CHAPTER ONE
INTRODUCTION
1.1            Background to the Study
Nosocomial infection also known as Hospital Acquired Infections (HAI) is a localized or systemic infection acquired in a hospital or any other health care facility by a patient admitted for a reason other than the pathology present during admission. It may also include an infection acquired in a healthcare facility that may manifest 48 hours after the patient's admission into the health care facility or discharge (Hildron, Edwards, Patel, Horan, Sievert, Pollock & Fridkin, 2008). Epidemiological studies report that nosocomial infections are caused by pervasive pathogens such as bacteria (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud & Duveau, 2005), viruses (De-Oliveira, White, Leschinsky, Beecham, Vogt, Moolenaar, Perz & Safranek, 2005) and fungi present in air, surfaces or equipment. The pathogens are not present or incubating prior to the patient's admission into healthcare facility and are most likely transmitted by direct person-to-person contact during invasive medical procedures (Anderson, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009). Some of the pathogens are highly resistant to antimicrobial agents, andthis necessitates the prescription of more potent and costly antimicrobial agents (Mulvey & Simor,2009).
Nosocomial infections are prevalent nationally and internationally; and occur in patients of all age groups: neonates (Aly, Herson, Duncan, Herr, Bender, Patel & EI-Mohandes, 2005), immuno-compromised adults and the elderly (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud& Duveau, 2005).  The  most frequent  types  of nosocomial  infections  are  those associated  with  the  urinary tract,  surgical  wounds,  respiratory  tract and  blood  stream (Lo, 2008). It is a serious global public health issue, causing the suffering of 1.4 million people across the world at any given time (WHO, 2007).
Nosocomial infection in developing countries is difficult to address because it is such a complex problem with diverse underlying causes. International non-governmental organizations (INGOs) and inter-governmental organizations such as United Nations agencies add a unique perspective to the push for infection control measures in hospitals in the developing world.  However, these organizations have not been able to address all facets of the problem such as infrastructure, leadership and individual health care worker behavior.  Nosocomial infection control is not simply a matter of encouraging hand hygiene in settings where clean water and soap may not be consistently available. Nor is infection control a matter of providing supplies to health care workers who are not trained to use them properly (WHO, 2010).
The burden of HAI is already substantial in developed countries, where it affects from 5% to 15% of hospitalized patients in regular wards and as many as 50% or more of patients in intensive care units (ICUs) (WHO, 2009). In developing countries, the magnitude of the problem remains underestimated or even unknown largely because HAI diagnosis is complex and surveillance activities to guide interventions require expertise and resources (Allegranzi & Pittet, 2008). Surveillance systems exist in some developed countries and provide regular reports on national trends of endemic HAI (Pittet, Allegranzi, Sax, Bertinato, Concia & Cookson, 2005) such as the National Healthcare Safety Network of the United States of America or the German hospital infection surveillance system. This is not the case in most developing countries (WHO, 2010) because of social and health-care system deficiencies that are aggravated by economic problems. Additionally, overcrowding and understaffing in hospitals result in inadequate infection control practices, and a lack of infection control policies, guidelines and trained professionals also adds to the extent of the problem.