Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania

Gurskis, Vaidotas; Asembergiene, Jolanta; Kėvalas, Rimantas; Miciulevičienė, Jolanta; Pavilonis, Alvydas; Valintėlienė, Rolanda; Dagys, Algirdas

doi:10.3390/medicina45030027

Cited by 14 publications

(10 citation statements)

References 44 publications

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“…The bundle addressed handling of ventilator circuits and oral suctioning, hand hygiene, regular oral care with chlorhexidine, and backrest elevation. By applying a multimodal intervention, three PICUs reduced the incidence of hospital-acquired pneumonia from 5.6 per 100 patients at baseline to 1.9 in the intervention (P = 0.016) [91]. An educational program targeting resident physicians and nurses in a PICU of a lower-middle-income country resulted in a non-significant VAP reduction of 28% (P = 0.21) [92].…”

Section: Preventionmentioning

confidence: 97%

Ventilator-associated pneumonia in neonates, infants and children

Aelami

Lotfi

Zingg

2014

Antimicrob Resist Infect Control

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Ventilator-associated pneumonia (VAP) is relatively common in mechanically-ventilated children, but there is a wide variation in reported VAP rates, depending on settings and geographical regions. Surveillance definitions in children are challenging. Although these are provided by the German nosocomial infection surveillance system and an independent Dutch group, the combination of clinical and radiologic signs leaves room for interpretation. Of note, the United States Centers for Disease Prevention and Control guidelines do not offer algorithms for neonates. Despite the fact that most experts agree on the low sensitivity and specificity of existing definitions, little has changed over the past years. However, the number of studies reporting on VAP prevention programs has increased in recent years. Single interventions, such as chlorhexidine mouth wash or stress ulcer prophylaxis, were not effective. Successful prevention programs combined multiple interventions, such as hand hygiene, glove and gown use for endotracheal tube manipulation, backrest elevation, oral care with chlorhexidine, stress ulcer prophylaxis, cuff pressure maintenance where appropriate, use of orogastric tubes, avoidance of gastric overdistension, and elimination of non-essential tracheal suction. These multimodal strategies have proved to be successful among neonates, infants, and children. Importantly, they are applicable in high-as well as in low-and middle-income countries. This review provides an update of VAP incidence rates and summarizes current knowledge on its epidemiology, risk factors, surveillance definitions, and prevention programs in the pediatric setting.

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Section: Preventionmentioning

confidence: 97%

Ventilator-associated pneumonia in neonates, infants and children

Aelami

Lotfi

Zingg

2014

Antimicrob Resist Infect Control

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“…Additionally, NI is associated with excess treatment costs through an increase in the length of hospital stays and the presence of resistant bacteria. It was reported that the development of NI prolongs hospitalization up to 24 days when compared with children with the same degree of traumatic injury without NI [11,14,15].…”

Section: Background/rationalementioning

confidence: 99%

Risk Factors and Cost of Nosocomial Infections in Pediatric Patients With Traumatic Brain Injury

Girgin

Öztürk

2020

Preprint

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Aim: This study aimed to determine the factors that increase and decrease the presence of the nosocomial infections in pediatric patients with traumatic brain injury, and the effects on both treatment cost and length of hospital stay.Methods: We performed a case-control study on patients admitted to the pediatric intensive care unit (PICU) with (n=66) or without (n=120) traumatic brain injury (TBI) between 2012 and 2014. The risk factors, length of stay, and costs of nosocomial infections, were determined. Results: Data for 186 patients were analyzed. Hundred and twenty patients were controls (54 males vs. 66 females), while 66 were cases (27 males vs. 39 females). Seventeen out of the 186 PICU patients had nosocomial infections. The most isolated microbial agent was Acinetobacter baumannii (four cases). Thirteen (76.5%) out of the 17 infections were catheter-related bloodstream infections. The mean expenses per PICU patient were $762, with an additional cost of $2081 for patients with nosocomial contamination. Conclusion: The use of catheters was the most critical risk factor for nosocomial infections in our study. The cost was probably underestimated for several reasons. Nevertheless, the findings supported our hypothesis about the additional burden of nosocomial spread on PICU patients. The results of this study should help to provide evidence on cost-effectiveness or calculating the cost-benefit ratio of reducing nosocomial infections in children.

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“…Ventilator-associated tracheobronchitis (VAT) diagnosis was based on the absence of clinical and radiographic evidence of pneumonia and the following criteria: positive culture obtained by deep tracheal aspirate and 2 signs or symptoms with no recognizable cause (fever [>38.5°C], cough, new or increased sputum production, rhonchi, or wheezing) (12;13). In the period from 2006 to 2007, when the multimodal intervention was designed (education of the PICU staff about VAP prevention and correction of daily care of a patient according to the evidence-based recommendations, feedback communication with the PICU staff in the postintervention period and implementation of new daily care protocols), there was a sharp decrease in the VAP incidence (21.8 versus 8.8 per 1000 ventilator-days) (14). Later, the implementation of VAP prevention bundle (semi-recumbent 30°-45° position of the head, daily evaluation of readiness to wean, comprehensive oral care protocol, periodical check for gastric overdistention, ETT cuff pressure between 20 and 30 cm of water, stress ulcer prophylaxis, periodic drainage and absence of tubing condensate and annual reporting of surveillance results in the PICU) led to a further decline in the VAP incidence curve (2.0 per 1000 ventilator-days in 2012; surveillance data were submitted to the INICC registry) (1).…”

Section: Vap Definition and Prevention In The Picumentioning

confidence: 99%

Microbial colonization of the lower airways after insertion of a cuffed endotracheal tube in pediatric patients

2018

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Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania

Cited by 14 publications

References 44 publications

Ventilator-associated pneumonia in neonates, infants and children

Ventilator-associated pneumonia in neonates, infants and children

Risk Factors and Cost of Nosocomial Infections in Pediatric Patients With Traumatic Brain Injury

Microbial colonization of the lower airways after insertion of a cuffed endotracheal tube in pediatric patients

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