Prevalence and determinants of microbiologically unconfirmed healthcare-associated infections among hospitalized patients in Western Sierra Leone, 2024: a point prevalence survey

Background Healthcare-associated infections (HAIs) are a major global health problem. Gaps in their detection in low—and middle-income countries may be caused by limited surveillance capacity and lack of contextualised surveillance tools. Aim This study aimed to evaluate the prevalence of HAIs and their determinants using contextually adapted HAI case definitions and tools. Methods This was a cross-sectional multicenter point prevalence survey among adults (≥18 years) and children ( > 1 month) from 10 hospitals in Western Sierra Leone. The determinants of HAIs were derived using logistic regression analysis and adjusted relative risks with 95% confidence intervals reported as a measure of association, and a p≤ 0.05 considered statistically significant. Findings Among the 10 hospitals, the mean hospital bed capacity was 109, and the average hand hygiene (HH) compliance was 30.6%. None of the hospitals had a functional bacteriology laboratory. Of the 319 eligible patients, 40 (12.5%) acquired HAI, with 31 (77.5%) having suspected bloodstream infections. Cigarette smoking (aOR: 3.764, 95% CI: 1.07-13.13, P: 0.038), leucopenia (aOR: 0.137, 95% CI: 0.-1.003, P: 0.05), blood transfusion (aOR: 0.309, 95% CI: 0.126-0.759, P: 0.01) and use of oxygen apparatus (aOR: 0.260, 95% CI: 0.084-0.805, P: 0.02) were shown to be predictors of HAIs. Conclusion There was a high prevalence of microbiologically unconfirmed HAIs with patient-related factors and service delivery interventions as independent predictors. Fundamental gaps are low HH compliance and limited laboratory capacity to support HAI surveillance. We recommend sustained HH improvement initiatives, strengthening bacteriology capacity for HAI detection, and periodic point prevalence surveys on HAIs as an entry point.