Abstract:

Healthcare-associated infections (HCAI) are the most common preventable adverse events during patient care delivery worldwide, accounting for prolonged hospitalization and death. HCAI surveillance is essential to strengthen infection prevention and control (IPC) practices and improve patient safety. Cameroon does not have a national HCAI surveillance system. We describe some promising practices and challenges in the process of establishing a national HCAI surveillance system in Cameroon. This was a four-phase approach, including an assessment of health facilities’ HCAI surveillance capacity, drafting and implementation of a surveillance protocol in pilot facilities for one year, and performance evaluation. A group of experts met and developed the national protocol and adapted HCAI case definitions from the US Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance (NNIS). Prioritized HCAIs were catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) and surgical site infections (SSI). 627 HCAI cases were suspected with 9(1.4%) confirmed. The most common pathogens were Pseudomonas aeruginosa and Escherichia coli. Some 2(15.4%) facilities detected and responded to colonization of surfaces by pathogens thereby strengthening their IPC programs. Some facilities strengthened their laboratory capacity to confirm HCAI cases. The lack of dedicated funding for patients’ laboratory analysis and the absence of a legal framework were some challenges identified. The establishment of an HCAI surveillance system in Cameroon showed some promising practices. The use of a protocol with clinical case definitions was useful and seems to be an option in situations of limited laboratory capacity.

References:

[1] Allegranzi, B., Nejad, S.B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L. and Pittet, D., 2011. The burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet, 377(9761), pp.228-241.

[2] Talaat, M., El-Shokry, M., El-Kholy, J., Ismail, G., Kotb, S., Hafez, S., ... & Lessa, F. C. (2016). National surveillance of health care–associated infections in Egypt: developing a sustainable program in a resource-limited country. American journal of infection control, 44(11), 1296-1301.

[3] Lukas, S., Hogan, U., Muhirwa, V., Davis, C., Nyiligira, J., Ogbuagu, O., & Wong, R. (2016). Establishment of a hospital-acquired infection surveillance system in a teaching hospital in Rwanda. International Journal of Infection Control, 12(3).

[4] Tomczyk, S., Twyman, A., de Kraker, M. E., Rehse, A. P. C., Tartari, E., Toledo, J. P., ... & Allegranzi, B. (2022). The first WHO global survey on infection prevention and control in health-care facilities. The Lancet Infectious Diseases, 22(6), 845-856.

[5] Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and drug resistance, 2321-2333.

[6] Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478-482.

[7] Alrebish, S. A., Yusufoglu, H. S., Alotibi, R. F., Abdulkhalik, N. S., Ahmed, N. J., & Khan, A. H. (2022, December). Epidemiology of Healthcare-Associated Infections and Adherence to the HAI Prevention Strategies. In Healthcare (Vol. 11, No. 1, p. 63). MDPI.

[8] Burke, J. P. (2003). Infection control-a problem for patient safety. New England Journal of Medicine, 348(7), 651-656.

[9] Tenna, A., Stenehjem, E. A., Margoles, L., Kacha, E., Blumberg, H. M., & Kempker, R. R. (2013). Infection control knowledge, attitudes, and practices among healthcare workers in Addis Ababa, Ethiopia. Infection Control & Hospital Epidemiology, 34(12), 1289-1296.

[10] Borg, M. A. (2010). Prevention and control of healthcare-associated infections within developing countries. International Journal of Infection Control, 6(1).

[11] World Health Organization. (2011). Report on the burden of endemic health care-associated infection worldwide.

[12] Storr, J., Twyman, A., Zingg, W., Damani, N., Kilpatrick, C., Reilly, J., ... & Allegranzi, B. (2017). Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrobial Resistance & Infection Control, 6, 1-18.

[13] Takaya, S., Hayakawa, K., Matsunaga, N., Moriyama, Y., Katanami, Y., Tajima, T., & Ohmagari, N. (2020). Surveillance systems for healthcare-associated infection in high and upper-middle income countries: A scoping review. Journal of Infection and Chemotherapy, 26(5), 429-437.

[14] Stempliuk, V. (2018). Surveillance of Healthcare-Associated Infections in Low-and Middle-Income Countries: From the Need to a Reality. Current Treatment Options in Infectious Diseases, 10(1), 1-6.

[15] Nejad, S. B., Allegranzi, B., Syed, S. B., Ellis, B., & Pittet, D. (2011). Health-care-associated infection in Africa: a systematic review. Bulletin of the World Health Organization, 89(10), 757-765.

[16] Emori, T. G., Culver, D. H., Horan, T. C., Jarvis, W. R., White, J. W., Olson, D. R., ... & Hughes, J. M. (1991). National nosocomial infections surveillance system (NNIS): description of surveillance methods. American journal of infection control, 19(1), 19-35.

[17] Karami, M. (2016). Surveillance systems for nosocomial infections: methods and challenges. Infection Control & Hospital Epidemiology, 37(2), 237-238.

[18] Nouetchognou, J. S., Ateudjieu, J., Jemea, B., Mesumbe, E. N., & Mbanya, D. (2016). Surveillance of nosocomial infections in the Yaounde University Teaching Hospital, Cameroon. BMC Research Notes, 9, 1-8.

[19] Wasserman, S., & Messina, A. (2018). Bundles in infection prevention and safety. Guide to infection control in the healthcare setting, 1-15.

[20] Emori, T. G., & Gaynes, R. P. (1993). An overview of nosocomial infections, including the role of the microbiology laboratory. Clinical microbiology reviews, 6(4), 428-442.

[21] Nogueira Junior, C., Mello, D. S. D., Padoveze, M. C., Boszczowski, I., Levin, A. S., & Lacerda, R. A. (2014). Characterization of epidemiological surveillance systems for healthcare-associated infections (HAI) in the world and challenges for Brazil. Cadernos de Saúde Pública, 30, 11-20.

[22] Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4), 305-315.

[23] Ataiyero, Y., Dyson, J., & Graham, M. (2019). Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. American Journal of Infection Control, 47(5), 565-573.

[24] Kretzer, E. K., & Larson, E. L. (1998). Behavioural interventions to improve infection control practices. American journal of infection control, 26(3), 245-253.

[25] Neo, J. R. J., Sagha-Zadeh, R., Vielemeyer, O., & Franklin, E. (2016). Evidence-based practices to increase hand hygiene compliance in health care facilities: An integrated review. American Journal of Infection Control, 44(6), 691-704.

[26] Sievert, D. M., Ricks, P., Edwards, J. R., Schneider, A., Patel, J., Srinivasan, A., ... & Fridkin, S. (2013). Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infection Control & Hospital Epidemiology, 34(1), 1-14.

[27] Góngora Rubio, F., Oliveira, V. D. C., Rangel, R. M. C., Nogueira, M. C. L., & Almeida, M. T. G. (2013). Trends in bacterial resistance in a tertiary university hospital over one decade. Brazilian Journal of Infectious Diseases, 17, 480-482.

[28] Tanihara, S., & Suzuki, S. (2016). Estimation of the incidence of MRSA patients: evaluation of a surveillance system using health insurance claim data. Epidemiology & Infection, 144(11), 2260-2267.

[29] Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care-associated infection. American journal of infection control, 40(6), 486-490.

[30] Pilnick, A., & Dingwall, R. (2011). On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social science & medicine, 72(8), 1374-1382.

[31] Stevenson, F. A., Cox, K., Britten, N., & Dundar, Y. (2004). A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health expectations, 7(3), 235-245.

[32] Bailey, T. M., & Ries, N. M. (2005). Legal issues in patient safety: the example of nosocomial infection. Healthc Q, 8, 140-145.

[33] Laugesen, J., Hassanein, K., & Yuan, Y. (2015). The impact of Internet health information on patient compliance: a research model and an empirical study. Journal of medical Internet research, 17(6), e143.

[34] Biswal, M., Mewara, A., Appannanavar, S. B., & Taneja, N. (2015). Mandatory public reporting of healthcare-associated infections in developed countries: how can developing countries follow? Journal of Hospital Infection, 90(1), 12-14.