title: Rates of hospital-acquired respiratory illness in Bangladeshi tertiary care hospitals: results from a low-cost pilot surveillance strategy.
abstract: BACKGROUND
  Patients hospitalized in resource-poor health care settings are at increased risk for hospital-acquired respiratory infections due to inadequate infrastructure.
  
  
  METHODS
  From 1 April 2007 through 31 March 2008, we used a low-cost surveillance strategy to identify new onset of respiratory symptoms in patients hospitalized for >72 h and in health care workers in medicine and pediatric wards at 3 public tertiary care hospitals in Bangladesh.
  
  
  RESULTS
  During 46,273 patient-days of observation, we recorded 136 episodes of hospital-acquired respiratory disease, representing 1.7% of all patient hospital admissions; rates by ward ranged from 0.8 to 15.8 cases per 1000 patient-days at risk. We identified 22 clusters of respiratory disease, 3 of which included both patients and health care workers. Of 226 of heath care workers who worked on our surveillance wards, 61 (27%) experienced a respiratory illness during the study period. The cost of surveillance was US$43 per month per ward plus 30 min per day in data collection.
  
  
  CONCLUSIONS
  Patients on these study wards frequently experienced hospital-acquired respiratory infections, including 1 in every 20 patients hospitalized for >72 h on 1 ward. The surveillance method was useful in calculating rates of hospital-acquired respiratory illness and could be used to enhance capacity to quickly detect outbreaks of respiratory disease in health care facilities where systems for outbreak detection are currently limited and to test interventions to reduce transmission of respiratory pathogens in resource-poor settings.
authors.affiliation: International Centre for Diarrheal Diseases Research, Bangladesh (ICDDR,B). egurley@icddrb.org
authors.forename: Emily S
authors.initials: ES
authors.lastname: Gurley
authors.forename: Rashid Uz
authors.initials: RU
authors.lastname: Zaman
authors.forename: Rebeca
authors.initials: R
authors.lastname: Sultana
authors.forename: Michael
authors.initials: M
authors.lastname: Bell
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Fry
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Mahmudur
authors.initials: M
authors.lastname: Rahman
authors.forename: M Waliur
authors.initials: MW
authors.lastname: Rahman
authors.forename: M Jahangir
authors.initials: MJ
authors.lastname: Hossain
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010361:Patients; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D055815:Young Adult