Healthcare-associated infections (HAIs) are more common and severe in developing countries. The WHO analyzed data from over 220 publications and found that developing countries have a HAI prevalence of 15.5% compared to 7-10% in developed countries. HAI rates in intensive care units in developing countries are triple those in the US. Critically ill patients in low-income countries have double the device-associated HAI rates of industrialized countries. Common HAIs include bloodstream infections, pneumonia, and urinary tract infections. Improved infection control and prevention, including hand hygiene, are needed to reduce HAIs.

1. Healthcare associated infections
in developing countries

2. Background
• Healthcare-associated infections (HCAI/HAIs) are one of the most
common adverse events in patient care and account for substantial
morbidity and mortality.
• High HCAI rates are an indicator of poor quality of healthcare services.
• 7% of patients in developed and 10% in developing countries will acquire
at least one HAI.
• Preventable through effective infection prevention and control measures

3. Findings of WHO
The Lancet by Benedetta Allegranzi and colleagues from WHO:
• The investigators analysed pooled data from 220 selected publications from 1995 to 2008,
including data from the Americas (22%), Europe (20%), southeast Asia (16%), the eastern
Mediterranean (8%), Africa (5%), and other regions (29%).
• Prevalence of HCAIs in developing countries was found to be 15·5 per 100 patients, at least
double the rates published by the European Centre for Disease Prevention and Control.
• Incidence of HCAIs acquired in intensive-care units from developing countries was 34·2 per
1000 patient-days, triple the rates in the USA.
• Critically ill patients admitted to hospital in low-income countries had at least double the
device-associated HCAI rates of patients in industrialised countries. (E.g. ventilator associated
pneumonia, and catheter-associated urinary tract infection.)
• At any time, up to 7% of patients in developed and 10% in developing countries will acquire at
least one HAI.
• These infections also present a significant economic burden at the societal level.

4. Nosocomial infections
• Infections acquired in hospital or healthcare service unit that first appear 48 h or more
after hospital admission or within 30 days after discharge following in patient care.
• Unrelated to the original illness and neither present nor incubating as at the time of
admission.
Reasons why nosocomial infections are even more alarming:
• People who are in hospital are sicker on average
• Many medical procedures that bypass the body's natural protective barriers
• Medical staff move from patient to patient thus providing a way for pathogens to spread
• Inadequate sanitation protocols regarding uniforms equipment sterilization
• Washing and other preventive measures that may either be unheeded by hospital
personnel or too lax to sufficiently isolate patients from infectious agents
• Routine use of anti-microbial agents in hospitals creates selection pressure for the
emergence of the resistant strains of microorganisms

5. Common Victims
• Healthcare-associated infections occur in both adult and pediatric patients.
• Bloodstream infections, followed by pneumonia and urinary tract infections
are the most common infections in children.
• Urinary tract infections are the most common healthcare – associated
infections in adults.
• Children younger than 1 year, babies with extremely low birth weight
<1000g and children in either the PICU or NICU have higher rates of HCAIs.

6. Sources and Symptoms
• The source of healthcare-associated infections may be suggested by the instrumentation
used in various procedures.
• An endotracheal tube may be associated with sinusitis, tracheitis, and pneumonia
• An intravascular catheter may be the source of phlebitis or line infection
• A Foley catheter may be associated with a urinary tract infection
Sources
Symptoms
• Patients with pneumonia may have fever, cough, purulent sputum and abnormal chest
auscultatory findings such as decreased breath sounds, crackles or wheezes.
• Patients with urinary tract infection may present with or without fever. Upon inspection,
their urine can be cloudy and foul-smelling.
• Neonates may have very subtle and nonspecific signs of infection. Fever may or may not
be present. Signs of infection can include temperature and/or blood pressure instability,
apnea, bradycardia, lethargy, fussiness, and feeding intolerance.

7. Prevention and cure
• The most effective method of containment is disinfection of
instruments and especially hospital staff and visitors.
• The surgeons disinfection procedure-hand scrubbing 5 min
has to be repeated many times a day
• For the hospital staff, the issue of the hand disinfection
• Plasma sterilisation of equipment

8. Findings
• Infection frequencies reported in high-quality studies were greater than those from
low quality studies
• Prevalence of health-care-associated infection in developing countries was much
higher than proportions reported from Europe and the USA.
• Pooled overall health-care-associated infection density in adult intensive-care units
was 47·9 per 1000 patient-days, at least three times as high as densities reported
from the USA
• Surgical-site infection was the leading infection in hospitals (pooled cumulative
incidence 5·6 per 100 surgical procedures)

9. Conclusion
• Intensive care is a risk factor for the emergence of antibiotic resistant bacteria.
• Gram-positive bacteria have overtaken Gram-negative organisms as the predominant
cause of nosocomial infections.
• Inadequate antibiotic therapy is associated with poor outcome and particularly with
bacterial resistance.
• Infection control measures are important for the effective control, prevention and
treatment of infection.
• Shorter duration of treatment and correct dosage of antibiotic therapy is recommended
to reduce the selection pressure for resistant isolakes.
• Hand washing is the single most important measure to prevent nosocomial infections.
• With the escalating armamentarium of antimicrobial resistance, healthcare sector has to
go back to the very basics of hospital infection control

10. Conclusion
• Intensive care is a risk factor for the emergence of antibiotic resistant bacteria.
• Gram-positive bacteria have overtaken Gram-negative organisms as the predominant
cause of nosocomial infections.
• Inadequate antibiotic therapy is associated with poor outcome and particularly with
bacterial resistance.
• Infection control measures are important for the effective control, prevention and
treatment of infection.
• Shorter duration of treatment and correct dosage of antibiotic therapy is recommended
to reduce the selection pressure for resistant isolakes.
• Hand washing is the single most important measure to prevent nosocomial infections.
• With the escalating armamentarium of antimicrobial resistance, healthcare sector has to
go back to the very basics of hospital infection control