Organisation of hospital infection control in Mongolia.

As with other areas of the public sector in Mongolia, the healthcare system has undergone significant structural and policy reforms since the early 1990s. The previous infection control system, characterised as a sanitary-epidemiological network, was dismantled with no replacement. A new infection control management system was established in 1997 with the adoption of infection control policies and guidelines, establishment of hospital infection control programmes in all major hospitals, training of health professionals and the commencement of passive surveillance of hospital-acquired infections (HAIs). Recent health statistics claim that HAIs occur in 0.01-0.02% of all hospital admissions with the highest percentage (0.05%) in tertiary hospitals in the capital city Ulaanbaatar, but this is very likely to be an underestimate. In 2002 the Government approved a national programme to establish a sentinel surveillance system for HAIs with improved laboratory-based monitoring. However, implementation has been delayed due to insufficient support from stakeholders and a shortage of resources and trained infection control professionals. Non-governmental infection control initiatives are limited by time and coverage.

Prevalence of hospital-acquired infections and antibiotic use in two tertiary Mongolian hospitals.

Health statistics of Mongolia indicate that hospital-acquired infections (HAIs) occur in 0.01-0.05% of all hospital admissions. This is considerably lower than internationally reported rates. A one-day survey was conducted in two tertiary hospitals of Ulaanbaatar in September 2008 to estimate HAI prevalence, associated risk factors and patterns of antibiotic usage. Among 933 patients surveyed, 50 (5.4%) were diagnosed with HAI. Prevalence of surgical site infection was 1.1% (3.9% among surgical patients), bloodstream infection 0.3%, respiratory tract infection 1.3%, urinary tract infection 1.3%, and other HAI 1.4%. Microbiological investigations were only documented for 18.9% of all patients. A total of 558 patients (59.8%) were taking 902 courses of antibiotics; 92.1% of patients were prescribed antibiotics without a sensitivity test. Multiple logistic regression analysis revealed that HAI was significantly associated with the admission source, the hospital, length of hospital stay, surgical and other invasive procedures, urinary catheters and other indwelling devices. The study results were comparable with reports from some other developing countries and confirm that official statistics underestimate the true frequency of HAI in Mongolia.