Maha Talaat1, Mona El-Shokry2, Jehan El-Kholy3, Ghada Ismail4, Sara Kotb5, Soad Hafez6, Ehab Attia7, Fernanda C Lessa8. 1. Global Disease Detection Center, US Centers for Disease Control and Prevention, Cairo, Egypt; US Naval Medical Research Unit, No. 3, Cairo, Egypt. Electronic address: maha.m.talaat.ctr@mail.mil. 2. Global Disease Detection Center, US Centers for Disease Control and Prevention, Cairo, Egypt; US Naval Medical Research Unit, No. 3, Cairo, Egypt; Ain Shams University Hospitals, Cairo, Egypt. 3. Cairo University Hospitals, Cairo, Egypt. 4. Ain Shams University Hospitals, Cairo, Egypt. 5. Global Disease Detection Center, US Centers for Disease Control and Prevention, Cairo, Egypt; US Naval Medical Research Unit, No. 3, Cairo, Egypt. 6. Alexandria University Hospitals, Alexandria, Egypt. 7. Ministry of Health and Population, Cairo, Egypt. 8. Centers for Disease Control and Prevention, Atlanta, GA.
Abstract
BACKGROUND: Health care-associated infections (HAIs) are a major global public health concern. The lack of surveillance systems in developing countries leads to an underestimation of the global burden of HAI. We describe the process of developing a national HAI surveillance program and the magnitude of HAI rates in Egypt. METHODS: The detailed process of implementation of a national HAI surveillance program is described. A 3-phase surveillance approach was implemented in intensive care units (ICUs). This article focuses on results from the phase 2 surveillance. Standard surveillance definitions were used, clinical samples were processed by the hospital laboratories, and results were confirmed by a reference laboratory. RESULTS: Ninety-one ICUs in 28 hospitals contributed to 474,544 patient days and 2,688 HAIs. Of these, 30% were bloodstream infections, 29% were surgical site infections, 26% were pneumonia, and 15% were urinary tract infections. Ventilator-associated pneumonia had the highest incidence of device-associated infections (4.3/1,000 ventilator days). The most common pathogens reported were Klebsiella spp (28.7%) and Acinetobacter spp (13.7%). Of the Acinetobacter spp, 92.8% (157/169) were multidrug resistant, whereas 42.5% (151/355) of the Klebsiella spp and 54% (47/87) of Escherichia coli were extended-spectrum β-lactamase producers. CONCLUSIONS: Implementation of a sustainable surveillance system in a resource-limited country was possible following a stepwise approach with continuous evaluation. Enhancing infection prevention and control programs should be an infection control priority in Egypt.
BACKGROUND: Health care-associated infections (HAIs) are a major global public health concern. The lack of surveillance systems in developing countries leads to an underestimation of the global burden of HAI. We describe the process of developing a national HAI surveillance program and the magnitude of HAI rates in Egypt. METHODS: The detailed process of implementation of a national HAI surveillance program is described. A 3-phase surveillance approach was implemented in intensive care units (ICUs). This article focuses on results from the phase 2 surveillance. Standard surveillance definitions were used, clinical samples were processed by the hospital laboratories, and results were confirmed by a reference laboratory. RESULTS: Ninety-one ICUs in 28 hospitals contributed to 474,544 patient days and 2,688 HAIs. Of these, 30% were bloodstream infections, 29% were surgical site infections, 26% were pneumonia, and 15% were urinary tract infections. Ventilator-associated pneumonia had the highest incidence of device-associated infections (4.3/1,000 ventilator days). The most common pathogens reported were Klebsiella spp (28.7%) and Acinetobacter spp (13.7%). Of the Acinetobacter spp, 92.8% (157/169) were multidrug resistant, whereas 42.5% (151/355) of the Klebsiella spp and 54% (47/87) of Escherichia coli were extended-spectrum β-lactamase producers. CONCLUSIONS: Implementation of a sustainable surveillance system in a resource-limited country was possible following a stepwise approach with continuous evaluation. Enhancing infection prevention and control programs should be an infection control priority in Egypt.