Risk Factors of Hospital Acquired Infections among Patients Admitted in A Selected Hospital in Dhaka

Abstract

This prospective cross sectional observational and analytical study was conducted at UnitedHospital Ltd. Gulshan, Dhaka at all age and sex during January to July, 2015 with a view to findout the incidence of Hospital Acquired Infection (HAI), patient related risk factors, hospitalrelated risk factor, offending organism caused for HAI and their antimicrobial sensitivity. Out oftotal 1108 respondents, 104 (9.4%) respondents were found to develop HAI which yieldedincidence rate 8.75/1000 hospital days. Respiratory tract infection was the highest 56.7% among the types of HAI followed by urinary tract infection (15.4%). Not any single factor of socio demographic characteristics was found associated with the development of HAI.168 (16.7%) respondents of extreme of age group developed infection comparison to around 940(8.1%) of not of extreme of age develop infection and the association was found statisticallysignificant (p<0.001). An individual who required nursing assistance most of the time had 20 times more risk ofdeveloping HAI and those who required some assistance had 6.78times more risk than those whorequired no assistance. The Odds ratio (OR) for 3 functional categories were: 0.3, 0.9 and 6.1.60% HAI had >3 visitors followed by 39.6% were 3 visitors while 2.1%, 2.9% visited by 1 & 2visitor respectively. For the development of HAI, visitors were found statistically markedly significant (p<0.001). An individual who was visited by more than three visitors had around 118times more risk of developing HAI of respondents than who had no or one visitor. The Odds ratiofor 4 visitor categories were: 0.2, 0.2, 9.4 and 23.6. 96 (11.9%) with antibiotic therapy during hospitalization showed HAI while 8(2.6%) found HAI with no antibiotic (p<0.001). Regarding application of antimicrobial use up to 5 days, 16respondents (5.7%), 28 (7.6%) of 6-10 days, 32 (28.1%) of 11-15 days, 10 (45.5%) of 16-20 daysand 14 (70.0%) of duration more than 20 days developed infection. The association of duration ofantimicrobial use and development of HAI was found statistically highly significant (t=9.675,p=0.000). Around 24% respondents with underlying illness developed HAI in comparison 6.5% respondents without illness and the association was found statistically highly significant (p<0.001). 20.8% respondents with invasive device application developed HAI compare to 2.8%without device and statistically highly significant (p=0.000). 3.3% of respondents developed HAIwho had the application of invasive device up to 5 days, while 21.8% by 6-10 days, 38.9% by 11-15 days, 21.4% by 16-20 days and 50% by more than 20 days. The association of developing HAI with duration of use of invasive device was statistically highly significant (t=12.063,p=0.000).31.8% respondents having immunosuppressive therapy developed HAI on the contrary to7.5%without such therapy which showed association statistically highly significant (p<0.001).24.5% (80) respondents representing immunosuppressive condition developed HAI where 3.1% (24) had infection did not present such condition and association was found statistically highlysignificant (p=0.000). The mean hospital days for development of HAI group was 19.96±13.11 whereas hospital dayson discharge without infection group was 9.77±7.13. The association between hospital days anddevelopment of infection was found statistically highly significant (t=7.845, P=0.000). Routine operation 47 (20.2%) and emergency 19 (26.8%) respondents having HAI established nostatistically significant (p>0.05). On the other hand respondents having post operative showed HAI, 55(18.1%) and non-operative 49 (6.1%) infection. The association found statistically significant (p<0.001). 16 (14.5%) respondents found frequent transfer developed HAI comparison to 88 (8.8%) without transfer and association was statistically not significant (p>0.05). Regarding general cleanliness of ward/department, 9% had HAI satisfactory group contrary to 10.4% HAI from dirty group of respondents. No statistically significant association was found (p>0.05). The Logistic regression predicting independent risk factors revealed functional state (OR=22.067, p=0.001), number of visitor/patients/day (OR=71.000, p=0.000), underlying illness (OR=4.602, p=0.000), duration of device use (OR=19.000, p=0.011 and duration of antimicrobial use (OR=1.079, p=0.001) were found as independent risk for developing HAI. Gram negative Enterobacteriaceae as a group were most predominant pathogens. The highest infective agents were 33% HAI from Klebsiella pneumoniae followed by 17% Acinetobacter baumannii and both Esch.coli and Pseudomonas aeruginosa each 14%.Only colistin sulphate was reported sensitivity range from 76 to 100% while almost all other isolates were observed multi drug resistance (MDR). Measured aimed at increasing awareness of hospital staff, a large scale study, formulation of antibiotic policy, controlling of visitors, appropriate device handling procedure, establishing a strong surveillance programme through infection control and prevention department for minimize or control hospital acquired infection. Epidemiological studies are strongly recommended in order to detect source of infection.