title: Surveillance for respiratory health care-associated infections among inpatients in 3 Kenyan hospitals, 2010-2012.
abstract: BACKGROUND
  Although health care-associated infections are an important cause of morbidity and mortality worldwide, the epidemiology and etiology of respiratory health care-associated infections (rHAIs) have not been documented in Kenya. In 2010, the Ministry of Health, Kenya Medical Research Institute, and Centers for Disease Control and Prevention initiated surveillance for rHAIs at 3 hospitals.
  
  
  METHODS
  At each hospital, we surveyed intensive care units (ICUs), pediatric wards, and medical wards to identify patients with rHAIs, defined as any hospital-onset (≥3 days after admission) fever (≥38°C) or hypothermia (<35°C) with concurrent signs or symptoms of acute respiratory infection. Nasopharyngeal and oropharyngeal specimens were collected from these patients and tested by real-time reverse transcription polymerase chain reaction for influenza and 7 other viruses.
  
  
  RESULTS
  From April 2010-September 2012, of the 379 rHAI cases, 60.7% were men and 57.3% were children <18 years old. The overall incidence of rHAIs was 9.2 per 10,000 patient days, with the highest incidence in the ICUs. Of all specimens analyzed, 45.7% had at least 1 respiratory virus detected; 92.2% of all positive viral specimens were identified in patients <18 years old.
  
  
  CONCLUSIONS
  We identified rHAIs in all ward types under surveillance in Kenyan hospitals. Viruses may have a substantial role in these infections, particularly among pediatric populations. Further research is needed to refine case definitions and understand rHAIs in ICUs.
authors.affiliation: Centers for Disease Control and Prevention-Nairobi, Kenya; Jomo Kenyatta University, Nairobi, Kenya. Electronic address: ndegwalk@gmail.com.
authors.forename: Linus K
authors.initials: LK
authors.lastname: Ndegwa
authors.affiliation: Centers for Disease Control and Prevention-Nairobi, Kenya.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Katz
authors.affiliation: Centers for Disease Control and Prevention-Atlanta, Atlanta, GA.
authors.forename: Kelly
authors.initials: K
authors.lastname: McCormick
authors.affiliation: Centers for Disease Control and Prevention-Atlanta, Atlanta, GA.
authors.forename: Z
authors.initials: Z
authors.lastname: Nganga
authors.affiliation: Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: Ann
authors.initials: A
authors.lastname: Mungai
authors.affiliation: Centers for Disease Control and Prevention-Nairobi, Kenya.
authors.forename: Gideon
authors.initials: G
authors.lastname: Emukule
authors.affiliation: University of Nairobi, Nairobi, Nairobi, Kenya.
authors.forename: M K H M
authors.initials: MK
authors.lastname: Kollmann
authors.affiliation: Diagnostics and Laboratory Systems Program, Kenya Medical Research Institute/Centers for Disease Control, Kisumu, Kenya.
authors.forename: Lilian
authors.initials: L
authors.lastname: Mayieka
authors.affiliation: Kenya Ministry of Medical Services, Nairobi, Kenya; New Nyanza Provincial Hospital, Nairobi, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Otieno
authors.affiliation: Centers for Disease Control and Prevention-Nairobi, Kenya.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.affiliation: Centers for Disease Control and Prevention-Nairobi, Kenya.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Mott
authors.affiliation: Centers for Disease Control and Prevention-Atlanta, Atlanta, GA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ellingson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000453:epidemiology*; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D007362:Intensive Care Units; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D055815:Young Adult
keywords: Health care–associated infections; Respiratory health care–associated infections; Viral