nosocomial infection in an iranian neonatal intensive care unit: hospital epidemiology and risk factors

Background: hospital-acquired infection is one of themainconcerns in neonatal intensive care units (nicus), leading to increased mortality, hospital stay, and costs. objectives: this study aimed to investigate the risk factors of hospital-acquired infection in nicus. methods: a descriptive, cross-sectional, prospective study was conducted in the nicu of ali asghar children hospital for one year. all admitted newborns were sampled on a simple basis. the criteria for the diagnosis of hospital-acquired infection were based on the definitions of the cdc and the nnis system. risk factors such as days of fully catheters usage, nurse-to-patient ratio, history of surgery, prematurity, and mechanical ventilation were considered as variables. the data collection tools consisted of a patient information questionnaire, the monthly report of the hospital infection control committee based on the nnis system, a daily schedule of all risk factors for each infant, and the monthly nurse-to-patient ratio in the nicu. the stata software was used for data analysis. results: in our study, 654 newborns were enrolled. the rate of hospital-acquired infections was 13.5%. moreover, 80.7% of the cases exhibited sepsis (72.7% diagnosed based on clinical findings and 8% based on positive blood culture). statistical analysis showed 9% pneumonia cases, 8% surgical site infection cases, and 2.3% urinary tract infection cases. the average time to the occurrence of hospital-acquired infection was 13.5 days after admission. all risk factors were significantly higher in the infected group than in the control group (p = 0.0001). furthermore, surgical interventions were significantly more in the infected group than in the non-infected group (34.1% vs. 6.7%, respectively, p = 0.0001). the prevalence rates in different weight ranges (less than 1000 g, 1001 to 1500 g, 1501 to 2500, and above 2501 g) were 2.6%, 6.9%, 21.4%, and 69.1%, respectively, in the infected group, which were significantly different from those of the non-infected group (p = 0.0001). the most common etiologic microorganism was acinetobacter baumannii. conclusions: factors such as surgery, the presence of a central venous catheter, and the increased length of hospital stay significantly increased the hospital-acquired infections. reducing invasive procedures, maintenance of full catheters, and providing optimal nursing care can help control hospital-acquired infections.