Hospital Acquired Infections and Infection Prevention Practice in Teaching Hospitals in the Amhara Regional State, Ethiopia
Creators: name: Worku, Walelegn
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2017

description: Background: Hospital acquired infections are major public health concerns throughout the world, contributing to increased morbidity, mortality, and health cost. Hospitals are the main sources for the risk of acquiring infection during health care delivery. There is little evidence concerning the burden of unsafe care in developing countries, where the risk of harm to patients is likely to be greater, due to low infrastructure, technologies, and human resources. Limited researches to specific infections show that a significant number of inpatients acquire infections in hospital set ups in Ethiopia. There is limited information that indicate magnitude, barriers and factors for prevention and control practice of hospital acquired infections in teaching hospitals. Objective: The overall objective of this study was to assess the magnitude and risk factors of hospital acquired infections and barriers and health care workers practice of infection prevention and control in Amhara Regional state teaching Hospitals, Ethiopia. Methods: Mix of quantitative and qualitative methods were employed. A repeated cross-sectional and matched case control study designs were employed between April and July 2015 at the University of Gondar and Felege-Hiwot medical teaching hospitals. All eligible inpatients admitted for at least 48 hours on the day of the survey were included. Trained physicians and nurses collected data according to the Centers for Disease Control and Prevention(CDC) definitions of hospital acquired infections. A total of 908 patients for the prevalence survey, 545 patients, 109 cases and 436 controls for the matched case control study and 422 health care workers for the practice of infection prevention and control were included in this study. The collected data were cleaned, coded and entered into Epi-Info software version 3.5.3 and analysis was done using STATA 13. Univariate and multivariable Conditional logistic regression were used for the analysis. Odds ratios with the corresponding 95% confidence intervals were estimated and p values were determined. Variables with P &lt; 0.05 in the multivariable conditional logistic regression analysis were considered as significant independent predictors in this study. For the qualitative study, a phenomenological approach was used to explore the lived experience of healthcare workers and management staffs towards infection prevention practice and control. XII Data were collected from ten in-depth interviews and four focus group discussions, by face to face interviews using open ended interview guides in safe and quiet places. Data were managed using open code software version 4.03 and contents were analyzed thematically. Results: The overall point prevalence of hospital acquired infection was 14.9 % (95% CI: 12.7- 17.1). Klebsiella spp (22.44%) and Staphylococcus aureus (20.4%) were the most commonly isolated hospital acquired infections causing pathogen in these hospitals. Patients admitted in wards with medical waste containers the room had 82% less chance of developing hospital acquired infections (AOR 0.18: 95% CI, 0. 03-0.98). The odds of developing hospital acquired infections among immune deficient patients were 2.34 times higher than non-immuno- compromised patients, with 95% CI: (1.17-4.69). Patient received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively. The proportion of infection prevention practice towards hospital acquired infection was 55% with 95% CI: (50.1-59.6). In the past one year 234 (56.7%) and 150 (36.3%) health care workers were exposed to blood and body fluids and sharp or needle sticks injury, respectively. Nurses practice 2.09 times more compared to physicians to infection control with (95% CI: 1.27-3.43). In the qualitative assessment, a total of ten different barriers were identified: such as lack of availability of facilities, shortage of material supply, lack of maintenance of facilities and equipment's, high patient flow, lack of experience, emergency situation, healthcare worker behavior and healthcare worker's knowledge, low awareness of patients and visitors and large number of families and visitors to the hospital. Conclusions: High prevalence of hospital acquired infection was observed in teaching hospitals. Surgical site infection and pneumonia were the most common type of infections. Infection prevention and control practice were low in the study setting. High proportion of healthcare workers were exposed to risks. Nursing professionals practiced prevention better than physicians. Important barriers for infection prevention were identified