Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital

Abstract

BackgroundHealthcare associated infections (HAI) are the most common preventable adverse events following admission to healthcare facilities. Data from low-income countries are scarce. We sought to prospectively define HAI incidence at Angkor Hospital for Children (AHC), a Cambodian pediatric referral hospital.MethodsProspective HAI surveillance was introduced for medical admissions to AHC. Cases were identified on daily ward rounds and confirmed using locally adapted Centers for Disease Control and Prevention (CDC) definitions. During the surveillance period, established infection prevention and control (IPC) activities continued, including hand hygiene surveillance. In addition, antimicrobial stewardship practices such as the creation of an antimicrobial guideline smartphone app were introduced.ResultsBetween 1st January and 31st December 2015 there were 3,263 medical admissions and 102 HAI cases. The incidence of HAI was 4.6/1,000 patient-days (95% confidence interval 3.8–5.6) and rates were highest amongst neonates. Median length of stay was significantly longer in HAI cases: 25 days versus 5 days for non-HAI cases (p < 0.0001). All-cause in-hospital mortality increased from 2.0 to 16.1% with HAI (p < 0.0001). Respiratory infections were the most common HAI (54/102; 52.9%). Amongst culture positive infections, Gram-negative organisms predominated (13/16; 81.3%). Resistance to third generation cephalosporins was common, supporting the use of more expensive carbapenem drugs empirically in HAI cases. The total cost of treatment for all 102 HCAI cases combined, based on additional inpatient days, was estimated to be $299,608.ConclusionsProspective HAI surveillance can form part of routine practice in low-income healthcare settings. HAI incidence at AHC was relatively low, but human and financial costs remained high due to increased carbapenem use, prolonged admissions and higher mortality rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-017-0172-5) contains supplementary material, which is available to authorized users.

Antimicrobial Resistance in Invasive Bacterial Infections in Hospitalized Children, Cambodia, 2007–2016

“…From 2011–2012 onward, the proportion of resistant hospital-acquired K. pneumoniae isolates declined. This drop may be linked to maturation of a hospitalwide infection-control program implemented in 2010 ( 20 ) and enforced by prospective hospital-acquired infection surveillance from 2015 onward ( 21 ) or to the clinical microbiology service operating since 2012 with a strong focus on antimicrobial drug stewardship. Indeed, a recent study of prescribing practices at this hospital found 84%–89% of antimicrobial drug prescriptions were appropriate ( 22 ).…”

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

“…Although multi-center studies reporting HAIs in other countries were not published, a single-center study in an ICU reported a high device associated HAI incidence rate of 27.3 per 1000 patient-days in Nepal (68). In Pakistan, a single pediatric ICU study reported a device associated HAI incidence rate of 6.3 per 1000 patient-days (69), whereas in Cambodia, the device associated HAI incidence rate in one pediatric ICU was reported as 4.6 per 1000 patientdays (70).…”

“…We did not identify a systematic review that included data from multiple countries in the South Asia or South East Asia region reporting causes of hospitalacquired bacteremia. The organisms causing hospital-onset bacteremia (defined as blood cultures obtained after 48 hours of admission to a hospital) in eight countries determined using studies published between 2010 and 2018 (42,50,55,56,62,70,(73)(74)(75) (Supplementary Table S2) are listed in Table 2. We identified very few or no studies from Bangladesh, Pakistan, and Laos that determined the causes of hospital-acquired bacteremia, indicating the need for more comprehensive studies in these areas.…”

A Review of Current Interventions for COVID-19 Prevention

“…As per WHO guidelines, infection prevention and control (IPC) is a practical, evidence-based approach to prevent patients and health workers from being harmed by avoidable infections. Statistics revealed that maintaining effective IPC resulted in a O30% reduction in healthcare-associated infections (HAIs) (14). Hence, considering the global emergency of CoVID-19 infections, preventive care is the only option left to restrict its spreadability.…”