2.34; 95% CI 2.23-2.47), positioning (aOR, 1.63; 95% CI 1.55-1.72), use of mechanical ventilation (aOR, 2.31; 95% CI 2.15-2.47), and intensive care unit admission (aOR, 1.29; 95% CI 1.22-1.36) were associated with the incidence of HAP. In addition, poverty (aOR, 1.08; 95% CI 1.04-1.13), general hospitals (aOR, 1.54; 95% CI 1.39-1.70), higher bed-to-nurse ratio (Grade ≥ 5; aOR, 1.45; 95% CI 1.32-1.59), higher number of beds per hospital room (6 beds; aOR, 3.08; 95% CI 2.77-3.42), and ward with caregiver (aOR, 1.19; 95% CI 1.12-1.26) were related to the incidence of HAP.ConclusionsThe incidence of HAP was associated with various sociodemographic, clinical, and hospital environmental factors. Thus, taking a comprehensive approach to prevent and treat HAP is important.
| S-EPMC8753882 | biostudies-literature
Project description:BackgroundThe mortality and neurologic sequelae associated with acute bacterial meningitis (ABM) remain high despite advances in medical care. The main aim of this study was to evaluate short-term outcome in patients treated as bacterial meningitis at a teaching hospital in Ethiopia to identify factors that could be focused on to improve outcome in this setting.MethodsA hospital based longitudinal study was conducted at Jimma University Hospital in southwest Ethiopia from March 1, 2013 to December 31, 2015. Participants of this study were patients of age 18 years and older who were treated as confirmed or possible cases of ABM. Patients were followed throughout their hospital stay for change in their clinical course and predefined end points. A multivariable analysis was done to identify factors associated with unfavorable outcomes.Result90 patients admitted with diagnosis of acute bacterial meningitis were included in the study; cerebrospinal fluid was analysed for 85 (94.4%) of them. Causative bacteria were isolated in 26 (28.9%) patients only; most of these isolates (84.6%) were either Streptococcus pneumoniae or Neisseria meningitidis. Patients managed as cases of ABM at the hospital suffered from a high rate of unfavorable outcome (36.7%) and an overall mortality rate of 22.2%. Impaired level of consciousness (AOR = 0.766, 95% CI = 0.589-0.995), dexamethasone therapy (AOR = 4.676, 95% CI = 1.12-19.50) and fever persisting after two days of admission (AOR = 24.226, 95% CI = 5.24-111.96) were found to be independently associated with unfavorable outcome.ConclusionOutcome in patients treated for ABM at the hospital was found to be poor. Impaired mentation, treatment with adjunctive dexamethasone and persistent fever were found to be associated with poor outcome. Thus, development of clinical guidelines for treatment of ABM that suit the local context is essential to improve patient management and outcome.
| S-EPMC6051621 | biostudies-literature
Project description:BackgroundEthiopia is among sub-Saharan African countries with a high number of malaria cases each year, with most of the landmass favoring the breeding of the vectors. There have been extensive efforts to control and prevent the transmission of malaria, which is part of the country's prevention-based health policy.ObjectiveThis study aimed to determine malaria prevalence and associated risk factors among patients visiting Mizan-Tepi University Teaching Hospital (MTUTH).Materials and methodsA cross-sectional study was conducted from September to December 2021 among patients visiting MTUTH, Southwest Ethiopia. A pretested structured questionnaire was used to collect sociodemographic data, and a capillary blood sample was collected after obtaining written informed consent from the study participants. The data were entered into Epi-data manager (v4.0.2.101) and analyzed with SPSS version 25.0, with a P-value of < 0.05 set as a significance.ResultsA total of 439 patients participated, of which 20.7% (91) were positive for malaria parasites, with a higher prevalence observed among the age group interval of 25-34 years (5.5%). Inadequate access to insecticide-treated bed net (ITN) 23.9% (105) and a low level of ITN usage 20.5% (90) were recorded. Patients living in areas of stagnant water were more likely to get infected with the malaria parasite (AOR = 16.191, 95% CI: 9.137, 28.692) compared to those who live away from stagnant water, and individuals living in houses not sprayed with insecticides were more susceptible to malaria infection (AOR = 0.215, 95% CI: 0.128, 0.360).ConclusionThe overall malaria prevalence in this study was 20.7% (91), which proves that malaria remains a major threat to the communities in the study area, with Plasmodium falciparum contributing to most of the cases. Improving the habits of ITN usage and indoor residual spray through health education may help to reduce the impact of malaria in the study area.
| S-EPMC9333314 | biostudies-literature
Project description:Coronavirus disease 2019 (COVID-19) is usually less severe in children compared to adults. This study describes detailed clinical characteristics, treatment and outcomes of children with COVID-19 in a non-hospitalised and hospitalised setting and quantifies factors associated with admission to hospital and intensive care unit in children with SARS-CoV-2 infection on a nationwide level. Data were collected through the Swiss Paediatric Surveillance Unit from children < 18 years with confirmed SARS-CoV-2 infection. All 33 paediatric hospitals in Switzerland reported non-hospitalised and hospitalised cases from March 1 to October 31, 2020 during both pandemic peaks. In total, 678 children were included. The median age was 12.2 years (IQR 5.0-14.6), 316 (46.6%) were female and 106 (15.6%) had comorbidities. Overall, 126 (18.6%) children were hospitalised of whom 16 (12.7%) required ICU admission. Comorbidities were the only factor associated with hospital admission in a multivariable regression analysis (odds ratio 3.23, 95%CI 1.89 to 5.50; p-value < 0.01). Children with preexisting comorbidities did not require ICU admission more often. Hospitalised children more often presented with fever (96 [76.2%] vs 209 [38.1%], p-value < 0.01) and rash (16 [12.8%] vs 6 [1.1%], p-value < 0.01). Anosmia/dysgeusia was more prevalent in non-hospitalised children (73 [13.3%] vs 3 [2.4%], p-value < 0.01). In hospitalised children, oxygen treatment was required in 34 (27.0%), inotropes in nine (7.3%) and mechanical ventilation in eight (6.3%) cases. Complications were reported in 28 (4.1%) children with cardiovascular complications being most frequent (12 [1.8%]). Three deaths were recorded.Conclusion: This study confirms that COVID-19 is mostly a mild disease in children. Fever, rash and comorbidities are associated with higher admission rates. Continuous observation is necessary to further understand paediatric COVID-19, guide therapy and evaluate the necessity for vaccination in children. What is Known: • Clinical manifestations of SARS-CoV-2 infection in children vary from asymptomatic to critical disease requiring intensive care unit admission. • Most studies are based on hospitalised children only; currently, there is limited data on non-hospitalised children. What is New: • The clinical spectrum and severity of COVID-19 is influenced by age: in children less than 2 years, fever, cough and rhinorrhoea are the most common symptoms and in adolescents, fever, cough and headache are more common. • Hospitalised children more often presented with fever and rash, while anosmia/dysgeusia is more prevalent in non-hospitalised children. • Children with pre-existing comorbidities are more frequently hospitalised but do not require ICU admission more often.
| S-EPMC8628837 | biostudies-literature
Project description:The disease burden and outcomes of community-acquired (CA-) and hospital-acquired acute kidney injury (HA-AKI) are not well understood. The aim of the study was to investigate the incidence, outcomes, and risk factors of AKI in a large Taiwanese adult cohort.This retrospective cohort study examined 734,340 hospital admissions from a group of hospitals within an organization in Taiwan between January 1, 2010 and December 31, 2014. Patients with AKI at discharge were classified as either CA- or HA-AKI based on the RIFLE (risk, injury, failure, loss of function, end stage of kidney disease) classification criteria. Outcomes were in-hospital mortality, dialysis, recovery of renal function, and length of stay. Risks of developing AKI were determined using multivariate logistic regression based on demographic and baseline clinical characteristics and nephrotoxin use before admission.AKI occurred in 1.68% to 2% hospital discharges among adults without and with preexisting chronic kidney disease (CKD), respectively. The incidence of CA-AKI was 17.25 and HA-AKI was 8.14 per 1000 admissions. The annual rate of CA-AKI increased from 12.43 to 19.96 per 1000 people, but the change in HA-AKI was insignificant. Comparing to CA-AKI, those with HA-AKI had higher levels of in-hospital mortality (26.07% vs 51.58%), mean length of stay (21.25?±?22.35 vs 35.84?±?34.62 days), and dialysis during hospitalization (1.45% vs 2.06%). Preexisting systemic diseases, including CKD were associated with increased risks of CA-AKI, and nephrotoxic polypharmacy increased risk of both CA- and HA-AKI.Patients with HA-AKI had more severe outcomes than patients with CA-AKI, and demonstrated different spectrum of risk factors. Although patients with CA-AKI with better outcomes, the incidence increased over time. It is also clear that optimal preventive and management strategies of HA- and CA-AKI are urgently needed to limit the risks in susceptible individuals.
| S-EPMC4902543 | biostudies-literature
Project description:Background:World Health Organization and Centers for Disease Control and Prevention recommend all health professionals to get vaccinated against hepatitis B virus before they start the clinical attachments during their stay in the medical school. However, only 18-39% of healthcare workers in low- and middle-income countries received the vaccine. Therefore, this study aims to determine the attitude and vaccination status of health professionals working at Adama General Hospital and Medical College. Methods:An institution-based cross-sectional study was conducted from December 2016 to February 2017 with 403 health professionals working at Adama General Hospital and Medical College. Data were collected using self-administered questionnaire distributed at the participant's work unit and analyzed using SPSS version 20. Multiple logistic regression analysis was conducted to identify factors that affect the complete vaccination status and p value < 0.05 was considered statistically significant. Result:The prevalence of complete vaccination against hepatitis B virus was 25.6%. The most frequently mentioned reasons for not being vaccinated were high cost of the vaccine (41%) and unavailability of the vaccine (36%). More than three-fourths (77.8%) of study participants strongly agreed that hepatitis B is a major public health threat and there was tendency among participants to believe that their profession will put them at increased risk of acquiring the disease (strongly agreed: 75.9%). Attending infection-prevention training [AOR = 2.3; 95% CI, 1.24-6.31], history of exposure to risky behavior [AOR = 5.5; 95% CI, 2.86-9.29], and long years of work experience [AOR = 3.1; 95% CI, 1.98-5.24] were statistically significant with complete vaccination status. Conclusion:Only one-quarter of health professionals received the recommended full dose of the vaccine. Sustained hepatitis B vaccination programs for healthcare workers need to be established by collaboration of different stakeholders to optimize health professionals' safety against this contagious infection.
| S-EPMC5901831 | biostudies-literature
Project description:BACKGROUND:Hospital-Acquired Infections (HAIs) are acquired when the patient is hospitalized for more than 48 hours. In Ethiopia data are scarce in management appropriateness of HAIs. Hence, this study was aimed to assess the prevalence and management of HAIs among patients admitted at Zewditu Memorial Hospital. METHOD:A facility based prospective cross sectional study was conducted from March 1, 2017 to August 30, 2017. The sample was proportionally allocated among (medical, pediatrics, gynecology and obstetrics and surgical) wards, based on patient flow. Data were collected using data abstraction format and supplemented by key informant interview. Interview was made on eight physicians and four microbiologists who have been working in the wards during study period. Management appropriateness was assessed using Infectious Disease Society of America guideline and experts opinion (Infectious disease specialist). A multivariate logistic regression was used to identify factors associated with HAIs. RESULT:The prevalence of HAIs was 19.8%. Surgical Site Infection (SSI) and pneumonia accounted for 20 (24.7%) of the infections. Culture and sensitivity was done for 24 (29.6%) patients. Of the 81 patients who developed HAIs, 54 (66.67%) of them were treated inappropriately. Physicians' response for this variation was information gap, forgetfulness, affordability and availability issue of first line medications. Younger age (AOR (Adjusted odds ratio) = 8.53, 95% CI: 2.67-27.30); male gender (AOR = 2.06, 95% CI: 1.01-4.22); longer hospital stay (AOR = 0.17, 95% CI: 0.06-0.51); and previous hospital admission (AOR = 3.22, 95% CI: 1.76-5.89); were independent predictors of HAIs. CONCLUSION:Prevalence of HAIs and inappropriate management were substantially high in this study. Pneumonia and SSI were the common types of HAIs. Locally conformable guidelines could help to correct such problems.
| S-EPMC7182178 | biostudies-literature
Project description:BackgroundNeedle stick and sharps injuries are occupational hazards to healthcare workers. Every day healthcare workers are exposed to deadly blood borne pathogens through contaminated needles and other sharp objects. About twenty blood borne pathogens can be transmitted through accidental needle stick and sharp injury. The study was conducted to determine the lifetime and past one year prevalence of needle stick and sharps injuries and factors associated with the past one year injuries among hospital healthcare workers in Southeast Ethiopia.MethodsAn institutional based cross sectional study was conducted in December 2014 among healthcare workers in four hospitals of Bale zone, Southeast of Ethiopia. A total of 362 healthcare workers were selected randomly from each department in the hospitals. Data were collected using self-administered questionnaire. The collected data were entered into Epi-Info version 3.5 and analyzed using SPSS version 20.0. Multivariable logistic regression analysis was used to identify the independent effect of each independent variable on the outcome variable. Written informed consent was secured from the participants.ResultsThe prevalence of lifetime needle stick and sharp injury was 37.1% with 95% CI of 32.0% to 42.5%. The prevalence of injury within the past one year was 19.1% with 95% CI of 14.9% to 23.3%. Emergency ward was a department with highest needle stick and sharp injury (31.7%). The main cause of injury was syringe needles (69.8%). Participants who practiced needle recapping had higher odds of needle stick and sharp injury within the past 12 months (AOR = 3.23, 95% CI: 1.78, 5.84) compared to their counterparts.ConclusionsNearly one out of five respondents had experienced needle stick and/or sharp injury at least once within past one year. There were practices and behaviors that put healthcare workers at risk of needle stick and sharp injury at the study area. Needle recapping was key modifiable risk behavior. Health policy makers and hospital administrators should formulate strategies to improve the working condition for healthcare workers and increase their adherence to universal precautions.
| S-EPMC4607483 | biostudies-literature