Background: Hospital-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.
Methods: The 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.
Results: Data 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 ORof 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.
Conclusion: This 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.