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Re: Prevalence of hospital-acquired infection in a Moroccan university hospital

      To the Editor:
      The comprehensive point-prevalence study at the Ibn Sina University Hospital in Rabat, Morocco,
      • Jroundi I.
      • Khourdri I.
      • Azzouzi A.
      • Zeggwagh A.A.
      • Brebrahim N.F.
      • Hassouni F.
      • et al.
      Prevalence of hospital-acquired infection in a Moroccan university hospital.
      to assess the existing hospital-acquired infection (HAI) was innovative. Such studies would be advantageous in other academic and nonacademic hospitals. Nevertheless, workups involving clinicians, clinical microbiologists, and epidemiologists and scrutiny of clinical and radiologic findings would not be feasible in nonacademic establishments. Chances of HAI surveillance would be low in private sector hospitals in developing countries. Alternatively, a culture-based surveillance for HAI ought to be a valid proxy. That was evident at the Sant Parmanand Hospital, Delhi, India, a private, 140-bed, multispecialty, tertiary care hospital.
      Effective October 2002, all bacterial culture-positive hospitalized patients are being categorized as hospital- or community-acquired infection, depending on the time interval between time of admission and collection of pathologic specimens. Samples positive on culture after 2 to 3 days of hospitalization are labeled as “hospital acquired.” An infection control team comprising clinicians, clinical microbiologist, and infection control/microbiology technicians would review such cases regularly. HAI cases are quantified monthly per 100 hospitalized cases. The team briefs management through the hospital director. The culture report including susceptibility profiles is communicated to the personnel responsible for patient care.
      During the initial 6-month period October 2002 to March 2003, HAI patients averaged 0.98 per 100 admissions, SE 0.26. The annual averages ± SE for the subsequent 12-month periods were 0.26 ± 0.07, 0.4 ± 0.04, 0.44 ± 0.04, and 0.4 ± 0.04, respectively. During 2005, there were 54 episodes of HAI recorded in 49 patients. The sites were urinary tract infections in 18 cases; pulmonary tissues in 16 cases, and blood and purulent material in 10 cases each. Isolates included Escherichia coli strains, 16; Klebsiella species, 13; Staphylococcus aureus, 13; Proteus species, 7; Pseudomonas species, 3; and a solitary Paracolon species. As in Rabat,
      • Jroundi I.
      • Khourdri I.
      • Azzouzi A.
      • Zeggwagh A.A.
      • Brebrahim N.F.
      • Hassouni F.
      • et al.
      Prevalence of hospital-acquired infection in a Moroccan university hospital.
      local HAI infection was dominant in the urinary tract, and gram-negative bacteria and not gram-positive bacteria were the dominant offenders.
      The average HAI incidence in the first 6 months of surveillance could be regarded as the basic scenario in the hospital. Culture-based surveillance would appear to lower the HAI in the subsequent 4-year interval: analysis of variance, P < .0001. Although hospital management was not approached for additional budget, motivated infection control team members ensured prompt communication of relevant data to clinicians. There has been no secondary spread of infection. A similar strategy of a motivated team of clinicians and microbiology personnel should effectively address HAI, even with rather inadequate fiscal support.
      The authors thank Sarita Kumar for excellent secretarial assistance.

      References

        • Jroundi I.
        • Khourdri I.
        • Azzouzi A.
        • Zeggwagh A.A.
        • Brebrahim N.F.
        • Hassouni F.
        • et al.
        Prevalence of hospital-acquired infection in a Moroccan university hospital.
        Am J Infect Control. 2007; 35: 412-416

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