Point-prevalence survey of hospital acquired infections in three acute care hospitals in Northern Nigeria

Abstract

Background Effective infection prevention and control strategies require reliable data describing the epidemiology of hospital acquired infections (HAIs), and this is currently lacking in Nigeria. The objective of this study was to evaluate the prevalence, types and risk factors associated with HAIs in acute care hospitals in Northern Nigeria. Methods A pilot point-prevalence survey was conducted in three acute care hospitals in Northern Nigeria between April and May 2019 using a protocol developed by the European Centre for Disease Prevention and Control. Patients admitted into the wards at or before 8.00 am on the survey date were included. Patients’ medical records were reviewed by a clinical pharmacist with the support of the attending physician and nurse to identify HAIs. Results Of the 321 patients surveyed, 50 HAIs were identified among 46 patients translating into a point-prevalence of 14.3%. The most common HAIs were bloodstream infection (38.0%), surgical site infections (32.0%) and pneumonia (12.0%). Neonatal (53.0%), pediatric surgical (26.7%) and surgical (10.1%) specialties had the highest prevalence. Device associated infections represented 16% of all HAIs including bloodstream infections and pneumonia. Of all the HAIs, 15 (30.0%) were present at the time of admission while 75.5% originated from the current hospitals. Univariate analysis showed that newborn (less than 1 month old) (OR: 4.687 95% CI: 1.298–16.927), intubation (OR: 3.966, 95% CI: 1.698–9.261), and neonatal (OR: 41.538 95% CI: 4.980–346.5) and pediatric surgical (OR: 13.091 95% CI: 1.532–111.874) specialties were significantly associated with HAI. Conclusion The prevalence of HAI was relatively high compared to other developing countries and was significantly associated with neonatal and pediatric surgical specialties. Hospital infection control strategies should be strengthened to reduce the burden of HAIs.

Operationalising One Health in Nigeria: Reflections From a High-Level Expert Panel Discussion Commemorating the 2020 World Antibiotics Awareness Week

“…Approaches must emphasise increased reflections of emerging professionals on how we live and interact with animals, and the larger environment, as a determinant of our collective health. In particular, the training of formal prescribers and managers of antibiotics in human and animal health on the rational use of antimicrobials must be prioritised since these sectors are major hotspots for antibiotic consumption in Nigeria (11,19). These trainings should be adaptable to identified peculiarities of the local health facilities that drive inappropriate use and aim to develop sustainable local capacity for antibiotic stewardship and improved patient care.…”

Healthcare-associated infections and antimicrobial use in surgical wards of a large urban central hospital in Blantyre, Malawi: a point prevalence survey

“…Healthcare-associated infections (HAI) constitute a worldwide public health concern affecting hospitalised patients, hospitals and health systems [ [1] , [2] , [3] ]. They increase healthcare costs by prolonging the hospital stay and requiring the use of expensive broad-spectrum antibiotics and they are associated with high morbidity and mortality [ [4] , [5] , [6] , [7] ].…”

“…However, in a context where the microbiology service is limited, HAI are diagnosed clinically and treated empirically. This makes the treatment of HAI less effective and more costly [ 4 , 5 , 9 ]. In Europe, about 1%–35% of pathogens isolated in HAI are resistant to antimicrobials [ [10] , [11] , [12] , [13] , [14] ].…”

“…In Europe, about 1%–35% of pathogens isolated in HAI are resistant to antimicrobials [ [10] , [11] , [12] , [13] , [14] ]. Meanwhile, the AMR rates reported among isolates from HAI in Africa are of 10%–100% [ 4 , 15 ].…”

“…Where studied, prevalence of HAI in Africa has been reported in up to 15.5% of patients admitted to general wards and 50% of patients admitted to intensive care units (ICUs) [ 1 , 9 , 16 , 17 ]. High rates of HAI in Africa are due to the paucity of infection prevention and control (IPC) policies and guidelines, exacerbated by the lack of personnel, lack of antimicrobial policies resulting in the emergence of MDR pathogens, poor laboratory support, limited funding, and suboptimal adherence to safe practices by health workers and typically limited compulsion to report HAI [ 4 , 9 , 15 , 18 , 19 ]. In addition to these, the structure of hospitals (including the fixed components within the facility with which health care workers, patients, and families touch or interact as a part of the health care process) plays a role in risk of acquiring HAI [ 20 ].…”