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Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital
BACKGROUND: Healthcare 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 refe...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260112/ https://www.ncbi.nlm.nih.gov/pubmed/28138385 http://dx.doi.org/10.1186/s13756-017-0172-5 |
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author | Hearn, Pasco Miliya, Thyl Seng, Soklin Ngoun, Chanpheaktra Day, Nicholas P. J. Lubell, Yoel Turner, Claudia Turner, Paul |
author_facet | Hearn, Pasco Miliya, Thyl Seng, Soklin Ngoun, Chanpheaktra Day, Nicholas P. J. Lubell, Yoel Turner, Claudia Turner, Paul |
author_sort | Hearn, Pasco |
collection | PubMed |
description | BACKGROUND: Healthcare 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. METHODS: Prospective 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. RESULTS: Between 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. CONCLUSIONS: Prospective 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 MATERIAL: The online version of this article (doi:10.1186/s13756-017-0172-5) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5260112 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-52601122017-01-30 Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital Hearn, Pasco Miliya, Thyl Seng, Soklin Ngoun, Chanpheaktra Day, Nicholas P. J. Lubell, Yoel Turner, Claudia Turner, Paul Antimicrob Resist Infect Control Research BACKGROUND: Healthcare 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. METHODS: Prospective 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. RESULTS: Between 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. CONCLUSIONS: Prospective 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 MATERIAL: The online version of this article (doi:10.1186/s13756-017-0172-5) contains supplementary material, which is available to authorized users. BioMed Central 2017-01-23 /pmc/articles/PMC5260112/ /pubmed/28138385 http://dx.doi.org/10.1186/s13756-017-0172-5 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Hearn, Pasco Miliya, Thyl Seng, Soklin Ngoun, Chanpheaktra Day, Nicholas P. J. Lubell, Yoel Turner, Claudia Turner, Paul Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital |
title | Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital |
title_full | Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital |
title_fullStr | Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital |
title_full_unstemmed | Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital |
title_short | Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital |
title_sort | prospective surveillance of healthcare associated infections in a cambodian pediatric hospital |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5260112/ https://www.ncbi.nlm.nih.gov/pubmed/28138385 http://dx.doi.org/10.1186/s13756-017-0172-5 |
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