Abstract
Introduction: Healthcare-associated (nosocomial) infections are defined as those infections that are not present or incubated at the time of admission to the hospital, The WHO estimates that the rate of Healthcare-associated infections (HAIs) is 7-12% among hospitalized patients all over the world, where >1.4 million people had infection-related complications during their stay in the hospital. The burden of HAIs is more in developing countries, with the highest prevalence in the ICUs.
Aim: To study the Incidence, type of causative organisms and site of Healthcare-associated infection in adult ICU. To assess the Impact of Healthcare-associated infection on the length of stay and mortality.
Methodology: A Prospective - cohort study, which was studied for five months from October 2019 to February 2020. Patients who are admitted to the intensive care unit and then developed an infection and who stayed for more than 48 hours were included. Depending on the criteria patients were classified into catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infections (CLABSI), Ventilator-associated pneumonia (VAP), and Surgical Site Infections (SSI).
Results: A total of 111 cases were studied as per recruitment criteria, out of which 18 cases had Healthcare-associated infections. Cumulative Incidence rate (attack rate) was 16.22%, Ventilator-Associated Pneumonia (VAP) rate = 5.16 per 1000 ventilator days, Urinary tract infection rate (CAUTI) = 3.95per1000catheter days, Central line-associated bloodstream infection (CLABSI) rate = 6.17 per 1000 central line days. Blood Stream Infection (BSI) 38.9% was the most commonest site infection, followed by Pneumonia at 27.8%, Urinary Tract Infection (UTI) at 22.2% and Surgical Site Infection (SSI) at 11.1% respectively. Gram-negative bacteria were the most frequently associated organisms. The most common pathogen was Klebsiella. pneumoniae (45.5% cases), followed by E. coli (18.1% cases), a combination of Staphylococcus aureus and Pseudomonas (9.2% cases) and others like Acinetobacter baumanii, Citrobacter freundii, Enterobacter cloacae (each 4.5% cases). The average length of stay for patients with Healthcare-associated infection in ICU was 18.06 days±11.021 days. Mortality with Healthcare-associated infection was 16.7%. Mortality was associated with patients having bloodstream infection and pneumonia and organism associated with mortality were Klebsiella pneumoniae and Staphylococcus aureus.
Conclusion: Healthcare-associated infections (HAI) develop in patients while receiving care in health facilities. This study provides information on the prevention strategies for HAI and improving the health care service level.

Key words: Healthcare-associated Infection, Intensive Care Unit, Catheter-Related Blood Stream Infection, Ventilator-Associated Pneumonia, Catheter-Associated Urinary Tract Infection, Surgical Site Infection Infection, Mortality