Healthcare-associated infections including neonatal bloodstream infections in a leading tertiary hospital in Botswana

Abstract

Background: Healthcare-associated infections (HAIs) increase morbidity, mortality, length of hospital stay and costs, and should be prevented where possible. In addition, up to 71% of neonates are prone to bloodstream infections (BSI) during intensive care due to a variety of factors. Consequently, the objectives of this study were to estimate the burden of HAIs and possible risk factors in a tertiary hospital in Botswana as well as describe current trends in bacterial isolates from neonatal blood specimen and their antibiotic resistance patterns. Methods: Point Prevalence Survey (PPS) in all hospital wards and a retrospective cross-sectional review of neonatal blood culture and sensitivity test results, with data abstracted from the hospital laboratory database. Results: 13.54% (n = 47) of patients had HAIs, with 48.9% (n = 23) of them lab-confirmed. The highest prevalence of HAIs was in the adult intensive care unit (100%n = 5), the nephrology unit (50%n = 4), and the neonatal intensive care unit (41.9%n = 13). One-fourth of HAIs were site unspecific, 19.1% (n = 9) had surgical site infections (SSIs), 17% (n = 8) ventilator-associated pneumonia/complications, and 10.6% (n = 5) were decubitus ulcer infections. There were concerns with overcrowding in some wards and the lack of aseptic practices and hygiene. These issues are now being addressed through a number of initiatives. Coagulase Negative Staphylococci (CoNS) was the commonest organism (31.97%) isolated followed by Enterococci spp. (18.03%) among neonates. Prescribing of third-generation cephalosporins is being monitored to reduce Enterococci, Pseudomonas and Acinetobacter spp. infections. Conclusions: There were concerns with the rate of HAIs and BSIs. A number of initiatives are now in place in the hospital to reduce these including promoting improved infection prevention and control (IPC) practices and use of antibiotics via focal persons of the multidisciplinary IPC committee. These will be followed up and reported on. ARTICLE HISTORY

Prevalence of healthcare-associated infections and antimicrobial use among inpatients in a tertiary hospital in Fiji: a point prevalence survey

“…The HAI prevalence from our research in Fiji is similar or slightly lower than estimates from other studies in LMICs which also used ECDC criteria, such as 8.2% in Ghana, 8.4% in Pakistan, 13.5% in Botswana and 11.5% across four Latin American countries [ 21 – 23 ]. Compared to high-income settings, Fiji’s HAI prevalence is higher than that reported in the USA (3.2%), Europe (6.5%), and Japan (7.4%) but lower than rates in Australia (9.9%) and Singapore (11.9%) [ 17 – 20 , 28 ].…”

“…With neonatal ICU patients excluded, the HAI prevalence among children in our study was only 4.4% (3/69). Other recent PPSs from LMICs also include similarly high proportions of paediatric (from 15 to 26%) [ 21 – 24 ] and obstetric (from 19 to 30%) [ 21 , 23 ] patients, whereas recent studies from high-income countries showing higher HAI prevalence excluded paediatric patients [ 18 , 19 ]. Third, inpatients in Fiji may not have been as sick as those in other studies, although no comorbidity data was collected to allow direct comparison.…”

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis

“…From the study, the national pooled prevalence of HCAI in Ethiopia was 16.96% (95% CI: 14.10%-19.82%). The result was higher than studies conducted in China (3.12%) [ 35 ], Morocco (10.3%) [ 36 ], Botswana (13.54%) [ 6 ], and South Africa (7.67%) [ 7 ]. The possible reasons for high prevalence in this study might be very low hand hygiene practice by physicians and resource constraints [ 37 ], low adherence to infection prevention practice [ 38 ], low level of job satisfaction [ 39 ], morally distressed nurses [ 40 ], and low implementation of the nursing process [ 41 ] in our settings, and also less attention given to HCAI.…”

“…Though data is scarce, the burden of HCAI was found to be high in Sub-Saharan Africa (SSA) countries [ 5 ]. Specifically, the prevalence of HCAI was noted in Botswana (13.4%) [ 6 ], South Africa (8%) [ 7 ], and Ethiopia (13% to 22%) [ 8 – 10 ].…”

The burden of healthcare-associated infection in Ethiopia: a systematic review and meta-analysis

“…Nosocomial infection (NI) was found between 1.6 and 28.7% in Sub-Saharan Africa [ 4 ]. Specifically, the overall prevalence of HCAI was found in Botswana (13.4%) [ 5 ] and South Africa (8%) [ 6 ]. Regarding types of HCAI, a meta-analysis showed that RTI, UTI, SSI, and BSI from highest to lowest magnitude in order were found worldwide, but SSI (51.1%) was the leading in Africa [ 7 ].…”