NOSOCOMIAL INFECTIONS IN A RURAL REGIONAL-HOSPITAL IN A DEVELOPING-COUNTRY - INFECTION-RATES BY SITE, SERVICE, COST, AND INFECTION-CONTROL PRACTICES

OBJECTIVE: To assess the prevalence of nosocomial infections at a rura l government hospital from 1992 to 1995. DESIGN: Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infections, co st to government, and infection control practices. SETTING: 653-bed ru ral hospital providing primary and tertiary care. PATIENTS: Patients a dmitted to the hospital between 1992 and 1995 who were found with hosp ital-acquired infections during their stay. INTERVENTIONS: None. RESUL TS: Over the 4-year period, 7,158 nosocomial infections were identifie d from 72,532 patients (10.0/100 admissions). High nosocomial infectio n rates were found on the intensive-care unit (67/100 admissions), uro logy (30/100 admissions), neurosurgery (29.5/100 admissions), and newb orn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 a dmissions) accounted for most nosocomial infections (42%), followed by postoperative wound infections (26.8%) with a rate of 2.6/100 admissi ons. Nosocomial pneumonias and bloodstream infections also were common with 13.2% and 8.0%, respectively. The highest rates occurred on the intensive-care unit for bath pneumonia (26.4/100 admissions) and blood stream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,000 annually (US $1=$6 Trinidad and Tobago). Poor infection control practices, inadequate han dwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident. CONCLUSIONS: Strict adherence to prope r infection control practices, such as handwashing techniques, and imp rovement of facilities are crucial steps in preventing cross-infection s in the hospital environment. Implementing these measures may substan tially reduce the massive drain on the hospital budget in treating nos ocomial infections. The saved revenue could go toward improvement of w ard facilities and reduction of over-crowding, thus further reducing c ross-infection.