The Epidemiology of Healthcare-associated Infections in Pediatric Cardiac Intensive Care Units

Alten, Jeffrey A.; Rahman, Akm Fazlur; Zaccagni, Hayden; Shin, Andrew; Cooper, David S.; Blinder, Joshua J.; Retzloff, Lauren; Aban, Inmaculada; Graham, Eric M.; Zampi, Jeffrey D.; Domnina, Yuliya A.; Gaies, Michael

doi:10.1097/inf.0000000000001884

Cited by 48 publications

(44 citation statements)

References 23 publications

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“…and Chen et al., respectively [ 20 , 23 ]. In addition, concerning device-days (catheter-days and ventilator-days), the rate of HAIs observed in our study is much higher than those reported in other studies [ 30 , 31 ], this could be because other studies have been conducted in only one ward of a hospital.…”

Section: Discussioncontrasting

confidence: 82%

Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance

Izadi

Eshrati²,

Etemad³

et al. 2020

New Microbes and New Infections

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Hospital-acquired infections (HAIs) lead to increased length of hospital stay, inappropriate use of broad-spectrum antibiotics and multiple antibiotic resistance. This study aimed to investigate the rate of HAIs in Iran. In this multi-centre study, the rate of HAIs was calculated based on the data collected through Iranian nosocomial infections surveillance for patients with HAIs, as well as through hospital statistics and information systems on hospital-related variables. Data were analysed using Stata software; in addition, ArcGIS was used for plotting the geographical distribution of HAIs by different provinces. The mean age of the 107 669 patients affected by HAIs was 52 ± 26.71 years. Just over half (51.55%) of the patients were male. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. The most common HAIs were urinary tract infections (26.83%; 1.99 per 1000 patient-days), ventilator-associated events (20.28%; 1.5 per 1000 patient-days), surgical-site infections (19.73%; 1.45 per 1000 patient-days) and bloodstream infections (13.51%; 1 per 1000 patient-days), respectively. The highest rate of HAIs was observed in intensive care units. Device, catheter and ventilator-associated infections accounted for 38.72%, 18.79% and 16% of all HAIs, respectively. Based on the results, HAIs are common in intensive care units, and urinary tract infections and device-related infections are more prevalent in Iran. To reduce HAIs it is recommended to implement appropriate policies and interventions, train staff about the use of devices, and prepare and update protocols and guidelines for improving the quality of care.

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Section: Discussioncontrasting

confidence: 82%

Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance

Izadi

Eshrati²,

Etemad³

et al. 2020

New Microbes and New Infections

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“…Along with a high mortality, this group of patients also has a higher risk for complications such as hospital-acquired infections 6 ; the need for a tracheostomy secondary to long-term use of mechanical ventilation 7 ; or long-term physical and psychological problems following ICU treatment such as the so-called "post-PICU syndrome" 8 .…”

Section: Introductionmentioning

confidence: 99%

A comparative two-cohort study of pediatric patients with long term stay in ICUs

Mancebo

Navazo

Arteta

et al. 2021

Sci Rep

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During the last decades, the number of patients with long stay admissions (LSA) in PICU has increased. The purpose of this study was to identify factors associated with PICU LSA, assessing healthcare resources use and changes in the profile of these patients. A retrospective, observational, single-center study was carried out. Characteristics of LSA were compared between two periods (2006–2010 and 2011–2015). During the earlier period there were 2,118 admissions (3.9% of them LSA), whereas during the second period, there were 1,763 (5.4% of them LSA) (p = 0.025). LSA accounted for 33.7% PICU stay days during the first period and 46.7% during the second (p < 0.001). Higher use of non-invasive ventilation (80.2% vs. 37.8%, p = 0.001) and high-flow oxygen therapy (68.8% vs. 37.8%, p = 0.005) was observed in the 2011–2015 cohort, whereas the use of arterial catheter (77.1% vs. 92.6%, p = 0.005), continuous infusion of adrenaline (55.2% vs. 75.9%, p = 0.004), and hemoderivative transfusion (74% vs. 89.2%, p = 0.010) was less frequent. In the 2006–2010 cohort, hospital-acquired infections were more common (95.2% vs. 68.8%, p < 0.001) and mortality was higher (26.8% vs. 13.8%, p = 0.026). The number of long-stay PICU admissions have increased entailing an intensive use of healthcare resources. These patients have a high risk for complications and mortality.

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“…Moreover, recent work on using graphical methods to routinely monitor a range of morbidities highlighted the complexity of graphically summarising multiple morbidities 28. The Pediatric Cardiac Critical Care Consortium (PC⁴) was set up in 2009, and provides partner sites with access to real-time, reliable and actionable data to be used for local quality improvements 29–32. However, membership of PC 4 is voluntary for institutions on a subscription basis, the reported measures been selected by clinicians, the reporting of outcomes is accessible only to subscribing member institutions and these are limited to in-hospital measures.…”

Section: Discussionmentioning

confidence: 99%

What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study

Brown

Pagel

Ridout³

et al. 2019

BMJ Open

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ObjectivesGiven the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months.DesignThe design was a prospective, multicentre, multidisciplinary mixed methods study.SettingThe setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.ParticipantsIncluded were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.ResultsFamilies and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).ConclusionsEvaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.

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The Epidemiology of Healthcare-associated Infections in Pediatric Cardiac Intensive Care Units

Abstract: We provide comprehensive multicenter benchmark data regarding rates of HAIs within dedicated pediatric CICUs. We confirm that although rare, HAIs of all types are associated with significant resource utilization and mortality.

Cited by 48 publications

References 23 publications

Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance

Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance

A comparative two-cohort study of pediatric patients with long term stay in ICUs

What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study

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