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Background: Nosocomial infections are a serious public health problem affecting both developed and developing countries. They are caused mainly by multi-drug-resistant pathogens that limit treatment options, leading to high morbidity and mortality, longer hospital stays and increased costs of health care. This study aimed to evaluate nosocomial infections, risk factors and causative pathogens at two large teaching hospitals in Zambia. Material and methods: A yearlong hospital-based cross-sectional study was conducted from April 2020 to April 2021 at two large tertiary-level hospitals in Zambia. Hospitalised and out-patients with previous hospital contact were screened for nosocomial infections, followed by the collection of specimens (skin swabs, urine or sputum) for bacteriological culture and Polymerase Chain Reaction (PCR) amplification of 16S rRNA gene fragments. Nosocomial infections were defined according to the World Health Organization case definitions. Frequencies were estimated, and the association between the outcome variable (positive culture) and categorical predictor variables were analysed using the Chi-square test. Results: Eight hundred and forty-one clinical specimens (skin swabs, urine or sputum) were collected and analysed, 640 from the University Teaching Hospital in Lusaka and 201 from the Ndola Teaching Hospital in Ndola. Of these, 71.2% were from male, with only 28.8% from female patients. The median age was 50 years old. Catheter-associated urinary tract infections (57%) were the most common, followed by those from pressure sores (38.7%). The most frequently observed pathogens included Escherichia coli (17.8%), Pseudomonas aeruginosa (13.7%), Klebsiella pneumonia (5.6%) and Proteus vulgaris (5.5%). Conclusions: The hospital infection rate at the two urban tertiary hospitals was very high. Age over 65 years, male gender, presence of medical devices, presence of a wound, longer hospital stays, previous hospital contacts and low systolic blood pressure were associated with the risk of developing nosocomial infections. Despite improved infection control following the COVID-19 waves, nosocomial infections have remained a significant public health threat.

Background: Hands of healthcare workers (HCWs) and family caregivers are a potential source of bacterial pathogens that may be transferred to susceptible individuals. However, there is a paucity of data regarding the effect of hand rubs used in Zambian hospitals. Therefore, we determined the effect of locally made alcohol-based hand rubs in three selected wards of the Children Hospital at the University Teaching Hospital in Zambia. Methods: This was a cross-sectional study involving 31 participants (12 family caregivers, 5 doctors and 14 nurses). The samples were collected before and after the use of the alcohol-based hand rub by direct fingerprints. They were then cultured and identified using conventional microbiological methods. The Kirby-Bauer Disc Diffusion method was used for antimicrobial susceptibility testing. Results: All samples collected from the participants yielded bacterial growth with a total of 7 species isolated. These included coagulase-negative staphylococcus (33.3%), Bacillus species (28.9%), Staphylococcus aureus (22.2%), Enterobacter agglomerans (6.7%), Corynebacterium species (4.4%), Escherichia coli (2.2%) and Burkholderia pseudomallei (2.2%). Notably, all study participants hands were not only contaminated but with drug-resistant organisms as most of the bacterial isolates were resistant to routine antibiotics used at the hospital including ciprofloxacin. S. aureus was also resistant to oxacillin thus suggesting the presence of Methicillin-Resistant S. aureus. The use of alcohol-based hand rubs reduced the bacterial load by 92.6% on doctors and nurses’ hands and by 84.5% on the hands of family caregivers. Conclusion: This study confirms that the hands of HCWs and family caregivers may play a role in the transmission of drug-resistant bacteria and that alcohol-based hand rubs can be an effective way of reducing bacterial hand contamination among healthcare workers and family caregivers. Therefore, we recommend that measures be put in place by the hospital to ensure the availability of hand rubs to HCWs as well as caregivers.