Prospective incidence study of nosocomial infections in a pediatric intensive care unit

Urrea, Mireya; Pons, Martí; Serra, M. Bassecourt; Latorre, Carlota Cesarini; Palomeque, A.

doi:10.1097/01.inf.0000069758.00079.d3

Cited by 137 publications

(104 citation statements)

References 13 publications

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“…This distribution is similar to that reported by other authors [1,5,15,16], although different from some Brazilian reports [2,14], which describe pneumonia as the most common neonatal NI. The proportion of bloodstream infections in this study (68.2%) is definitely worrisome, since neonatal sepsis carries on a particular increased mortality, prolonged length of hospital stay and slower growth among very low birth weight infants and our rates are higher than those usually observed [1,3,5,15].…”

Section: Discussionsupporting

confidence: 75%

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

et al. 2008

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This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI) in a Brazilian neonatal intensive care unit (NICU). This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%), with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%). Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD). Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.

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Section: Discussionsupporting

confidence: 75%

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

et al. 2008

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“…[1][2][3][4] Central venous catheter (CVC)-associated BSI rates in PICUs range from 7.7 to 46.9 infections per 1,000 CVC-days. [4][5][6][7][8][9] These rates are comparable to BSI rates found in burn units and neonatal intensive care units. 6 Coagulasenegative staphylococci are the most common pathogens identified among patients with catheter-related BSI (38% of episodes), although gram-negative rods are isolated in 25% of PICU bacteremia cases.…”

supporting

confidence: 58%

Risk Factors for Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients: A 2-Year Prospective Cohort Study

Elward

Fraser

2006

Infect. Control Hosp. Epidemiol.

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“…[1][2][3][4][5][6][7][8][9][10][11] According to the National Nosocomial Infection Surveillance System established by the Centers for Disease Control and Prevention (CDC), the pooled mean in 2004 among 54 PICUs was 6.6 CA-BSIs per 1000 catheterdays, higher than in many adult ICUs. 12 More recent estimates that included 36 PICUs have shown a pooled mean rate of 5.3 CA-BSIs per 1000 catheterdays.…”

mentioning

confidence: 99%

Decreasing PICU Catheter-Associated Bloodstream Infections: NACHRI's Quality Transformation Efforts

Miller

Griswold

Harris³

et al. 2010

Pediatrics

327

232

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WHAT'S KNOWN ON THIS SUBJECT:CA-BSIs are a significant source of morbidity, mortality, and added medical costs to hospitalized adult and pediatric patients. Despite these data, strategies for reducing health care complications such as pediatric CA-BSIs have received relatively little attention. WHAT THIS STUDY ADDS:In contrast with adult ICU care, maximizing insertion-bundle compliance alone cannot help PICUs to eliminate CA-BSIs. Instead, the main drivers for additional reductions in pediatric CA-BSI rates seem to be issues surrounding daily maintenance care for central lines.abstract OBJECTIVE: Despite the magnitude of the problem of catheter-associated bloodstream infections (CA-BSIs) in children, relatively little research has been performed to identify effective strategies to reduce these complications. In this study, we aimed to develop and evaluate effective cathetercare practices to reduce pediatric CA-BSIs. STUDY DESIGN AND METHODS:Our study was a multi-institutional, interrupted time-series design with historical control data and was conducted in 29 PICUs across the United States. Two central venous catheter-care practice bundles comprised our intervention: the insertion bundle of pediatric-tailored care elements derived from adult efforts and the maintenance bundle derived from the Centers for Disease Control and Prevention recommendations and expert pediatric clinician consensus. The bundles were deployed with quality-improvement teaching and methods to support their adoption by teams at the participating PICUs. The main outcome measures were the rate of CA-BSIs from January 2004 to September 2007 and compliance with each element of the insertion and maintenance bundles from October 2006 to September 2007. RESULTS:Average CA-BSI rates were reduced by 43% across 29 PICUs (5.4 vs 3.1 CA-BSIs per 1000 central-line-days; P Ͻ .0001). By September 2007, insertion-bundle compliance was 84% and maintenance-bundle compliance was 82%. Hierarchical regression modeling showed that the only significant predictor of an observed decrease in infection rates was the collective use of the insertion and maintenance bundles, as demonstrated by the relative rate (RR) and confidence intervals (CIs) (RR: 0.57 [95% CI: 0.45-0.74]; P Ͻ .0001). We used comparable modeling to assess the relative importance of the insertion versus maintenance bundles; the results showed that the only significant predictor of an infection-rate decrease was maintenancebundle compliance (RR: 0.41 [95% CI: 0.20 -0.85]; P ϭ .017). CONCLUSIONS:In contrast with adult ICU care, maximizing insertionbundle compliance alone cannot help PICUs to eliminate CA-BSIs. The main drivers for additional reductions in pediatric CA-BSI rates are issues that surround daily maintenance care for central lines, as defined in our maintenance bundle. Additional research is needed to define the optimal maintenance bundle that will facilitate elimination of CA-BSIs for children. Catheter-associated bloodstream infections (CA-BSIs) are a significant cause of morbidity, morta...

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Prospective incidence study of nosocomial infections in a pediatric intensive care unit

Abstract: Performance of surveillance highlights the importance of nosocomial infections and their influence in the hospital stay and can guide selection of prevention and control measures to reduce morbidity and mortality in a PICU.

Cited by 137 publications

References 13 publications

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

Risk Factors for Nosocomial Primary Bloodstream Infection in Pediatric Intensive Care Unit Patients: A 2-Year Prospective Cohort Study

Decreasing PICU Catheter-Associated Bloodstream Infections: NACHRI's Quality Transformation Efforts

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