Incidence, accuracy, and barriers of diagnosing healthcare-associated infections: A case study in southeast Iran

Abstract

Background Healthcare-associated infections (HAIs) are a threat to patients. Accurate surveillance is required to identify and prevent HAIs. To estimate the incidence rate, report the accuracy and identify the barriers of reporting HAIs using a mixed-method study. Methods In this quantitative study, we externally evaluated the incidence rate and accuracy of the routine surveillance system in one of the main hospitals by an active follow-up of patients from September to December 2021. We used in-depth interviews with 18 experts to identify the barriers of the routine surveillance system. Results Among 404 hospitalized patients, 88 HAIs were detected. The estimated rate of HAIs was 17.1 (95% Confidence Intervals 95: 14.1, 21.1) per 1000 patient-days follow-up. However, in the same period, 116 HAIs were reported by the routine surveillance system, but the agreement between the two approaches was low (sensitivity = 61.4%, specificity = 82.6%, negative predictive value = 89.7%, and positive predictive validity = 46.5%). The minimum and maximum positive predictive values were observed in urinary tract infection (32.3%) and surgical site infection (60.9%). The main barrier of reporting HAIs was lack of cooperation in reporting HAIs by infection control link nurses and laboratory supervisors. Conclusions The discrepancy between the longitudinal study findings and the routine surveillance might be related to the inaccessibility of the surveillance system to clinical information of patients. In this regard, decreasing the barriers, increasing the knowledge of infection control nurses and other nurses, as well as the development of hospital information systems are necessary.

Barriers and Problems in Implementing Health-Associated Infections Surveillance Systems in Iran: A Qualitative Study

“…Among the essential problems standing in the way of the HAIs surveillance system are misdiagnosis and underreporting of HAIs, which is one of the problems of the HAIs surveillance system in Iran (25). According to the results of this study, there are several reasons for these problems in Iranian hospitals.…”

Risk and outcomes of healthcare-associated infections in three hospitals in Bobo Dioulasso, 2022 (Burkina Faso): a longitudinal study

“…These frequencies may differ from one study to another depending on the case definitions and methodology used. It is recognized that longitudinal or incidence studies such as the present one offer greater precision in assessing the extent of these infections [14]. However, these studies are time-consuming and require more resources than the prevalence studies which are more commonly conducted.…”

“…In Africa, hospital-wide prevalence of HAIs varied from 6.7% to 18.7%, with a high prevalence that can exceed 50% in ICUs [9–13]. Most of these studies are prevalence studies, which have the advantage of being easy and quick to conduct, but the disadvantage of low precision and lack of information on the outcomes of HAIs [14].…”