title: National surveillance of health care-associated infections in Egypt: Developing a sustainable program in a resource-limited country.
abstract: Health care-associated infections (HAIs) are a major global public health concern. The lack of surveillance systems in developing countries leads to an underestimation of the global burden of HAI. We describe the process of developing a national HAI surveillance program and the magnitude of HAI rates in Egypt.
  
  
  
  The detailed process of implementation of a national HAI surveillance program is described. A 3-phase surveillance approach was implemented in intensive care units (ICUs). This article focuses on results from the phase 2 surveillance. Standard surveillance definitions were used, clinical samples were processed by the hospital laboratories, and results were confirmed by a reference laboratory.
  
  
  
  Ninety-one ICUs in 28 hospitals contributed to 474,544 patient days and 2,688 HAIs. Of these, 30% were bloodstream infections, 29% were surgical site infections, 26% were pneumonia, and 15% were urinary tract infections. Ventilator-associated pneumonia had the highest incidence of device-associated infections (4.3/1,000 ventilator days). The most common pathogens reported were Klebsiella spp (28.7%) and Acinetobacter spp (13.7%). Of the Acinetobacter spp, 92.8% (157/169) were multidrug resistant, whereas 42.5% (151/355) of the Klebsiella spp and 54% (47/87) of Escherichia coli were extended-spectrum β-lactamase producers.
  
  
  
  Implementation of a sustainable surveillance system in a resource-limited country was possible following a stepwise approach with continuous evaluation. Enhancing infection prevention and control programs should be an infection control priority in Egypt.
authors.affiliation: Global Disease Detection Center, US Centers for Disease Control and Prevention, Cairo, Egypt; US Naval Medical Research Unit, No. 3, Cairo, Egypt. Electronic address: maha.m.talaat.ctr@mail.mil.
authors.forename: Maha
authors.initials: M
authors.lastname: Talaat
authors.affiliation: Global Disease Detection Center, US Centers for Disease Control and Prevention, Cairo, Egypt; US Naval Medical Research Unit, No. 3, Cairo, Egypt; Ain Shams University Hospitals, Cairo, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: El-Shokry
authors.affiliation: Cairo University Hospitals, Cairo, Egypt.
authors.forename: Jehan
authors.initials: J
authors.lastname: El-Kholy
authors.affiliation: Ain Shams University Hospitals, Cairo, Egypt.
authors.forename: Ghada
authors.initials: G
authors.lastname: Ismail
authors.affiliation: Global Disease Detection Center, US Centers for Disease Control and Prevention, Cairo, Egypt; US Naval Medical Research Unit, No. 3, Cairo, Egypt.
authors.forename: Sara
authors.initials: S
authors.lastname: Kotb
authors.affiliation: Alexandria University Hospitals, Alexandria, Egypt.
authors.forename: Soad
authors.initials: S
authors.lastname: Hafez
authors.affiliation: Ministry of Health and Population, Cairo, Egypt.
authors.forename: Ehab
authors.initials: E
authors.lastname: Attia
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Lessa
mesh_terms: D003428:Cross Infection / Q000453:epidemiology*; D003906:Developing Countries; D004534:Egypt / Q000453:epidemiology; D062665:Epidemiological Monitoring; D006291:Health Policy; D006801:Humans
keywords: Health care–associated infections; antimicrobial resistance; surveillance in intensive care units