Prevalence of hospital-acquired infections in intensive care units in public hospitals in Tehran, Iran, in 2012-2014

Document Type : Original Article

Authors

1 Environmental and Occupational Hazards Control Research Center AND Department of Environmental Health Engineering, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Public Health, School of Health, Safety, and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Environmental Health Engineering, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran

4 Water Purification Research Center, Islamic Azad University, Medical Sciences Branch, Tehran, Iran

Abstract

Infection control and hospital-acquired infection (HAI) prevalence have recently attracted much attention especially in developing countries. The aim of this study was to estimate the prevalence of HAI in public hospitals in Tehran, Iran, more specifically, to determine the epidemiological status of nosocomial infections in intensive care units (ICUs) of 3 public hospitals. The study was conducted in 3 governmental hospitals and all patients who had been in the hospital for at least 48 hours and had a primary diagnosis of HAI were included in the study. The study was performed on 1470 patients who were admitted to the ICU from 2012-2014; among them, 200 cases were affected by infectious diseases. The data collected using the questionnaire included demographic characteristics, length of admission, and cause of hospital infection which were all verified by the Infection Control Center (ICC). The clinical signs and symptoms of patients were also controlled. The effects of seasonal variation on HAI were also investigated by analyzing the data obtained in various seasons. Statistical analysis was performed using SPSS software. The chi-square (X2) test was used to compare categorical variables and a 2-sided P-value of less than 0.05 was considered as significant. The effect of season on HAI prevalence was analyzed using Kruskal-Wallis Test. The prevalence of nosocomial infections was 13.65% in the study. Urinary tract (40.9%) and surgical wounds (26.1%) were the most common types of infections. Bacteriological analysis suggested that Escherichia coli (35.6%) and Staphylococcus aureus (26%) were the most prevalent microorganisms related to the incidence of HAI. The results obtained showed that HAIs were more prevalent during spring. The prevalence of nosocomial infection observed in the present study seems quite high. The results showed that the length of hospitalization was positively associated with HAI. Statistical analysis showed that long length of hospitalization, age, and season are risk factors for the development of HAI during hospitalization. Furthermore, like similar studies, gram-negative bacteria were found to be the most common cause of nosocomial infections. 

Keywords


1. Tikhomirov E. WHO programme for the control of hospital infections. Chemioterapia 1987; 6(3): 148-51.
2. Rafiee M, Jahangiri-Rad M, Hajjaran H, Mesdaghinia A, Hajaghazadeh M. Detection and identification of Legionella species in hospital water supplies through Polymerase Chain Reaction (16S rRNA). J Environ Health Sci Eng 2014; 12: 83.
3. Lee TB, Baker OG, Lee JT, Scheckler WE, Steele L, Laxton CE. Recommended practices for surveillance. Association for Professionals in Infection Control and Epidemiology, Inc. Surveillance Initiative working Group. Am J Infect Control 1998; 26(3): 277-88.
4. Plowman R. The socioeconomic burden of hospital acquired infection. Euro Surveill 2000; 5(4): 49-50.
5. Pottinger JM, Herwaldt LA, Perl TM. Basics of surveillance-an overview. Infect Control Hosp Epidemiol 1997; 18(7): 513-27.
6. World Health Organization. Emergencies preparedness, response: Infection prevention and control in health care [Online]. [cited 2016]; Available from: URL: http://www.who.int/csr/bioriskreduction/infection_control/en/
7. Mayon-White RT, Ducel G, Kereselidze T, Tikomirov E. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect 1988; 11(Suppl A): 43-8.
8. Polin RA, Saiman L. Nosocomial infections in the neonatal intensive care unit. NeoReviews 2003; 4(3): 81-8.
9. Kyne L, Sougioultzis S, McFarland LV, Kelly CP. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol 2002; 23(11): 653-9.
10. Rosenthal VD, Maki DG, Mehta A, Alvarez-Moreno C, Leblebicioglu H, Higuera F, et al. International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control 2008; 36(9): 627-37.
11. Martin C. Antimicrobial prophylaxis in surgery: general concepts and clinical guidelines. French Study Group on Antimicrobial Prophylaxis in Surgery, French Society of Anesthesia and Intensive Care. Infect Control Hosp Epidemiol 1994; 15(7): 463-71.
12. Pourakbari B, Rezaizadeh G, Mahmoudi S, Mamishi S. Epidemiology of nosocomial infections in pediatric patients in an Iranian referral hospital. J Prev Med Hyg 2012; 53(4): 204-6.
13. Askarian M, Mahmoudi H, Assadian O. Incidence of nosocomial infections in a big university affiliated hospital in Shiraz, Iran: A six-month experience. Int J Prev Med 2013; 4(3): 366-72.
14. Kallel H, Bahoul M, Ksibi H, Dammak H, Chelly H, Hamida CB, et al. Prevalence of hospital-acquired infection in a Tunisian hospital. J Hosp Infect 2005; 59(4): 343-7.
15. Dumpis U, Balode A, Vigante D, Narbute I, Valinteliene R, Pirags V, et al. Prevalence of nosocomial infections in two Latvian hospitals. Euro Surveill 2003; 8(3): 73-8.
16. Duerink DO, Roeshadi D, Wahjono H, Lestari ES, Hadi U, Wille JC, et al. Study group 'antimicrobial resistance in indonesia prevalence and prevention' amrin. J Hosp Infect 2006; 62(2): 219-29.
17. Masoumi Asl H. The national nosocomial infections surveillance in Iran. A 4 years report. BMC Proc 2011; 5(Suppl 6): P243.
18. Vincent JL. Nosocomial infections in adult intensive-care units. Lancet 2003; 361(9374): 2068-77.
19. Allegranzi B, Pittet D. Preventing infections acquired during health-care delivery. Lancet 2008; 372(9651): 1719-20.
20. Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int J Infect Dis 2008; 12(5): 505-12.
21. Zaidi AK, Huskins WC, Thaver D, Bhutta ZA, Abbas Z, Goldmann DA. Hospital-acquired neonatal infections in developing countries. Lancet 2005; 365(9465): 1175-88.
22. Zahraei SM, Eshrati B, Masoumi AH, Pezeshki Z. Epidemiology of four main nosocomial infections in Iran during March 2. Arch Iran Med 2012; 15(12): 764-6.
23. Mir Mehdi F. Study of the nosocomial infections in Tabriz Imam Hospital. Proceedings of the 11th Congress of Infectious and Tropical Diseases in Iran; 2003 Feb 28-Mar 4; Tehran, Iran; 2003. p. 46-8.
24. Turkish Neonatal Society, Nosocomial Infections Study Group. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010; 52(1): 50-7.
25. Ducel G, Fabry J, Nicolle LE. Prevention of Hospital-acquired Infections: A Practical Guide. 2nd ed. Geneva, Switzerland: World Health Organization; 2002.
26. Kim PE, Musher DM, Glezen WP, Rodriguez-Barradas MC, Nahm WK, Wright CE. Association of invasive pneumococcal disease with season, atmospheric conditions, air pollution, and the isolation of respiratory viruses. Clin Infect Dis 1996; 22(1): 100-6.