title: Prospective surveillance of healthcare associated infections in a Cambodian pediatric hospital.
abstract: BACKGROUND
  Healthcare associated infections (HAI) are the most common preventable adverse events following admission to healthcare facilities. Data from low-income countries are scarce. We sought to prospectively define HAI incidence at Angkor Hospital for Children (AHC), a Cambodian pediatric referral hospital.
  
  
  METHODS
  Prospective HAI surveillance was introduced for medical admissions to AHC. Cases were identified on daily ward rounds and confirmed using locally adapted Centers for Disease Control and Prevention (CDC) definitions. During the surveillance period, established infection prevention and control (IPC) activities continued, including hand hygiene surveillance. In addition, antimicrobial stewardship practices such as the creation of an antimicrobial guideline smartphone app were introduced.
  
  
  RESULTS
  Between 1st January and 31st December 2015 there were 3,263 medical admissions and 102 HAI cases. The incidence of HAI was 4.6/1,000 patient-days (95% confidence interval 3.8-5.6) and rates were highest amongst neonates. Median length of stay was significantly longer in HAI cases: 25 days versus 5 days for non-HAI cases (p< 0.0001). All-cause in-hospital mortality increased from 2.0 to 16.1% with HAI (p< 0.0001). Respiratory infections were the most common HAI (54/102; 52.9%). Amongst culture positive infections, Gram-negative organisms predominated (13/16; 81.3%). Resistance to third generation cephalosporins was common, supporting the use of more expensive carbapenem drugs empirically in HAI cases. The total cost of treatment for all 102 HCAI cases combined, based on additional inpatient days, was estimated to be $299,608.
  
  
  CONCLUSIONS
  Prospective HAI surveillance can form part of routine practice in low-income healthcare settings. HAI incidence at AHC was relatively low, but human and financial costs remained high due to increased carbapenem use, prolonged admissions and higher mortality rates.
authors.affiliation: Cambodia-Oxford Medical Research Unit, Microbiology Department, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia.
authors.forename: Pasco
authors.identifier: 0000-0001-8060-3183
authors.initials: P
authors.lastname: Hearn
authors.affiliation: Cambodia-Oxford Medical Research Unit, Microbiology Department, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia.|Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Thyl
authors.initials: T
authors.lastname: Miliya
authors.affiliation: Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Soklin
authors.initials: S
authors.lastname: Seng
authors.affiliation: Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Chanpheaktra
authors.initials: C
authors.lastname: Ngoun
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Nicholas P J
authors.initials: NPJ
authors.lastname: Day
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
authors.forename: Yoel
authors.initials: Y
authors.lastname: Lubell
authors.affiliation: Cambodia-Oxford Medical Research Unit, Microbiology Department, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.|Angkor Hospital for Children, Siem Reap, Cambodia.
authors.forename: Claudia
authors.initials: C
authors.lastname: Turner
authors.affiliation: Cambodia-Oxford Medical Research Unit, Microbiology Department, Angkor Hospital for Children, PO Box 50, Siem Reap, Cambodia.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Turner
keywords: Cambodia; Healthcare associated infection; Pediatric HAI; Prospective HAI surveillance