THE PREVALENCE AND CHARACTERS OF HOSPITAL ACQUIRED INFECTIONS IN THREE PRIVATE HOSPITAL, JEDDAH, SAUDI ARABIA

Maram Ahmed Enani 1 , Razan Mohammed Alzahrani 1 , Khlood Aziz Alzubaidy 1 , Refal Ghassa Ajjaj 1 and Amal M Saeed 2 . 1. 5 year medical student, Ibn Sina National College, Jeddah, Saudi Arabia. 2. Professor of microbilogu and immunology, Ibn Sina National College, Jeddah, Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 18 August 2019 Final Accepted: 20 September 2019 Published: October 2019


ISSN: 2320-5407
Int. J. Adv. Res. 7 (10), 1262-1269 1263 The National Nosocomial Infections Surveillance (NNIS) defines NI as "a localized or systemic condition that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s) and that was not present or incubating at the time of admission to the hospital". (5) The common definition of HAI is "the infection acquiring during hospital care and not present or incubating at time of admission, it occurs within 48 hours after hospitalization, or after 3 days from discharging, or 30 days from an operation". (5-8) Several risk factors associate with HAIs : prolonged hospital stay, patients who are admitted to ICU are more prone to have NI and patients who are on (mechanical ventilation device , central venous line , or urinary catheter). Where the most common sites affected by HAI are the respiratory tract (31%) (usually ventilator-associated), urinary tract infection (24%) (usually catheter associated), blood stream infection (BSI) (16%) (usually associated with the use of an intravascular device) , and surgical wounds (8%). (1,4,6) The most common pathogens associated with HAIs are ( gramnegative bacteria as klebsiella pneumonia , E-coli, and pseudomonas aeruginosa , followed by gram positive bacteria as staphylococcus aureus, and enterococci ). (5,9,10) The prevalence of hospital-acquired infections ranges from 5% in Europe and North America to 40% in Sub-Saharan Africa, Latin America and parts of Asia.7 According to a survey by the World Health Organization (WHO) that has been conducted in 14 countries, 8.7% of hospital inpatients have NIs. (2) Till now, to the authors knowledge, there is no study measured the prevalence of HAI in private hospitals in Jeddah.
This study aimed to estimate the prevalence of NI in three private hospitals and identify the related risk factors in Jeddah , Saudi Arabia.

Method:-
This was a retrospective observational study conducted at three private hospitals: Ibn sine , al-jedaani safa , and al-Jedaani Ghuleel , Jeddah , Saudi Arabia . It included all hospitalized patient in ICU and surgical ward during the period of (January 2017 to August 2018) Complete enumeration of patients admitted to ICU and surgical wards from jan 2017 to August 2018 was done . Prior admission was obtained from research center at ISNC and concerned authorities to conduct the study . Date were collected from clinical records as temp . chart and laboratory reports were recorded . Check list was used to collect the data , and it consisted of three parts: first demographic data: age, sex and smoking habit. Second medical characteristics: patient diagnosis on admission, type of ward admitted to co-morbidity , type of HAI , microorganisms associated with infection , and length of hospital stay. And third exposure to invasive devices: (urinary catheters , central venous line , mechanical ventilation , drain and intubation.
HAI was defined according to CDC : any infection occurring more than 48 h after admission was considered .
Inclusion criteria: 1. All patients with complete data, admitted to ICU or surgical ward for more than 48 h and aged>18y were included. 2. Exclusion criteria: 3. Patients who: 1-Shifted out from hospital within 48h of admission . 4. Aged less than 18y . 5. With incomplete data.

Statistical analysis:-
The Statistical Package for Social Sciences (SPSS, version 21) was used for data entry and statistical analysis. Qualitative data were presented as frequency distributions, and quantitative data were presented as means and standard deviations. Independent t test and Chi square test were used to assess the association between having HAI and different risk factors. P-value < 0.05 was considered as significant.

Result
All admitted patients during this period were 2628 , 398 were included in this study. The samples mean age (48.58) with SD+16.65. Both male 66.8% and female 33.2% were included in this study. Only 17 (4.3%) were smokers. (Table 1 &      Out of 398 patients, 14 (3.5%) were HAI, 12 positive cases were ICU patients, and 2 were ward patients. Infection sites were as following UTI (2.5%), RTI (2.3%), 3 (0.8%) and 2 (0.5%). The most common organism were E-Coli alone or in combination in 6 (40.1%) cases, followed by "Klebsilla Pneumonia" and "Staph aureus" equally 3 (20.0%). Less than tenth 27 (6.8%) died. (Table 5   The result revealed a significant difference in age and LOS regarding infection, where older age and those with longer hospitalization having more infection than others (65.2 vs 47.9, p <0.0001) and (25 vs 4, p <0.0001) respectively. (Table 6) The result revealed a significant association between HAI , presence of drain, bedridden and death (p<0.0001). On the other hand there was no significant association between HAI and gender, smoking and surgical wound. (Table  7)

Discussion:-
Hospital acquired infections are widespread. They become a very important public health problem with increasing economic and human influence due to several reasons: 1) increasing number and crowding of people, 2) more frequent impaired immunity (age, illness and treatments), 3 ) new microorganisms, and 4) increasing bacterial resistance to antibiotics. They are a main cause of preventable disease and death in developing countries. (6,8) Now days patients are highly mobile and hospital stays become shorter, which means that patients usually are discharged before the infection becomes obvious (symptomatic). Where, a huge number of nosocomial infections in inpatients -and those from ambulatory care facilitiesbecomes obvious only after discharging. This lead to difficulty in determining whether the source of the organism causing the infection is endogenous or exogenous. (7,8) HAI is a quality indicator of hospital inpatient services. Globally, WHO estimates that at least 1.5 million of hospital patients suffer from a HAI in any Hospital at any time. (12) The overall HAI prevalence in the current study was 3.5%, it was lower than other studies, in Tunisia, a prospective cohort study was done and showed over all incidence of NI was (6.5%). (9) Another retrospective observational study was done at KAUH, Jeddah , Saudi Arabia during period of 2015-2016, concluded that incidence of NI was 7.3% . (10) Also, in Uganda study, the overall incidence of NI was (14%). (3) On the other hand, the current prevalence was higher than a multicenter European prospective study showed that the overall incidence of NI was (2.5%). (11) Also, in Danish study the incidence of HAI was 1. In the current study, Escherichia coli was the most common infecting organism in patients. It was responsible for approximately half of cases (40.0%). This consistent with Taif study and others. (4,5,8) In Tunisia study and the multicenter European prospective study the main organism was Gram-negative bacteria. (9,11) The association between patient age and hospitalization and the occurrence of HAI was statistically significant. Where, older patients and those with longer hospitalization showed higher rate of having HAI. This result was in agreement with Uganda, Moroco, Iran and Europ studies. (2,3,6,11)This could be explained by the fact that elderly patients have less immunity and more co-morbidities which contribute in the occurrence of several complications. Also long duration in hospital make patients more weaker and vulnerable to catch any infections. (3,6,11)