Prevalence and factors associated with nosocomial infections in public hospitals of Rwanda: a cross-sectional study

Healthcare-associated infections (HAIs) are a major public health concern, particularly in low-resource settings. This study assessed the prevalence and risk factors of nosocomial infections (NIs) in public hospitals of Rwanda.

A cross-sectional study was conducted among 783 patients from 20 public hospitals, selected via systematic random sampling. Patient characteristics were summarized using univariate analysis. A bivariate analysis was used to identify potential associations, and significant variables were entered into multi-variate logistic regression to determine independent factors associated with NIs.

The national prevalence of NIs was 21.7%. Independent factors positively associated with infection included surgery performed by a gynaecologist, general practitioner, or an intern; pre-operative haematocrit <30%; operative duration >1 h; the absence of prophylactic antibiotics; hospital stay ≥4 days; body temperature ≥38 °C; differing diagnoses at admission and discharge; wounds classified as clean-contaminated, contaminated, or dirty; and the presence of drains. Factors negatively associated with infection included gravidity, gestational age, vaginal examination, and emergency cesarean delivery.

NIs affect over one-fifth of hospitalized patients in Rwanda, with several modifiable clinical and procedural risk factors identified. Strengthening infection prevention and control practices including appropriate use of prophylactic antibiotics, adherence to aseptic procedures, and targeted monitoring of high-risk patients is critical to reducing HAIs in public hospitals.