Establishing a National Healthcare Associated Infection Surveillance System in Cameroon: Promising Practices and Challenges from Pilot Health Facilities

Healthcare-associated infections (HCAI) are the most common preventable adverse events during patient care delivery worldwide, accounting for prolonged hospitalization and death. HCAI surveillance is essential to strengthen infection prevention and control (IPC) practices and improve patient safety. Cameroon does not have a national HCAI surveillance system. We describe some promising practices and challenges in the process of establishing a national HCAI surveillance system in Cameroon. This was a four-phase approach, including an assessment of health facilities’ HCAI surveillance capacity, drafting and implementation of a surveillance protocol in pilot facilities for one year, and performance evaluation. A group of experts met and developed the national protocol and adapted HCAI case definitions from the US Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance (NNIS). Prioritized HCAIs were catheter-associated urinary tract infections (CAUTI), central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) and surgical site infections (SSI). 627 HCAI cases were suspected with 9(1.4%) confirmed. The most common pathogens were Pseudomonas aeruginosa and Escherichia coli. Some 2(15.4%) facilities detected and responded to colonization of surfaces by pathogens thereby strengthening their IPC programs. Some facilities strengthened their laboratory capacity to confirm HCAI cases. The lack of dedicated funding for patients’ laboratory analysis and the absence of a legal framework were some challenges identified. The establishment of an HCAI surveillance system in Cameroon showed some promising practices. The use of a protocol with clinical case definitions was useful and seems to be an option in situations of limited laboratory capacity.