National surveillance of health care–associated infections in Egypt: Developing a sustainable program in a resource-limited country

• Published in: American journal of infection control Vol. 44; no. 11; pp. 1296 - 1301
• Main Authors: Talaat, Maha, MD, MPH, DrPH, El-Shokry, Mona, MD, PhD, El-Kholy, Jehan, MD, PhD, Ismail, Ghada, MD, PhD, Kotb, Sara, MD, MPH, Hafez, Soad, MD, PhD, Attia, Ehab, MD, MPH, Lessa, Fernanda C., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2016; Mosby-Year Book, Inc
• Subjects: antimicrobial resistance; Cross Infection - epidemiology; Developing Countries; Disease control; Egypt - epidemiology; Epidemiological Monitoring; Health care–associated infections; Health Policy; Humans; Infection Control; Infectious Disease; Intensive care; LDCs; Nosocomial infections; Public health; Surveillance; surveillance in intensive care units; Egypt; antimicrobial resistance; surveillance in intensive care units; Health care–associated infections
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2016.04.212

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.