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

https://doi.org/10.1016/j.ajic.2016.04.212Get rights and content
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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.

Key Words

Health care–associated infections
antimicrobial resistance
surveillance in intensive care units

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Funding/Support: Supported by the U.S. Agency for International Development (USAID-Egypt), Work Unit 263-T-14-0001.

Conflicts of Interest: None to report.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, U.S. Government, the Centers for Disease Control and Prevention, or the Egyptian Ministry of Health and Population.

Additional Information: This protocol was approved by the Institutional Review Board at the U.S. Naval Medical Research Unit No. 3, Cairo, as a nonhuman research activity protocol no. 1114. M.T., M.E.-S., and S.K. are contractors of the U.S. Government. This work was prepared as part of their official duties.