Internal Medicine: Open Access
Open Access

Hospital Acquired Blood Stream Infections: Epidemiology, Risk Factors, & Outcome

Marah El-Beeli^{* *}Correspondence: Marah El-Beeli, Department of Infectious Diseases, Sultan Qaboos University, Muscat, Oman, Email:

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Description

Hospital acquired bloodstream infections (HA-BSIs) are one of the most serious hospital acquired infections. Surveys have shown that HA-BSIs were responsible for 20%-60% of hospitalization related deaths. Despite the high morbidity and fatality, and enormous burden of health care costs of HA-BSIs, to our knowledge, there are no published studies on HA-BSI in the Middle East. This study is an attempt to enhance the knowledge about HA-BSI and to advance scientific knowledge and improve services in Oman hospitals.

This study aims to 1) Estimate the prevalence of HA-BSI in Oman, 2) Estimate the in-hospital death rate resulting from HA- BSIs, 3) Evaluate the risk factors profile of the (death) outcome of HA-BSI in Oman, 4) To assess the ‘Knowledge, Attitude, and Practice among Healthcare Providers towards Infection Control Strategies related to HA-BSIs.

Discussion

This research is including four studies. The first study is ‘Prevalence of HA-BSIs in a Tertiary Hospital in Oman’. It is a cross-sectional study ambi-directional (retrospective & prospective) follow up. The study will retrieve data on hospital acquired infections from the infection control surveillance database at Sultan Qaboos University Hospital (SQUH). The prevalence rate of patients with HA-BSIs and the prevalence rate of HA-BSI isolates (HA-BSI events) will be calculated by dividing the number of cases with index by number of monthly inpatient admissions for the whole year. The prevalence rates will be reported per 1,000 admissions. The second study is ‘Risk factors associated with in-hospital deaths due to HA-BSIs’. A case- control study will be conducted to compare between HA-BSI (died) cases and matched HA-BSI (alive) controls. HA-BSI Cases and controls will be recruited from the registry established in study-1. Controls will be matched to the cases based on important confounding factors. The third study is ‘Knowledge, Attitude, and Practice among Healthcare Providers towards Infection Control Strategies related to HA-BSIs”. It is a Cross- sectional study. A random sample of healthcare providers among medical, nursing, and technical staff working at SQUH, will be enrolled using clustered random selection scheme. KAP questionnaire is designed according to elements required in the infection control strategies related to HA-BSI, and in reference to internationally-recognized standardized and validated KAP instruments. A total of 1246 cases of HA-BSI occurred during the time between January 2015 and December 2019. A pilot study has been conducted on 150 HA-BSI cases and 150 controls. Initial results indicated high response rate (92%) and cooperation rate (94%). Data collection tools have been standardized to the local setup (Cronbach’s a = 0.06). Pilot assessment indicated high inter-rater reliability (Pearson’s r coefficient= 0.88); and high validity parameters (content, construct & criterion).

The total admissions of 138437 of which there has been 1246 HA-BSI cases and 1602 isolates presenting an overall prevalence rate of 8.9 (95% CI 8.4, 9.4) and 11.5 (95% CI 10.9, 12.0) respectively) HA-BSI per 1000 admissions. The highest prevalence estimate recorded was in the ICU ward (43.5 (95% CI 39.0, 48.6),where among the total of 6915 admissions in the ICU over a period of 5 years there has been 301 HA-BSI cases. Among the total of 1246 of HA-BSI cases 349 patients have end up died representing 28% of the cases. And many risk factors are contributing to death result like age, co-morbidity and causative micro-organism.

Conclusion

Study protocol has been designed & validated to explore HA- BSI prevalence estimation, risk factors profile. Initial piloting indicated high applicability of study tools to local context.