Systematic review and meta-analysis of hospital acquired infections rate in a middle east country (1995-2020)

Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran.

A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh]  OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis.

A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively.

The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.