Healthcare associated infections including neonatal blood stream infections in a leading tertiary hospital in Botswana

Background: Healthcare associated infections (HAIs) increase morbidity, mortality, length of hospital stay and costs, and should be prevented where possible. In addition, up to 71% of neonates are prone to blood stream infections (BSI) during intensive care due to a variety of factors. Consequently, the objectives of this study were to estimate the burden of HAIs and possible risk factors in a tertiary hospital in Botswana as well as describe current trends in bacterial isolates from neonatal blood specimen and their antibiotic resistance patterns. Methods: Point Prevalence Survey (PPS) in all hospital wards and a retrospective cross sectional review of neonatal blood culture and sensitivity test results, with data abstracted from the hospital laboratory database. Results: 13.54% (n=47) of patients had HAIs, with 48.9% (n=23) of them lab confirmed. The highest prevalence of HAIs was in the adult intensive care unit (100% - n=5), the nephrology unit (50% - n=4), and the neonatal intensive care unit (41.94% - n=13). One fourth of HAIs were site unspecific, 19.1% (n=9) had surgical site infections (SSIs), 17% (n=8) ventilator associated pneumonia/complications, and 10.6% (n=5) were decubitus ulcer infections. There were concerns with overcrowding in some wards and the lack of aseptic practices and hygiene. These issues are now being addressed through a number of initiatives. Coagulase Negative Staphylococci (CoNS) were the commonest organism (31.97%) isolated followed by Enterococci spp. (18.03%) among neonates. Prescribing of third generation cephalosporins is being monitored to reduce Enterococci, Pseudomonas and Acinetobacter spp. infections. Conclusions: There were concerns with the rate of HAIs and BSIs. A number of initiatives are now in place in the hospital to reduce these including promoting improved infection prevention and control (IPC) practices and use of antibiotics via focal persons of the multidisciplinary IPC committee. These will be followed up and reported on.