Surveillance for healthcare associated respiratory infections in selected Kenyan Hospitals.

Abstract

Respiratory pathogens are highly transmissible in hospital settings, especially those without adequate infection prevention and control (IPC) programs. Although rates of healthcare-associated infections (HAI) in Kenya are suspected to be high, little data exists. Respiratory HAIs was evaluated from 1st September 2009 to 31st July 2010 in three hospitals in Kenya to determine the incidence of, and the risk factors associated with respiratory HAIs. During the study, in each of the selected wards, patients with respiratory HAI were identified, as any patient who developed new fever (≥380C) or hypothermia (<350C) in the hospital (≥3days after admission) with concurrent clinical features of acute respiratory infection. Nasopharyngeal and oropharyngeal specimens were collected from these patients and tested by real-time reverse transcription polymerase chain reaction for eight viruses. No follow-up occurred after patients were discharged. From September 2009 to July 2010, a total of 406 patients identified with HAIs, were recruited, of which 155 (38.2%), had respiratory HAIs. The overall incidence of respiratory HAI was 0.80 infections per 1000 patient-days, with the highest incidence in the ICUs’ (5.5/1000 patients days) followed by the eye ward (3.3/1000 patients days). Of all specimens analysed, 56 (42.1%) had at least one respiratory virus identified; 73.2% of all positive viral specimens were identified in patients ≤5 years old. Respiratory viral HAI were prevalent 79 (49.1%) in the patients’ ≤5 years admitted in hospitals in Kenya, of which RSV was the most prominent. Respiratory HAI was associated with the type of ward the patient was admitted, age of the patient and having a central line catheter in situ. Adjusting for age and hospital, patients in ICU had 12.6 (95% confidence interval 4.7-33.9) times greater odds (p<0.05) of respiratory HAI. In conclusion, respiratory HAI is common in children ≤5 years of age and patients admitted in the ICU. This gives an indication of the magnitude of the burden imposed by respiratory HAI in these groups of patients, and it should lead to increased efforts by healthcare workers to adhere to strict infection control measures to limit the spread of these infections in these patients’ populations