The prevalence, associated factors, patterns and outcomes of health care associated infections in patients admitted in medical wards at Bugando Medical Center, Mwanza, Tanzania
Maliha Ismail Kassam [Female]
The prevalence, associated factors, patterns and outcomes of health care associated infections in patients admitted in medical wards at Bugando Medical Center, Mwanza, Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS – Bugando] : 2022 - xv; 94 Pages Includes References and Appendices
Abstract:
Introduction: Health care associated infections (HCAIs) are a major largely preventable cause of morbidity and mortality worldwide. It is well documented that; bacteria are the leading cause of HCAIs and majority are multidrug resistant. Therefore, threatening the effectiveness of empirical therapy and associated with increased days of hospitalization, healthcare costs, morbidity and mortality. The magnitude of HCAI in low – and middle-income countries is on the rise and varies from 2.5% - 14.8% while in Europe it is 7.1%. Most of these data were collected from surgical wards, less is known about the magnitude of HCAI in medical ward. Previous studies done at BMC focused on surgical site infections as part of HCAI, and the prevalence was 65% in patients at surgical wards. Another study in Bugando Medical Centre showed a cumulative incidence of 10.6% of surgical site infections in women who underwent cesarean section. Little is known about the medical wards at BMC.
Objective: To determine the prevalence of health care associated infections; their patterns, associated factors and outcomes in adults admitted at medical wards at Bugando Medical Centre.
Methodology: This was a prospective study conducted in the adult medical wards of Bugando Medical Centre. From March 2022 – June 2022. Baseline information for each patient was obtained from patient and patients’ relatives in case the patient was unable to provide information. Consent forms were provided, and the aim of the study was explained. Face to face interviews was conducted using the structured questionnaires by the investigator herself, including history taking and physical examination. Full blood count, urinalysis was be done and chest x-ray for patient presenting with respiratory system symptoms. After 48 hours patients who were eligible for enrolment in the study (patient with no infection), were followed up in daily basis to examine if the develop HCAIs until they were discharged (home or mortuary). When they developed HCAIs, appropriate samples (e.g. urine for urinary tract infections) were collected and sent to Microbiology laboratory at CUHAS for processing (culture and sensitivity). Culture and sensitivity results were used for appropriate rational therapy. Data was recorded in a collecting sheet and analysis was done as per objective using STATA version 17.0 software. Primary outcome was prevalence of the health care associated infections; secondary outcomes were mortality associated with health care associated infection.
Results: We had 350 patients enrolled and 30 (8.6%) developed HCAI while admitted in the hospital. Out of 30, 9(30%) were culture positive with predominance of E. coli 33.3%. The prevalence of HCAI was significantly higher in bedridden patients at 17%. HCAI was significantly higher among patients with multiple indwelling devices than those with single device (13.9% vs 4.9%). For every year increase in age, the odds of HCAI significantly increase by 2%. Mortality had BSI 43.3% (13/30), followed by UTI 36.7% (11/30) then unidentified source of infections 10% (3/30). Among 9 patients with a positive culture result. The most common isolated organisms were E. coli (33.3%), S. aureus (22.2%), S. pyogenes (11%), Acinetobacter (11%), P. aeruginosa (11.1%). Gram negative bacteria being more prominent than Gram positive, 55.5% and 33.3% respectively. For every day increase in hospital stay, the odds of HCAI significantly increase by 92%. The odds of mortality were more than twice higher among patients with HCAI compared to their counterparts.
Conclusion: In our study the prevalence of HCAI was 8.6%. 30% of these HCAI were culture positive. Gram negative bacteria were prominent 55.5% and they were multidrug resistance bugs. HCAI was associated with longer duration of hospital stay. Most common HCAI was BSI 43.3%. HCAI increase mortality by 2 folds. This shows that even in medical ward HCAI id a problem and needs attention.
Implication: These data are important for improving clinician’s awareness of health care associated infections, its patterns, associated factors and outcomes in terms of their mortality and duration of hospital stay among admitted patients. The data will provide baseline data for future quality improvement projects to improve treatment, outcomes and reduce HCAI-related morbidity and mortality.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : Website: www.bugando.ac.tz
--Internal Medicine
The prevalence, associated factors, patterns and outcomes of health care associated infections in patients admitted in medical wards at Bugando Medical Center, Mwanza, Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS – Bugando] : 2022 - xv; 94 Pages Includes References and Appendices
Abstract:
Introduction: Health care associated infections (HCAIs) are a major largely preventable cause of morbidity and mortality worldwide. It is well documented that; bacteria are the leading cause of HCAIs and majority are multidrug resistant. Therefore, threatening the effectiveness of empirical therapy and associated with increased days of hospitalization, healthcare costs, morbidity and mortality. The magnitude of HCAI in low – and middle-income countries is on the rise and varies from 2.5% - 14.8% while in Europe it is 7.1%. Most of these data were collected from surgical wards, less is known about the magnitude of HCAI in medical ward. Previous studies done at BMC focused on surgical site infections as part of HCAI, and the prevalence was 65% in patients at surgical wards. Another study in Bugando Medical Centre showed a cumulative incidence of 10.6% of surgical site infections in women who underwent cesarean section. Little is known about the medical wards at BMC.
Objective: To determine the prevalence of health care associated infections; their patterns, associated factors and outcomes in adults admitted at medical wards at Bugando Medical Centre.
Methodology: This was a prospective study conducted in the adult medical wards of Bugando Medical Centre. From March 2022 – June 2022. Baseline information for each patient was obtained from patient and patients’ relatives in case the patient was unable to provide information. Consent forms were provided, and the aim of the study was explained. Face to face interviews was conducted using the structured questionnaires by the investigator herself, including history taking and physical examination. Full blood count, urinalysis was be done and chest x-ray for patient presenting with respiratory system symptoms. After 48 hours patients who were eligible for enrolment in the study (patient with no infection), were followed up in daily basis to examine if the develop HCAIs until they were discharged (home or mortuary). When they developed HCAIs, appropriate samples (e.g. urine for urinary tract infections) were collected and sent to Microbiology laboratory at CUHAS for processing (culture and sensitivity). Culture and sensitivity results were used for appropriate rational therapy. Data was recorded in a collecting sheet and analysis was done as per objective using STATA version 17.0 software. Primary outcome was prevalence of the health care associated infections; secondary outcomes were mortality associated with health care associated infection.
Results: We had 350 patients enrolled and 30 (8.6%) developed HCAI while admitted in the hospital. Out of 30, 9(30%) were culture positive with predominance of E. coli 33.3%. The prevalence of HCAI was significantly higher in bedridden patients at 17%. HCAI was significantly higher among patients with multiple indwelling devices than those with single device (13.9% vs 4.9%). For every year increase in age, the odds of HCAI significantly increase by 2%. Mortality had BSI 43.3% (13/30), followed by UTI 36.7% (11/30) then unidentified source of infections 10% (3/30). Among 9 patients with a positive culture result. The most common isolated organisms were E. coli (33.3%), S. aureus (22.2%), S. pyogenes (11%), Acinetobacter (11%), P. aeruginosa (11.1%). Gram negative bacteria being more prominent than Gram positive, 55.5% and 33.3% respectively. For every day increase in hospital stay, the odds of HCAI significantly increase by 92%. The odds of mortality were more than twice higher among patients with HCAI compared to their counterparts.
Conclusion: In our study the prevalence of HCAI was 8.6%. 30% of these HCAI were culture positive. Gram negative bacteria were prominent 55.5% and they were multidrug resistance bugs. HCAI was associated with longer duration of hospital stay. Most common HCAI was BSI 43.3%. HCAI increase mortality by 2 folds. This shows that even in medical ward HCAI id a problem and needs attention.
Implication: These data are important for improving clinician’s awareness of health care associated infections, its patterns, associated factors and outcomes in terms of their mortality and duration of hospital stay among admitted patients. The data will provide baseline data for future quality improvement projects to improve treatment, outcomes and reduce HCAI-related morbidity and mortality.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : Website: www.bugando.ac.tz
--Internal Medicine