Epidemiology of four main nosocomial infections in Iran during March 2007 - March 2008 based on the findings of a routine surveillance system

Abstract

Background: Annually, around six million patients are admitted to hospitals in Iran. Information about the prevalence of nosocomial infections (NIs) is necessary for both appropriate management and establishment of preventative measures in hospitals. This article is based on the findings of the Nosocomial Infection Surveillance System (NISS) which has been providing information on NIs in Iran since March 2007.

Methods: NISS covers 95 hospitals throughout Iran, each with over 200 beds. There are four main infections: urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and pneumonia (PNEU) included in NISS. Reports are completed on forms that have been provided based on national guidelines. In all selected hospitals there is one designated nurse who conducts infection control activities and is trained in the detection and reporting of NIs based on NISS guidelines.

Results: During March 2007 - March 2008, a total of 1,879,356 patients were admitted to the selected hospitals. The total detected NIs were 10557 with a prevalence of 0.57%. Of these, UTI was the most prevalent infection (32.2%) and BSI was the least (16.3%). Based on gender, females had more UTI, whereas PNEU was the highest in males. Of reported NIs, 9% were detected in children less than five years of age and included BSI (45%), PNEU (20%), SSI (19%) and UTI (16%). There were 26% reported NIs in the age group over 65 years, of which the most prevalent infections were UTI (42%) followed by PNEU (31%), SSI (15%) and BSI (12%). NIs were most often detected in intensive care units (ICUs; 26.7%), followed by surgery wards (12.8%).

Conclusion: In comparison with other studies and the World Health Organization (WHO) estimates, the rate of NIs appears to be less according to NISS. NISS has the capability to provide basic information for efficient management and control measures, in addition to indicating variations in NIs based on gender, age and location (hospital ward). In order to have a more realistic estimate of NIs and strengthen NISS, it is advisable to conduct a point prevalence study.