Background
Healthcare-associated infections are a major global public health problem. This study aims at establishing the prevalence and factors associated with nosocomial infections among patients admitted in public Hospitals of Rwanda.
Methods
Hospital-based cross-sectional study was conducted with a structured format to consider for presence of nosocomial infections among 733 participants. Patients were selected through systematic random technique. Multivariate logistic regression was computed to identify factors associated with nosocomial infections and variables with a p-value < 0.05 were considered statistically significant.
Results
National prevalence is 21.7%. The main factors positively associated with nosocomial infections ( risk factors ) were as follows: high temperature (AOR = 12.08, 95% CI: 5.69–25.65, p-value < 0.001); patients operated by a General Practitioner (AOR = 21.71, 95% CI, 1.67 -281.89,p-value = 0.02.) compared to those with surgeon; patients with postoperative hematocrit (HCT) levels exceeding 30% (AOR = 170.5, 95% CI: 1.77–16436.2, p-value = 0.03) compared to those with HTC levels ≤ 30%; patients who did not take prophylactic antibiotics (AOR = 8.61, 95% CI: 1.37–54.02, p-value = 0.02 )compared to those who took antibiotics; patients with long stay lasting four days or more (AOR = 190.36, 95% CI: 20.22–1791.86, p- value < 0.00) compared to those with shorter stay; patients with clean contaminated wounds (AOR = 6.8, 95% CI: 2.00–23.13, p-value < 0.001) and contaminated wounds (AOR = 3.66, 95% CI: 1.15–11.67, p-value = 0.03) compared to those to those with clean wounds ; patients operated for longer than one hour (AOR = 3.9, 95% CI: 1.33–11.43, p-value = 0.01) compared to those operated less than an hour. Besides, the following factors were negatively associated with nosocomial infections ( protective factors ); patients not immunosuppressed were less likely to develop nosocomial infections (AOR = 0.46, 95% CI [1.07–1.20], p-value = 0.01 ) compared to those with weak immune system ; patients with no Cesarean Section (C/S) history were less likely to develop nosocomial infections ( AOR = 0.11, 95% CI, 0.02–0.62, p-value 0.01) compared to those with C/S history ; patients without drain were less likely to develop nosocomial infections (AOR = 0.19, 95% CI: 0.06–0.60, p-value = 0.01) compared to those with drain; patients operated in areas other than the abdomen were less likely to develop nosocomial infections (AOR = 0.19, 95% CI: 0.04–0.81, p-value = 0.03) compared to those with abdomen as area of operation.
Conclusion and recommendations :
Briefly we recommend that all healthcare workers should strive for better strategies to minimize the prevalence of nosocomial infections, and this may be achieved by being vigilent to patients with higher temperature, improving IPC implementation (hand hygiene,complete PPE, availability of desinfectants, and other protective measures ) as recommeded by WHO, better diagnosis for reducing ALOS, giving antibiotic-prophylaxis to patients programmed for operations 24 hours before surgery.
