356
Table 1. Prevalence of Healthcare-Associated Infections by Demographic Characteristics Among Inpatients on May 11, 2017, in 6 MNGHA Hospitals
Overall Overall
Gender Male
Female
Age groups, y <65 ≥65
<1 1–15
16–45 46–64
Unit ICU Non-ICU
Ward, all others
207 12 28 13.5 179 86.5 <.001 1,459 88 86 5.9 1,373 94.1
Ward, SCA 232 14 18 7.8 214 92.2 1,182 71 67 5.7 1,115 94.3
Emergency (>1d)
45 3 1 2.2 44 97.8
Note. ICU, intensive care unit; SCA, specialty care areas included oncology, hematology, and organ transplant wards.
All possible HAI events identified by infection control
professionals were centrally reviewed and confirmed by an infec- tious disease consultant and an expert epidemiologist, with high concordance rate (94.7%; κ = 0.71). Differences in the prevalence of HAIs in different groups were examined using a χ2 test or the Fisher exact test as appropriate. All P values were 2-tailed.AP<.05 was considered significant. SPSS version 23.0 software (IBM, Armonk, NY) was used for all statistical analyses.
Results
Of 1,666 patient records reviewed, 114 HAI events were identified among 109 patients. As shown in Table 1, the overall point preva- lence rate was 6.8%. This rate was significantly higher among males than females (8.2%vs 5.5%;P=.030) andtended to be slightly higher among older patients (8.7%in those ≥ 65 years old vs 6.1%in those < 65 years old; P = .064).AlthoughmostHAI events were identified outside ICUs (75.4%), the point-prevalence rate was significantly higher in ICUs (13.5%; P < .001) than in specialty care wards (7.8%) and other types of wards (5.7%). The most common types of HAI were pneumonia (27.2%), urinary tract infection (20.2%), bloodstream infection (10.5%), gastrointestinal infection (9.6%), skin and soft tissue infection (9.6%), and SSI (7.9%) (Figure 1). Approximately one-fifth (19.2%) of HAI events were device
associated; among them, 22.6% were pneumonia, 43.5% were uri- nary tract infections, and 41.7% were bloodstream infections. The most commonly reported potential risk factors were prolonged hospital stay of >2 weeks (52.6%), ICU admission during current hospitalization (33.3%), surgery within the previous month
HAI No HAI
No. % No. % No. % 1,666 100 114 6.8 1,552 93.2
P Value
Majid M. Alshamrani et al
830 50 68 8.2 762 91.8 .030 836 50 46 5.5 790 94.5
1,206 72 74 6.1 1,132 93.9 .064 460 28 40 8.7 420 91.3
231 14 13 5.6 218 94.4 .233 223 13 18 8.1 205 91.9 429 26 22 5.1 407 94.9 323 19 21 6.5 302 93.5
Fig. 1. Distribution of the types of healthcare-associated infections detected among inpatients on May 11, 2017, in 6 MNGHA hospitals. Note. UTI, urinary tract infection; BSI, bloodstream infection; GI, gastrointestinal system infection, ST, soft tissue; SSI, surgical site infection; CVS, cardiovascular system infection; ENT, ear, nose, and throat infection.
(28.1%), receiving enteral feeding (27.2%), and total parenteral nutrition (21.1%). The most common associated pathogens were Pseudomonas spp (18.9%), Klebsiella spp (18.9%), Escherichia coli (13.2%), Staphylococcus aureus (6.6%), and Acinetobacter spp (6.6%). Approximately 14.9% (17 of 114) of HAI events were diagnosed without culture.
Discussion
Weobserved a 6.8%prevalence ofHAIs at 6 tertiary-care hospitals in SaudiArabia. The burden ofHAIs inMNGHAhospitals is generally comparable to those reported by large multicenter PPS studies done in European countries (6.0%),2 the United States (4.0%),3 Canada (11.6%),4 Japan (7.7%),5 Vietnam (7.8%),7 and China (3.7%).6 Nevertheless, these comparisons should be done very cau- tiously becausemultiple factors can markedly change the estimated burden. These factors include the use of different HAI definitions, inclusion of all versus random sample of eligible patients, inclusion of all ages versus exclusion of neonatal or pediatric patients, and the lack of a validation process for the diagnosed events. In the current study, pneumonia was the most frequently diag-
nosed HAI, representing 27% of all HAIs. This rate was similar to the majority of previous reports, which ranked pneumonia as either the first3,5–7 or second2,4 most frequent HAI, with percent- ages ranging from 16%5 to 47%.6 On the other hand, the frequency of SSI in the current study (7.9%) was clearly less than those of pre- vious reports, which reported rates similar or second to that of pneumonia (17%–27%).2,3,5,7 However, our patients received SSI treatment at the outpatient or emergency departments (not an included location in this study) and some patients did not return to the same MNGHA hospital where surgery was done, which could explain this difference. Underreporting of HAIs cannot be excluded in this study, especially with SSIs. Additionally, infection control professionals collected data from their own hospitals. However, underreporting is a chronic problem inherited in the PPS design and can only be minimized by training data collectors and validating diagnoses.10 In conclusion, we report an HAI burden that is generally com- parable to that in European and US hospitals but with some
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