PREVALENCE OF HOSPITAL-ACQUIRED INFECTIONS AMONG IN-PATIENTS AT THE UNIVERSITY OF BENIN TEACHING HOSPITAL
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Abstract
Background: Hospital-acquired infections (HAIs) present a major threat to patient safety, treatment outcomes, and healthcare sustainability globally, with a disproportionately higher burden in low- and middle-income countries (LMICs). Despite the critical role of tertiary health centres in specialized care, comprehensive data establishing both the precise prevalence of HAIs and the institutional capacity of reporting mechanisms remain scarce in many regional facilities. This study was conducted to investigate the epidemiological burden of HAIs and evaluate the existing surveillance reporting structures at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria.
Methods: A sequential mixed-methods cross-sectional design was deployed across diverse clinical wards at UBTH. For the quantitative phase, a sample size of 429 in-patients was selected utilizing a multi-stage sampling approach incorporating proportional allocation and simple random sampling. Data were gathered via researcher-administered structured questionnaires, clinical records, and laboratory reviews. Quantitative analysis was performed using descriptive statistics, chi-square tests, and binary logistic regression to isolate independent predictors. For the qualitative phase, purposive sampling was used to conduct seven (7) Key Informant Interviews (KIIs) with clinical consultants, nursing leadership, and infection control officers. Qualitative data were processed using thematic analysis via NVivo software.
Results: The quantitative survey achieved a 100% response rate across the 429 participants. The confirmed point prevalence of HAIs was 5.8% (n = 25), with an additional 0.2% (n = 1) categorized as suspected cases, while 93.9% (n = 403) showed no evidence of infection. Among the 25 confirmed cases, catheter-associated urinary tract infections (CAUTIs) were the most frequent clinical presentation at 48.0% (n = 12), followed by surgical site infections (SSIs) at 16.0% (n = 4), hospital-acquired pneumonia at 12.0% (n = 3), non-catheter- associated UTIs at 12.0% (n = 3), puerperal sepsis at 8.0% (n = 2), and burn area infections at 4.0% (n = 1). Multivariable binary logistic regression revealed that the lengths of hospital stay (OR = 1.067, 95% CI: 1.033–1.102, p < 0.001) and active urethral catheterization (OR = 6.233, 95% CI: 2.316–16.772, p < 0.001) were the only statistically significant independent predictors of acquiring an infection. Socio-demographic factors (such as age and sex) and chronic client comorbidities showed no significant independent associations (p > 0.05). Qualitatively, key informants highlighted a critical operational deficit: a formalized, hospital- wide infection reporting protocol for frontline clinicians is practically absent. Surveillance remains an entirely manual, paper-based tracking process conducted independently by an under-resourced Infection Prevention and Control (IPC) unit due to a complete lack of digital infrastructure, technical training, and routine departmental feedback loops. Despite these barriers, there was universal consensus on the institutional value of a centralized reporting framework for establishing data-driven benchmarks and enhancing active antimicrobial stewardship.
Conclusion: This study demonstrates that while the recorded point prevalence of HAIs at UBTH is relatively modest, it is significantly and independently driven by modifiable hospital-level exposures—specifically device utilization and prolonged admission windows—rather than immutable patient comorbidities. Crucially, the integrity of this epidemiological data is actively limited by a fragmented, manual reporting apparatus. To mitigate this burden and ensure patient safety, UBTH must transition away from paper-reliant tracking toward an integrated, hospital-wide electronic surveillance architecture alongside mandatory clinical care bundles and structured departmental data feedback loops
Methods: A sequential mixed-methods cross-sectional design was deployed across diverse clinical wards at UBTH. For the quantitative phase, a sample size of 429 in-patients was selected utilizing a multi-stage sampling approach incorporating proportional allocation and simple random sampling. Data were gathered via researcher-administered structured questionnaires, clinical records, and laboratory reviews. Quantitative analysis was performed using descriptive statistics, chi-square tests, and binary logistic regression to isolate independent predictors. For the qualitative phase, purposive sampling was used to conduct seven (7) Key Informant Interviews (KIIs) with clinical consultants, nursing leadership, and infection control officers. Qualitative data were processed using thematic analysis via NVivo software.
Results: The quantitative survey achieved a 100% response rate across the 429 participants. The confirmed point prevalence of HAIs was 5.8% (n = 25), with an additional 0.2% (n = 1) categorized as suspected cases, while 93.9% (n = 403) showed no evidence of infection. Among the 25 confirmed cases, catheter-associated urinary tract infections (CAUTIs) were the most frequent clinical presentation at 48.0% (n = 12), followed by surgical site infections (SSIs) at 16.0% (n = 4), hospital-acquired pneumonia at 12.0% (n = 3), non-catheter- associated UTIs at 12.0% (n = 3), puerperal sepsis at 8.0% (n = 2), and burn area infections at 4.0% (n = 1). Multivariable binary logistic regression revealed that the lengths of hospital stay (OR = 1.067, 95% CI: 1.033–1.102, p < 0.001) and active urethral catheterization (OR = 6.233, 95% CI: 2.316–16.772, p < 0.001) were the only statistically significant independent predictors of acquiring an infection. Socio-demographic factors (such as age and sex) and chronic client comorbidities showed no significant independent associations (p > 0.05). Qualitatively, key informants highlighted a critical operational deficit: a formalized, hospital- wide infection reporting protocol for frontline clinicians is practically absent. Surveillance remains an entirely manual, paper-based tracking process conducted independently by an under-resourced Infection Prevention and Control (IPC) unit due to a complete lack of digital infrastructure, technical training, and routine departmental feedback loops. Despite these barriers, there was universal consensus on the institutional value of a centralized reporting framework for establishing data-driven benchmarks and enhancing active antimicrobial stewardship.
Conclusion: This study demonstrates that while the recorded point prevalence of HAIs at UBTH is relatively modest, it is significantly and independently driven by modifiable hospital-level exposures—specifically device utilization and prolonged admission windows—rather than immutable patient comorbidities. Crucially, the integrity of this epidemiological data is actively limited by a fragmented, manual reporting apparatus. To mitigate this burden and ensure patient safety, UBTH must transition away from paper-reliant tracking toward an integrated, hospital-wide electronic surveillance architecture alongside mandatory clinical care bundles and structured departmental data feedback loops
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