Volume 9, Issue 2, February 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Study of the Prevalence of Nosocomial

Infections in the University Hospital Center of
Béni-Messous, Algiers in 2023 – Algeria
1
Brahimi G.; 2Ait Seddik S.; 3Chabane K.; 4Slaouti S.; 5Abdous I.
6
Bensaissa M; 7Bekka K.; 8Haifi A.; 9Mazouz F.Z; 10Seniane S.S., 11Anza H.K; 12Hamoudi S.
Department of Epidemiology and Preventive Medicine, Béni-Messous University Hospital,
Faculty of Medicine, University of Algiers

Abstract:- The risk of contracting an infection in the I. INTRODUCTION

hospital has always existed. It has increased with the
evolution of patient care practices. The objectives of Nosocomial infections (NI) represent a real public health
our study were to determine the prevalence rate problem today, with considerable consequences on patients by
of nosocomial infections in our establishment, to increasing the length of hospital stay, morbidity and even
know the most frequent sites of these infections mortality, and also on the socio-economic level due to the
and their prevalence, to determine the burden linked to overconsumption of hospital
microorganisms and to study the risk factors linked resources[1,2,3]. INs have costs, their impacts being direct
to these infections. and indirect (increased length of hospitalization, mobilization
of staff, lethality, temporary or permanent disabilities, number
This is a descriptive cross-sectional survey of days not worked per patient, etc.)
measuring the instantaneous prevalence of NI
(nosocomial infections) “on a given day”. Data collection The risk of contracting an infection in hospital has
took place from 28th May to 15th june 2023 with a single always existed. It has increased with the evolution of patient
pass per service. Only the microbiological results were care practices. The practice of care is effective but often
subsequently documented. The survey concerned 20 invasive because it is accompanied by the possibility of
hospitalization departments and all patients hospitalized contamination by microorganisms of endogenous or
for more than 48 hours. The definitions of hospital exogenous origin.
infection were based on those from the Centers for
Disease Control and Prevention (CDC). The data were Prevalence surveys constitute the basic tool for
entered and analyzed using Epi data 3.0 and Epi data monitoring nosocomial infections. They have even been
analysis software. recommended by the World Health Organization for national
or international studies [4].
A total of 393 patients were hospitalized, among
them 237 were included in the study (hospitalized for This advantage is even more considerable in countries of
more than 48 hours), i.e. a rate of 60.30%. The study low socio-economic level where the resources available for
population was relatively young with an average age of the fight against nosocomial infections are lacking [5]. In
41.9 ± 22.54 years. The overall prevalence rate was 5.9%. addition, these surveys constitute a staff awareness and
Overall, pulmonary infections (28.5%) were the most information tool [6, 7].
common. Pediatric services recorded a particularly high
prevalence (16%) after hematology (25%). On the day of Awareness of the reality of this phenomenon, in a
the survey, 54.4% of patients were under antibiotic context of improving the quality of care, has led to the control
treatment, including 51.2% with an empirical indication. of nosocomial infectious risk being made a real health priority
The most frequently isolated germs were Escherichia coli [8].
(27.2%) and Acinetobacter Baumanii (27.2%),
Staphylococcus aureus (18.18%). The occurrence of a In the Mediterranean region, few multicenter studies
nosocomial infection was significantly associated with have been conducted on the subject. Except a national
immunosuppression and the presence of a central venous prevalence study conducted in Morocco in 1994, and in
catheter. This study allowed us to better understand local the Mediterranean region in 2010 [9,10].
specificities by highlighting services presenting particular
risks and certain practices, in particular the frequent Other surveys concerning nosocomial infection have
prescription of antibiotics. been carriedout on a more restricted scale, often at the
level of a single hospital.
Keywords:- Prevalence, Nosocomial Infections, Risk Factors,
Microorganisms, University Hospital Center. The objectives of our study were to determine
the prevalence rate of nosocomial infections in our

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Volume 9, Issue 2, February 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
establishment, to know the most frequent sites of these III. RESULTS
infections and their prevalence, to determine the micro-
organisms most involved in nosocomial infections, to Among the 37 departments in our establishment, 20
study the risk factors linked to these infections. hospitalization departments were concerned by the survey, i.e.
(54%). The distribution of patients included according to the
II. MATERIAL AND METHODS services surveyed is given below medicine department,
surgery department, intensive care (Fig. 1)
This is a descriptive cross-sectional survey measuring
the instantaneous prevalence of ni “ON A GIVEN DAY”.

Data collection took place over 15 working days from

May 28 to June 15, 2023 with a single visit per department.
Only the microbiological results were subsequently
documented.

The survey concerned all hospitalization departments

and all hospitalized patients except those where the stay did
not exceed 48 hours (day hospital, hemodialysis patients,
patients who stayed less than 48 hours in adult UMC and
children).

The collection of information, by trained

investigators, was done by examining the medical records Fig 1 Distribution of Hospitalized Patients According to
of the patients, those of nursing care and the laboratory Service Specialty
results, in addition. Interrogation of personnel, if
necessary. Definitions of nosocomial infection were based on  Description of Patients Included
those of the Centers for Disease Control and Prevention [11].
 A total of 393 patients were hospitalized, among them
The data collected on a standardized form 237 were included in the study (hospitalized for more
concerned: the patient characteristics: admission, age, sex, than 48 hours), i.e. a rate of 60.30%.
intrinsic risk factors ( diabetes, obesity, undernutrition,  Our population was characterized by a slight female
immunosuppression, neutropenia); predominance. The sex ratio was 0.92.
 The mean age was 41.9 ± 22.54 years, with a median of
Extrinsic risk factors: urinary catheter, peripheral or 42 years and extreme ages ranging from 2 to 83 years.
central vascular catheter, parenteral nutrition, mechanical  24 children were less than two years old with an average
ventilation, surgical procedure; age of 5 ± 6.27 months.

The presence of a nosocomial infection: only active  Intrinsic (patient-related) risk factors
infections were taken into account: date of the start of
the infection, cultures, microbiological results and  59.9% of patients had an underlying pathology
resistance for certain organisms, two active infections  The main factors of fragility are represented in the
could be noted; following graph (Fig. 2)
The prescription of antibiotics: molecule and
indication. To guide the screening of infected patients, the
investigator should look for a temperature >37.8; general anti-
infectious treatment; the prescription of bacteriological
examinations (ECBU, blood cultures, etc.); In those who have
undergone surgery, the notion of flow at the wound level.

The data were validated and entered on Epi data 3.0

and Epi data analysis software.

The analysis of risk factors was carried out for all

nosocomial infections and for the most frequently identified
sites during the survey. A univariate analysis made it
possible to measure the association of the different
factors with the occurrence of nosocomial infection (or
sites of infection). This association was measured using
the odds ratio (OR). Fig 2 Main Factors of Fragility Linked to the Terrain

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Volume 9, Issue 2, February 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Extrinsic Risk Factors (Invasive Gestures)  Prevalence of Nosocomial Infections
171 patients (72.2%) had an invasive device, distributed Of the 237 patients surveyed, 13 patients had a
as follows (figure 3) nosocomial infection including one patient with two
anatomical sites, which gives a prevalence rate of infected
patients of 5.5% and a prevalence rate of nosocomial
infection 5.9% (14/237).

Infections occurred in six out of 20 departments.

Among them, medical departments were more affected by
this scourge (14.8%), while the prevalence rate in the surgical
sector was 9% (DNS). The prevalence of nosocomial
infection according to services is as follows (Table I)

Table 1 Prevalence of in by Service

Service Infected patients Number Prevalence
Gynecology 2 22 9%
Hematology 2 8 25
Pediatrics 7 42 16.7
Pneumo 1 14 7.1%
allergology
Internal 1 20 5%
medicine
Fig 3 Main Extrinsic Risk Factors
 Anatomical Sites of Nosocomial Infections
 Type of Intervention Pulmonary infections were the most frequent, they
Forty-nine patients (20.7%) were operated on. The represented 28.5% of all contracted INs, followed by surgical
distribution of interventions according to the surgical site site infections (SSI) and urinary infections with a frequency
showed a predominance of ophthalmological surgery (42.9%) of 21.42% and lastly and bacteremia/sepsis and skin
and Gynecology / obstetrics (18.4%) followed by CCI infections with a frequency of 14.28%
(16.3%), ENT (12.2%) and lastly general surgery (6.1% ) and
Urological surgery (4.1%).

 Anti-Infectious Treatment
The proportion of patients on antibiotics on the day of
the survey was 54.4% (129/237) with an indication of
empirical (preventive) prescription in 51.2% of cases, for
curative purposes in 44.2% and finally 4.7 % of prescriptions
were for a nosocomial infection. The use of monotherapy
was noted in 56 patients. Dual therapy in 40 patients and
triple therapy in 24 patients.

The most prescribed antibiotic is Cefotaxime in 54.3%

followed by Gentamicin in 31.8% and Ciprofloxacin in
13.9%.
Fig 5 Description of IN Infections According to Site
Anatomical

 Microorganisms Isolated
Among the 14 infections identified, 3 did not benefit
from a bacteriological sample. (table 2)

Table 2 Nature of Isolated Germs

Microorganisms Number %
Acinetobacter Baumanii 3 27.27 %
Candida Albicans 1 9.09 %
Escherichia Coli 3 27.27 %
Pseudomonas Sp 1 9.09 %
Staphylocoque Aureus 2 18.18 %
Klebseilla Pneumoniae 1 9.09 %
Fig 4 Anti-Infectious Treatment During Hospitalization Total 11 100%

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Volume 9, Issue 2, February 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
 Factors Associated with Nosocomial Infections The analysis of intrinsic factors revealed that three
Comparing infected and non-infected patients for factors were significantly linked to the presence of
certain characteristics allowed us to identify certain potential nosocomial infection; namely, age, obesity,
risk factors. These factors were of two types: intrinsic factors immunosuppression, central vascular catheter.
linked to patients and extrinsic factors linked to care (Table
3)

Table 3 Summary of Risk Factors

The patients Uninfected patients
Infected n = 13 n = 224 p value OR
Numbers (%) Workforce (%) IC à 95%
Age (ans)
0-19 7(53.9) 61(27.3)
19-39 3(23.1) 49(21.9) < 0.01 _
39-49 2(15.4) 26(11.6)
49-59 0(0) 40(17.9)
>60 1(7.7) 48 (21.4)
Obesity Yes 2(15.4) 9 (4) 0.05 4.34
No 11 (86.6) 215(96) [0.57-26.03]
Diabète Oui 1(7.7) 30 (13.4) 0.55
Non 12 (92.3) 194 (86.3)
Immuno Suppression
Yes 8(61.5) 46(20.5) <0.01 7.44
No 5(38.5) 178(79.4) [2.08-27.6]
Central vascular catheter
Yes 3(7.7) 9(0.9) <0.01 7.17
No 10(92.3) 215(99.1) [1.3 – 36]

IV. DISCUSSION 21]. Kallel H et al. found similar results in 46.8% of patients
under antibiotic treatments, half of whom received two or
The prevalence rate of nosocomial infections in our more molecules; third-generation cephalosporins were the
study was 5.9%. These figures are close to the range of those most frequently prescribed [19]. On the other hand, in the
reported in the literature, whether in European countries or in national prevalence survey conducted in France in 2001, only
South Mediterranean countries [12,13,14,15,16,17]. But it 15.9% of patients were prescribed antibiotics [22].
should be emphasized that medical activity predominates
within our establishment and direct comparison with Most studies show that the most reported INs are
literature data remains difficult due to various factors such as pulmonary infections, surgical site infections and urinary
the size and activity of the establishments, as well as the infections [23,24,25,26]. The same results were found in our
methodology adopted. study, pulmonary infections occupy first place with 28.7% of
all infections followed by surgical site infections (SSI) and
The high frequency of infections in intensive care is urinary infections with a frequency of 21.42% each. In some
regularly found in all IN prevalence surveys [9,13,18,19,20]. British hospitals Emmerson et al. showed that SSI comes in
It is associated with a high frequency of invasive procedures third position (10.7%) preceded by respiratory infections
being performed, but in our survey no cases were recorded, (22.9%) and urinary infections (32%) [27].
this is probably linked to poor recruitment (only three eligible
patients were present on the day of the survey). On the other The distribution of nosocomial infections according to
hand, we recorded high prevalence rates in hematology age groups finds a high prevalence among those under 20
(25%) and in the pediatrics department (16.77%), which is years old (10.3%) and those aged 40 to 49 years old (7.14%),
usually a department with a low prevalence rate of this is quite comparable to that found by Bezzaoucha and
nosocomial infections whether in developed countries or in al.[28]. This distribution is partly linked to the high risk in
other countries. countries with a lower socio-economic level, pediatric services already reported.
this is partly related to the nature of the activity which is
dedicated to oncology and intensive care [9,16,18]. Regarding the analysis of risk factors, the data in the
literature are relatively disparate; some authors have
Of particular concern was the prescribing of antibiotics. demonstrated that diabetes and obesity are risk factors for the
The proportion of patients on antibiotics on the day of the appearance of nosocomial infections (respiratory and
survey was 54.4% (129/237) with an indication for empirical complications). at the surgical site) [29,30] On our part, this
(preventive) prescription in 51.2% of cases (of which 33.3% relationship was non-significant for diabetes and borderline
received double antibiotic therapy and 7.5 % triple antibiotic significant for obesity.
therapy). The observation of high antibiotic prescribing has
been noted in studies conducted in developing countries|[16,

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Volume 9, Issue 2, February 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
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recognized as a predisposing factor for nosocomial infection nosoco- miales. La Revue du Praticien, 1989,
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