Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, Iran

SummaryBackgroundHospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region.MethodsThe study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60–700 beds. The study was conducted during all four season of 2008–2009. All of the patients admitted for ≥48 h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance (NNIS) guidelines.ResultsData from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections (2.5%), surgical site infections (2.4%), urinary tract infections (1.4%), and pneumonia (1.3%). A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 (95% confidence interval [CI] 1.21–2.02). Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 (95% CI 2.38–6.26), and using an urinary catheter, adjusted OR of 3.06 (95% CI 2.19–4.28). Being admitted to an ICU was not an independent HAI risk factor. For all HAIs, the OR of acquiring infection was 3.24 (95% CI 2.34–4.47) in the patients with hospital stays longer than eight days. A high discrepancy between HAIs and antibiotic use was observed. Antibiotics were administered to 71% of the patients, but only 9.4% of the patients also had at least one documented infection.ConclusionThis point prevalence study showed that HAIs are frequent in Shiraz university hospitals, and that the proportion of patients receiving antibiotics is high. The results imply that more primary prevention efforts are necessary to address HAIs associated with using indwelling devices and to prevent surgical site infections.

► Blood stream infection is the most prevalent HAI. ► Urinary catheter, intubation and vascular line are important factors in the incidence of HAI. ► Antibiotic administration is very prevalent in most wards. ► Hospital acquired infections are most prevalent in males. ► The prevalence of hospital acquired infection is not influenced by seasons.