Hospital acquired infections among the paediatric patients in tertiary level hospitals of Dhaka city: Extent, determinants and, impact on cost and hospital management

Abstract

Background: The cross sectional study titled- ‘Hospital Acquired Infections among the Paediatric Patients in Tertiary Level Hospitals of Dhaka City: Extent, Determinants and, Impact on Cost and Hospital Management’-was conducted from August 2013 to November 2016 on a total of 1055 pediatric patients admitted in three tertiary level hospitals of Dhaka city. Objective: The objectives of the study were to assess the extent and to find out the determining factors of hospital acquired infections and to estimate their impact on cost of treatment and on some indicators of hospital management among the admitted paediatric patients in the hospitals under study. Method: Data were collected through interviewer administered semi-structured questionnaire and observation check-list. Uni-variate, bi-variate and multi-variate analysis were done by using SPSS software program. Results: Among 1055 pediatric patients highest number (46.7%) belonged to the age group of 1-5 years of age, dominated by males (53.5%) by gender and 86.4% of the subjects were Muslim. Highest number (46.7%) came from rural areas and majority (58%) belonged to the family having 1 to 5 members. Regarding educational qualification highest number of fathers (29.8%) and mothers (28.2%) attended from class VI-to-X. By occupation most of the mothers (69.9%) were housewives and highest number (29.9%) of the fathers were engaged in agriculture. Highest number (29.7%) of the study subjects belonged to the group of having monthly family income from Tk. 15,001/ - to- Tk. 20,000/-. More than quarter(26.4%) of fathers and only 1.5% mothers were found as regular smoker. Nearly quarter (22.7%) of the pediatric patients under study were found as severely anemic. More than quarter (25.8%) was born by CS operation. Regarding diseases on admission gastro-intestinal disease and urinary disease were found in leading position representing by 19.7% and 18.6% respectively. More than one third (35.2%) of the pediatric patients had to under gone surgical operation during their stay at hospital. Majority (55%) of patients was found to have one or more underlying diseases other than those diseases due to which they had been admitted. Most (89.7%) of the study subjects were visited by 3 or more visitors and more than three fourth (76.3%) were given care by 2 or more attendants. Less than one fourth (23.9%) was found to have history of previous hospitalization, only 5.1% had history of previous surgical operation and nearly three quarters (73.3%) were treated with antibiotics within last three months. Over all prevalence and incidence of HAI in all the three study hospitals was 10.9%and 7.5 per 1000 bed days respectively. By major specialty of treatment prevalence of HAI was found higher (14.0%) in surgery ward than that of the medicine wards (9.2%). Surgical wound infection (24%) was found dominating over other types of HAI. Among the isolated organisms Staphylococcus Aureus (38.3%) was at the top of the list which was followed by E Coli (20%). Prevalence of HAI among the pediatric patients was found significantly different with the differences of education levels of the parents but the relation of HAI with the occupation of the parents was not found significant. Significant relationship was found between prevalence of HAI and the smoking habit of the parents. No evidence of significant difference of HAI was found with the geographical difference of residence. Children from bigger size families (>5 members) were found to have higher prevalence of HAI than that of those children came from smaller (1-5 members) families. Significantly higher number of HAI was found among the subjects born by CS operation. Among surgical patients significant relationship of HAI was found with mode of decision for surgery and types of surgical operations. Prevalence of HAI had significant relationship with higher number of visitors (3 or more) and attendants (2 or more). Significantly lower (8.3%) Prevalence of HAI was found among those patients who were given care by their mothers. Higher number of HAI was found significantly related with both the immunosuppressive conditions and the immunosuppressive therapies. Prevalence of HAI was also found significantly related with cleanliness status of pillow cover and bed sheets of the patients, face mask using, gown wearing and hand washing practice of the doctors and personal hygienic status of the attendants. Prevalence of HAI was also significantly higher among the patients who had positive history of taking antibiotics, being hospitalized and undergone surgery within last 3 months. It was found that if the age of the pediatric patients’ decreased likelihood of the HAI increased. But odds ratios were significant only for two groups (up to1 year; 4.10 and 2-5 years; 2.86). As income decreased, the likelihood of HAI increased. But odds ratio only for the 2nd income quartile (2.74) was statistically significant. It was also found that the hemoglobin level decreased likelihood of HAI highly increased. Odd ratio for severe and moderately anemic patients (6.10) was found statistically significant. As duration of operation increased, likelihood of HAI also increased though the odds ratio for none of the groups was statistically significant. Patients with more than 6 days waiting time for operation had 1.4 times likelihood of HAI than those who had to wait for less than 6 days, but the odds ratios were not statistically significant. Conclusion: Prevalence of HAI among the pediatric patients was found significantly different with the differences of hemoglobin level of patients and with the differences of education levels and smoking habit of their parents. Satisfaction level of the respondents was found significantly different among the parents of HAI and non-HAI patients. Mortality was significantly higher among the HAI patients than that of their non-HAI counterparts. Length of hospital stay and treatment cost was found significantly different among the HAI and non-HAI patients.