Device associated healthcare acquired infection rates in general hospitals in Saudi Arabia,2013-2016 Open Access

Gaid, Eiman (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/1544bp537?locale=en
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Abstract

Abstract

Background: Healthcare-associated infections (HAIs) are a serious patient safety issue in hospitals worldwide, affecting 5%-10% of hospitalized patients and deadly for patients in intensive care units (ICUs)[1]. Device-associated HAI (DA-HAI) surveillance is implemented in most hospitals. DA-HAIs account for up to 23% of HAIs in ICUs and about 40% of all hospital infections (i.e., central line-associated blood stream infections [CLABSI], ventilator-associated pneumonia [VAP], and catheter-associated urinary tract infections [CAUTI]). This surveillance focuses on DA-HAIs in ICUs and is used for comparison, benchmarking, and detecting areas to focus on for improvement.[2, 3] This study aims to identify DA-HAI rates among a group of selected hospitals in KSA from 2013 - 2016.

Methods: We analyzed secondary data from 12 medical/surgical intensive care units (M/SICUs) and two cardiac care units (CCUs) from 12 Ministry of Health (MoH) hospitals from different regions in the Kingdom of Saudi Arabia (KSA). These data were reported by infection control practitioners to the MoH via the electronic International Nosocomial Infection Control Consortium (INICC) system in each hospital.

Results: Among 6,178 ICU patients with 13,492 DA-HAIs during 2013 - 2016, the average length of stay (LOS) was 10.7 days (range 0 to 379 days). VAP was the most common DA-HAI (57.4%), followed by CAUTI (28.4%), and CLABSI (14.2%). In CCUs there were no CLABSI cases; CAUTI was reported from 1 - 2.6 per 1000 device-days; and VAP did not occur in Hospital B but occurred 8.1 times per 1000 device-days in the CCU in Hospital A. In M/SICUs, variations occurred among time periods, hospitals, and KSA provinces. CLABSI varied between hospitals from 2.2 to 10.5 per 1000 device-days. CAUTI occurred from 2.3 to 4.4 per 1000 device-days, while VAP had the highest rates, from 8.9 - 39.6 per 1000 device-days. Most hospitals had high device-utilization rates (from the 75th - 90th percentile of NHSN's standard and the 50th - 75th percentile of INICC's).

Conclusions: We found higher device-associated infection rates and higher device-utilization ratios in the study's CCUs and M/SICUs than National Healthcare Safety Network (NHSN) benchmarks, except for CLABSI rates, which were lower. To reduce the rates of infection, ongoing monitoring of infection control practices and comprehensive education are required. Further a more sensitive and specific national healthcare safety network is needed in KSA.

Table of Contents

Table of Contents

Chapter 1: Introduction.............................................................................................. 9

Problem Statement............................................................................................................................................................. 10

Purpose of Study.............................................................................................................................................................. 11

Definitions.............................................................................................................................................................................. 12

Chapter 2: Literature Review.................................................................................. 14

Surveillance for DA-HAIs...................................................................................................................................... 15

General Infection Control Measures........................................................................................................ 17

Central Line-associated Blood Stream Infection.......................................................................... 19

Catheter-associated Urinary Tract Infection (CAUTI).......................................................................... 24

Ventilator Association Pneumonia (VAP).......................................................................................................... 29

Chapter 3 - Manuscript.............................................................................................. 36

Abstract..................................................................................................................................................................................... 36

Introduction........................................................................................................................................................................... 37

Methodology........................................................................................................................................................................... 39

Study setting....................................................................................................................................................................... 39

INICC multidimensional approach...................................................................................................................... 40

Data collection.................................................................................................................................................................. 41

Data Source......................................................................................................................................................................... 41

Study Variables.................................................................................................................................................................. 42

Statistical Analysis.......................................................................................................................................................... 43

Ethical Considerations................................................................................................................................................. 45

Results......................................................................................................................................................................................... 46

DA-HAIs in Cardiac Care Units (CCUs) of Two Hospitals.......................................................................... 46

DA-HAIs in Medical/Surgical ICUs (M/SICUs) of 12 Hospitals............................................................ 47

Discussion................................................................................................................................................................................... 50

Chapter 4 - Conclusion and Recommendations................................................... 54

References...................................................................................................................... 56

Appendix......................................................................................................................... 59

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