Surveillance of healthcare-associated infection at Angkor Hospital for Children, Siem Reap, Cambodia

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Background: Healthcare-associated infections (HAI) are a significant global threat. Surveillance data relating to HAI in the developing world are limited. Cambodia is one of the most resource-limited countries in South-East Asia. We describe surveillance of HAI in a regional paediatric hospital in northwestern Cambodia. Methods: Standardised monthly cross-sectional HAI point prevalence surveys (PPS) were conducted at the Angkor Hospital for Children (AHC), Siem Reap. AHC is a 50-bedded hospital, with critical care, surgical and medical inpatients <16 years of age. Every child in the hospital was reviewed on a single day each month for evidence of an HAI. Patients at risk were those whose infection developed after 48 hours in hospital. In December 2011 we also screened for Staphylococcus aureus and multi-drug resistant Enterobacteriaceae carriage. Results: Between January and December 2011 622 patients were surveyed. The median age was 2.7 years (range 0-16 years, IQR 0.5-9); ICU/ER patients were significantly younger in age (p<0.0001). The number of patients at risk of HAI was greater in the intensive care (ICU), surgical (SU) and step-down care (LAU) settings (p<0.001). The overall prevalence of HAI was 13.2/100 patients at risk (3.1 on the SU to 45.1 in the ICU/Emergency room (ER)). The relative risk of having an HAI in ICU/ER was 5.9. The mean HAI prevalence declined from 14.9/100 in the first six months to 11.5/100 in the second, although this was not significant (p = 0.32). The commonest HAI was of respiratory origin (37/64; 58%). 79% of patients were receiving an antimicrobial including ceftriaxone (21.4%), ampicillin (5%), gentamicin (5.1%), cloxacillin (4.6%) and imipenem (3.8%). Five patients were found to be carrying S. aureus (9.8%), one methicillin-resistant (1.9% overall carriage prevalence). 83% of patients had faecal carriage of ESBL-producing Enterobacteriaceae. Conclusion: This is the first HAI surveillance data from Cambodia and confirms HAI as a major problem with respiratory HAIs most common. Rates of ESBL-carriage are alarming, possibly driven by high ceftriaxone usage. Current interventions include a hand hygiene programme, a VAP-prevention care bundle and the implementation of an antimicrobial guideline. This simple method of surveillance can be used to monitor future HAI trends in response to interventions.
Original languageEnglish
JournalInternational Journal of Infectious Diseases
Publication statusPublished - 2012


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