The Prevalence of Healthcare-Associated Infections in Mainland China: A Systematic Review and Meta-analysis

Wang, Jiancong; Fangfei, Liu; Tartari, Ermira; Jian-an, Huang; Harbarth, Stéphan Juergen; Pittet, Didier; Zingg, Walter

doi:10.1017/ice.2018.60

Cited by 67 publications

(59 citation statements)

References 27 publications

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“…From the study, the national pooled prevalence of HCAI in Ethiopia was 16.96% (95% CI: 14.10%-19.82%). The result was higher than studies conducted in China (3.12%) [ 35 ], Morocco (10.3%) [ 36 ], Botswana (13.54%) [ 6 ], and South Africa (7.67%) [ 7 ]. The possible reasons for high prevalence in this study might be very low hand hygiene practice by physicians and resource constraints [ 37 ], low adherence to infection prevention practice [ 38 ], low level of job satisfaction [ 39 ], morally distressed nurses [ 40 ], and low implementation of the nursing process [ 41 ] in our settings, and also less attention given to HCAI.…”

Section: Discussionmentioning

confidence: 59%

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis

et al. 2020

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Background Healthcare-associated infection is a global threat in healthcare which increases the emergence of multiple drug-resistant microbial infections. Hence, continuous surveillance data is required before or after patient discharge from health institutions though such data is scarce in developing countries. Similarly, ongoing infection surveillance data are not available in Ethiopia. However, various primary studies conducted in the country showed different magnitude and determinants of healthcare-associated infection from 1983 to 2017. Therefore, this systematic review and meta-analysis aimed to estimate the national pooled prevalence and determinants of healthcare-associated infection in Ethiopia. Methods We searched PubMed, Science Direct, Google Scholar, and grey literature deposited at Addis Ababa University online repository. The quality of studies was checked using Joanna Brigg’s Institute quality assessment scale. Then, the funnel plot and Egger’s regression test were used to assess publication bias. The pooled prevalence of healthcare-associated infection was estimated using a weighted-inverse random-effects model meta-analysis. Finally, the subgroup analysis was done to resolve the cause of statistical heterogeneity. Results A total of 19 studies that satisfy the quality assessment criteria were considered in the final meta-analysis. The pooled prevalence of healthcare-associated infection in Ethiopia as estimated from 18 studies was 16.96% (95% CI: 14.10%-19.82%). In the subgroup analysis, the highest prevalence of healthcare-associated infection was in the intensive care unit 25.8% (95% CI: 3.55%-40.06%) followed by pediatrics ward 24.16% (95% CI: 12.76%-35.57%), surgical ward 23.78% (95% CI: 18.87%-29.69%) and obstetrics ward 22.25% (95% CI: 19.71%-24.80%). The pooled effect of two or more studies in this meta-analysis also showed that patients who had surgical procedures (AOR = 3.37; 95% CI: 1.85–4.89) and underlying non-communicable disease (AOR = 2.81; 95% CI: 1.39–4.22) were at increased risk of healthcare-associated infection. Conclusions The nationwide prevalence of healthcare-associated infection has remained a problem of public health importance in Ethiopia. The highest prevalence was observed in intensive care units followed by the pediatric ward, surgical ward and obstetrics ward. Thus, policymakers and program officers should give due emphasis on healthcare-associated infection preventive strategies at all levels. Essentially, the existing infection prevention and control practices in Ethiopia should be strengthened with special emphasis for patients admitted to intensive care units. Moreover, patients who had surgical procedures and underlying non-communicable diseases should be given more due attention.

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Section: Discussionmentioning

confidence: 59%

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis

et al. 2020

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“…Health care-associated infection (HAI) is an infection occurring in a patient during the process of care in a hospital or other health-care facility, which was not present or incubating at the time of admission. HAIs can also appear after discharge from the hospital and include occupational infections among hospital/health-care staff [ 1 , 2 , 3 ]. HAIs result in considerable human suffering and financial losses on account of prolonged hospital stays, increased morbidity and mortality, additional diagnostic and therapeutic interventions and antimicrobial resistance [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections”? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India

Joshi

Diwan

Joshi

et al. 2018

IJERPH

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Background: Health care-associated infections (HAIs) result in treatment delays as well as failures and financial losses not only to patients but also to the treating hospital and overall health-care delivery system. Due to hospital-acquired infections, there are problems of increase in morbidity and mortality, additional diagnostic and therapeutic interventions and ultimately antimicrobial resistance. Proper understanding among health-care workers about the ill effects of HAIs is very important to address this issue. The present study is a qualitative exploration aimed at understanding various aspects of hospital environmental hygiene and Infection prevention control program, by exploring the staff perception regarding the challenges, facilitators and barriers as well as feasible measures towards improvement in a rural tertiary teaching hospital in central India. Method: A qualitative study was conducted using 10 focus group discussions (FGDs) among five different professional groups, which included hospital administrators, doctors, nurses, environmental cleaning staff, and undergraduate medical students. The FGD guide included the following topics: (1) opinion about the status of cleanliness, (2) concepts and actual practices prevailing of hospital environmental hygiene, (3) Barriers, constraints, and problems in maintaining hospital environmental hygiene, (4) Suggestions for improvements. The data were analyzed manually using the content (thematic) analysis method. Results: Two themes were identified: Theme 1: “Prevailing practices and problems related to hospital surface/object contamination and hospital infection control”. Theme 2: “Measures suggested for improving hospital cleanliness within the existing constraints”. The participants emphasized the influence of resource constraints and needed inputs. They brought up the consequent prevailing practices and problems related, on one hand, to various stakeholders (service consumers, hospital personnel including the management), on the other, to specific infection prevention and control processes. They also suggested various measures for improvement. Conclusions: The study has revealed prevailing practices, problems, and suggested measures related to hospital environmental hygiene, particularly hospital cleanliness and HAI prevention and control processes. These insights and assertions are important for developing future behavioral and structural interventions in resource-limited settings. This study recommends a nationwide reliable HAI surveillance system and a robust infection prevention and control program in each health-care institution.

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“…Acinetobacter baumannii is one of the most common nosocomial pathogens in Asia and South America. 1 A systematic review has revealed that A. baumannii accounted for 11.28% of nosocomial infections in general hospitals in China, making it the third most common nosocomial pathogen, 2 and carbapenem-resistant A. baumannii (CRAB) has emerged worldwide. As early as 2013, the US Centers for Disease Control and Prevention listed multidrug-resistant A. baumannii (MDRAB) including CRAB as a serious threat, 3 and the WHO listed CRAB as one of the three most critical threats in a global drug-resistant warning in 2017.…”

Section: Introductionmentioning

confidence: 99%

Risk factor for intestinal carriage of carbapenem-resistantAcinetobacter baumanniiand the impact on subsequent infection among patients in an intensive care unit: an observational study

et al. 2020

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ObjectivesTo assess the incidence and the impact of carbapenem-resistant Acinetobacter baumannii (CRAB) intestinal carriage on subsequent CRAB infection and to study risk factors of acquiring CRAB intestinal carriage among patients in intensive care unit (ICU).DesignObservational study including a case–control study and a retrospective cohort study.SettingA 50-bed general ICU of a university hospital, China.MethodsFrom May 2017 to April 2018, an observational study was conducted in a 50-bed general ICU of a university hospital in China. Rectal swabs were collected from ICU patients on admission and thereafter weekly. A case–control study was performed to analyse risk factors of the acquisition of CRAB intestinal carriage in ICU using multiple logistic regression. A retrospective cohort study was performed to address whether intestinal CRAB carriage could lead to an increased likelihood of subsequent CRAB infection using subdistribution hazard model regarding death in the ICU as a competing risk event.ResultsCRAB intestinal carriage was detected in 6.87% (66/961; 95% CI 5.27% to 8.47%) of patients on ICU admission, whereas 11.97% (115/961; 95% CI 9.91% to 14.02%) of patients acquired CRAB intestinal carriage during the ICU stay. Pancreatitis (OR 2.16, 95% CI 1.28 to 3.67), haematological disease (OR 2.26, 95% CI 1.42 to 3.58), gastric tube feeding (OR 3.35, 95% CI 2.03 to 5.51) and use of carbapenems (OR 1.84, 95% CI 1.11 to 3.07) were independent risk factors for acquiring CRAB intestinal carriage. The incidence of subsequent CRAB infection was 2.24-fold in patients with CRAB intestinal carriage compared with that in patients without (95% CI 1.48 to 3.39, p<0.001).ConclusionMore patients acquired CRAB intestinal carriage during their ICU stay than had on admission. Severity of illness, acute pancreatitis, tube feeding and use of carbapenems were independent risk factors of acquisition of CRAB intestinal carriage. Patients with CRAB intestinal carriage are more likely to develop CRAB infection.

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The Prevalence of Healthcare-Associated Infections in Mainland China: A Systematic Review and Meta-analysis

Cited by 67 publications

References 27 publications

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis

Healthcare-associated infection and its determinants in Ethiopia: A systematic review and meta-analysis

“How Can the Patients Remain Safe, If We Are Not Safe and Protected from the Infections”? A Qualitative Exploration among Health-Care Workers about Challenges of Maintaining Hospital Cleanliness in a Resource Limited Tertiary Setting in Rural India

Risk factor for intestinal carriage of carbapenem-resistantAcinetobacter baumanniiand the impact on subsequent infection among patients in an intensive care unit: an observational study

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