National Update on Healthcare-Associated Infections in Iran for 2023-Based on the Iranian Nosocomial Infections Surveillance (INIS) System.

Background: Healthcare-associated infections (HCAIs) pose a serious threat to healthcare systems. Accurately determining the incidence of HCAIs is crucial for planning and implementing efficient interventions, as they are associated with a wide range of challenges. The objective of this study was to assess and update the incidence rates of HCAIs in Iran in 2023, using data from the Iranian Nosocomial Infection Surveillance (INIS) system, a nationwide hospital-based surveillance program.

Methods: The Iranian Center for Communicable Diseases Control (ICDC) evaluated data from 1,066 hospitals using the INIS software. Hospitals' trained infection control staff collected all information and entered it into the INIS. HCAIs were diagnosed based on the CDC/NHSN case definition criteria. We calculated incidence rate (per 100 admissions and per 1,000 patient-days).

Results: We reported 170,948 HCAIs among 11,043,373 hospitalized patients, with an incidence rate of 4.95 per 1,000 patient-days, and the crude mortality rate of 19.85%. Looking at the relative frequencies, Pneumonia was the most frequent infection (28.32%), followed by urinary tract infections (UTIs) (26.6%), and surgical site infections (SSIs) (21.85%). HCAI rates were highest in intensive care units (ICUs), transplant wards, and burn units, with major surgeries like cardiovascular, neurosurgeries, and orthopedics having the highest SSI rates. The most common microorganisms were Klebsiella spp. (16.56%) and E. coli (14.6%), with high proportions of multidrug-resistance (MDR) including MRSA (43.2%), VRE (65.24%), and KPC (74.21%).

Conclusions: This study reveals a high incidence of HCAIs in Iranian hospitals in 2023, with pneumonia, UTIs, and SSIs being most common. The high proportion of MDR pathogens underscores the need for enhanced infection control, antibiotic stewardship program, and continuous staff education to reduce HCAIs and improve patient outcomes.