Detection of Multi-Drug Resistant Bacteria on Patient Medical File Surfaces in Critical Care Units at a National Referral Hospital in Uganda: A Cross-Sectional Study

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Abstract Background Antimicrobial resistance threatens the effective prevention and treatment of various infections. We examined the prevalence and factors associated with multi-drug-resistant bacteria on patient medical file surfaces at Mulago National Referral Hospital in Uganda. Methods This cross-sectional study included 33 randomly sampled patient medical files from which data were extracted using a chart abstraction tool. Biological samples from file surfaces were collected and examined for the presence of multi-drug-resistant bacteria. Logistic regression modeling was used to analyse the data. We conducted five key informant interviews with nurses in charge of intensive care units (ICU) and high-dependency units (HDU) and analyzed qualitative data thematically. Results The prevalence of multi-drug-resistant bacteria on patient file surfaces was 18.2%. Patients who stayed 11–15 days in hospital (adjusted odds ratio [aOR] 1.62, 95% CI: 1.06–2.49), were treated for cardiac failure [aOR] 2.15, 95% CI: 1.10–4.18), received treatment with aminoglycosides (aOR 1.77,95% CI:1.14–2.76), glycopeptides (aOR 1.92, 95% CI 1.11–3.31), or colistin (aOR 1.86, 95% CI: 1.06–3.26), had invasive procedures (aOR 1.68, 95% CI: 1.20–2.34) or files stored at the bedside (aOR 2.40, 95% CI: 1.01–5.70) were more likely to have multi-drug-resistant bacteria on file surfaces. Nurses in charge of ICU/HDU were knowledgeable regarding infection control practices; however, they encountered challenges in implementing and improving adherence to infection prevention and control (IPC) practices. Conclusions Antimicrobial-resistant bacteria were prevalent on the surfaces of patient medical files in Kampala, Uganda. Effective implementation of IPC measures is required to reduce multi-drug-resistant nosocomial infections in the ICU/HDU.

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