Mycobacterial infection in an inner city children's hospital.

Childhood tuberculosis is perceived by many as a disease of the past. Experience in a children's hospital serving a deprived population suggested that tuberculosis and other mycobacterial infections were not declining in clinical practice. Fifty three tuberculous and 11 atypical mycobacterial infections were identified between 1978 and 1992. There was no decline in tuberculosis and nine of the 11 atypical infections occurred in the last five years. Altogether 40% of cases of tuberculosis were in non-Asian children; 32% had arrived in the UK or visited family overseas in the previous year; and 38% had a history of tuberculosis contact, usually a close adult relative. Nationally, the previous decline in tuberculosis in all ages has reversed. In the local health districts in London's east end, childhood tuberculosis has also stopped declining and seems to be increasing. It is regrettable that BCG vaccination has been abolished by some districts in the UK, against current recommendations. Childhood tuberculosis is still common in the practice described here, including among children who do not fall into conventionally recognised high risk groups. Inner city dwellers and junior doctors are both highly mobile populations, adding to the risk that paediatricians, particularly those in training, may encounter tuberculosis with little or no previous experience of the condition.     

Experience with routine voluntary perinatal human immunodeficiency virus testing in an inner city hospital.

Women enrolled in prenatal care at Grady Health System, Atlanta, GA, have routinely been offered HIV counseling and voluntary testing since 1987. Consistently >90% have accepted testing. With implementation of US Public Health Service guidelines for perinatal zidovudine prophylaxis in 1994, the mother-to-child HIV transmission rate rapidly decreased from 18% to 8% during the subsequent 2 years.     

腹泻患儿扎如病毒感染研究

目的 了解广州地区婴幼儿扎如病毒性腹泻感染现状.方法 在2008年8月 - 2009年7月,每周二、周五采集10份腹泻标本,运用real-time RT-PCR进行检测,阳性标本再行RT-PCR扩增、纯化、克隆、测序.结果 扎如病毒检出率为1.0%(10/985),包括GI与GIV型,其中GI型占90%(9/10).结论 扎如病毒是该地区婴幼儿急性腹泻中检出率较低的病原体,GI-1是主要的感染型,GIV型感染在华南地区有增多趋势.     

Nutritional status of schoolchildren in an inner city area

Data were collected on the seven day weighed food intakes of 65 schoolchildren, aged 12-13 years, living in an inner city, socially deprived area in east London. Blood samples were collected during the week and analysed for cholesterol, serum ferritin, vitamins A, E, B-12, beta carotene, and folic acid. Boys generally fared better than girls with almost a quarter of the girls having intakes of calcium, magnesium, iron, zinc, vitamin A, and riboflavin less than the lower reference nutrient intake, an amount which, by definition, is enough for only the few people in a group who have low needs. Although the mean energy intake was close to the estimated average requirement for both boys and girls, 74% did not meet the recommended intake for fibre and a high proportion of children consumed more than 11% of their energy from saturated fat (85%) and added sugar (88%). Thirty seven per cent of the children ate no fresh fruit during the week they kept a diary and only 19% had vegetables (fresh or frozen), other than potatoes, on a daily basis. Their main sources of energy were chips, bread, and confectionery. No association was found between fat intakes and plasma cholesterol concentrations. Girls had significantly lower blood concentrations of folic acid, ferritin, and beta carotene. The findings of this study confirm the anxieties often expressed that many schoolchildren, particularly in less affluent areas, are eating diets which are unhealthy according to government recommendations.     

Nutritional status of schoolchildren in an inner city area.

Data were collected on the seven day weighed food intakes of 65 schoolchildren, aged 12-13 years, living in an inner city, socially deprived area in east London. Blood samples were collected during the week and analysed for cholesterol, serum ferritin, vitamins A, E, B-12, beta carotene, and folic acid. Boys generally fared better than girls with almost a quarter of the girls having intakes of calcium, magnesium, iron, zinc, vitamin A, and riboflavin less than the lower reference nutrient intake, an amount which, by definition, is enough for only the few people in a group who have low needs. Although the mean energy intake was close to the estimated average requirement for both boys and girls, 74% did not meet the recommended intake for fibre and a high proportion of children consumed more than 11% of their energy from saturated fat (85%) and added sugar (88%). Thirty seven per cent of the children ate no fresh fruit during the week they kept a diary and only 19% had vegetables (fresh or frozen), other than potatoes, on a daily basis. Their main sources of energy were chips, bread, and confectionery. No association was found between fat intakes and plasma cholesterol concentrations. Girls had significantly lower blood concentrations of folic acid, ferritin, and beta carotene. The findings of this study confirm the anxieties often expressed that many schoolchildren, particularly in less affluent areas, are eating diets which are unhealthy according to government recommendations.     

Evolution of an adenovirus outbreak in a multidisciplinary children's hospital

OBJECTIVE: To describe the course of an evolving adenovirus outbreak in a multidisciplinary children's hospital with a high-risk patient population. METHODS: Observational study in a 280-bed university hospital during June 2002. Active case finding identified children with adenovirus infection. Data are median (interquartile range) or n (%). Adenovirus infection was diagnosed in 49 children, median age 12 months (4-33). RESULTS: New cases were diagnosed over 26 days and peaked on day 17 (n = 15). Total infected inpatients peaked on days 17-21 (n = 36). Twenty-three infections (47%) were community-acquired and 26 (53%) hospital-acquired. Thirty-three children (67%) had a coexistent high-risk condition. Median hospital stay before and after diagnosis was 9 days (3-18) and 9 days (4-29), respectively. Twenty-two children (45%) were admitted to PICU. Overall hospital mortality was 22% (n = 11) and mortality attributed to adenoviral disease 12% (n = 6). Hospital mortality was similar between community- and hospital-acquired infections (22% compared to 23%) (P = 1.0). Twenty children (41%) received intravenous immunoglobulin (IVIG). Children treated with IVIG had a longer hospital stay (median 40 days vs 14 days) than those who did not receive IVIG (P = 0.01). Neither PICU mortality (29% vs 12%), nor hospital mortality (35% vs 14%), differed significantly between IVIG treated and untreated children (P = 0.76 and P = 0.16, respectively). CONCLUSION: The rapid spread of hospital-acquired adenovirus underlines the importance of effective infection control measures. Despite nosocomial infection amongst high-risk patients, mortality was similar to that of community-acquired infection. Administration of immunoglobulin was not associated with demonstrable benefit. A prospective randomized trial would be required to resolve this issue.     

Work-related risk factors for hepatitis B virus infection in personnel of a children's hospital

Seroprevalence of hepatitis B virus markers was examined in employees participating in patient care at The Children's Mercy Hospital in Kansas City, Missouri. Of 377 workers tested in 1985-86, 36 (9.6%) were seropositive for any marker. Among 285 employees who presumably have only work-related hepatitis B exposure, 14 (4.9%) were seropositive. Age 50 years and older, black race, and education no more than 12 years were associated with seropositivity among workers with work-related exposure. Employees in the clinics, laboratories, emergency room, and operating room had an increased prevalence of hepatitis B markers compared to those in other work locations (8 vs. 2%, p less than 0.05). Traditional risk factors for infection were not predictive of seropositivity. Although the risk of acquiring hepatitis B infection from employment in a children's hospital is low, this study does identify work-related risk factors. Possible reasons for this association are discussed.     

MRSA at an English children's hospital from 1998 to 2003

Aims: To investigate the epidemiological and clinical aspects of MRSA among inpatients and outpatients presenting to hospital. Methods: Analysis of demographic, epidemiological, and clinical data collected on 385 children first identified as having MRSA between January 1998 and December 2003 in a 250 bed English children''s hospital. Results: There were 267 inpatients and 118 outpatients. The number of new cases of MRSA declined from 72 in 1998 to 52 in 2003, whereas hospital activity increased. Ninety nine (37.1%) inpatients acquired MRSA outside the hospital; a further 90 occurred among 31 clusters of cases. One hundred and seventy eight (66.7%) inpatients were aged <2 years; cardiac services and paediatric &; neonatal surgery accounted for 59.6% of cases. Dermatology and A&;E accounted for 51.7% of outpatients; 73.8% of outpatients had recently previously attended the hospital. A total of 13.9% of inpatients with MRSA developed bacteraemia; MRSA accounted for 15% of Staphylococcus aureus bacteraemias. The risk of MRSA bacteraemia in colonised patients, and the proportion of S aureus bacteraemias that were MRSA, varied between specialties. Intravascular devices were the most common source of MRSA bacteraemia (63.4% of cases). The mortality rate was 7.3%. Conclusions: Enhanced surveillance of MRSA can identify at-risk patient groups, thus facilitating targeting of control measures. The absence of a link between numbers of cases of acquisition of MRSA and bacteraemia suggests that the rise in MRSA bacteraemia may not solely reflect an increase in MRSA prevalence in children in the UK. The need for larger epidemiological studies is emphasised.     

Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children's hospital

OBJECTIVE: Hand hygiene is an effective means of preventing hospital-associated infection, but compliance among health care workers is poor. Few studies aimed at increasing hand hygiene in the hospital setting have shown sustained improvement and concurrent decreases in hospital-associated infections, and even fewer have been performed in the pediatric setting. METHODS: We implemented a hand hygiene program with the hopes of improving hand hygiene and decreasing hospital-associated rotavirus infection rates. A multidisciplinary group developed a hospital supported, house-wide campaign. Opportunities for hand hygiene were observed during 5 periods. The frequency of hospital-associated rotavirus infection was tracked over time by review of laboratory records. Correlates of hand hygiene were investigated with the use of multivariate logistic regression. RESULTS: Overall hand hygiene compliance improved from 62% in period 1 to 81% in period 5 (P < 0.001). Soap and water was the most common method for practicing hand hygiene, and alcohol hand gel use increased from 4% to 29% between the first and last observation periods (P < 0.001). The rate of hospital-associated rotavirus infection decreased from 5.9 episodes per 1000 discharged patients in 2001 to 2.2 episodes per 1000 discharged patients in 2004 (P = 0.01). Period of observation, hospital ward, type of care provider and type of care performed were all independently associated with hand hygiene (adjusted P < or = 0.02 for all). CONCLUSION: Improving hand hygiene is an important goal for health care institutions. These data can be useful for development of interventions aimed at improving hand hygiene.     

2012至2017年某儿童专科医院住院患儿医院感染的部位及病原体分布

目的 了解儿童专科医院住院患儿医院感染的部位构成及病原体变迁,为医院感染预防与控制提供依据。方法 选取2012年1月1日至2017年12月31日在上海交通大学附属儿童医院确诊为医院感染的住院患儿为研究对象,回顾性分析其病原体检出情况及医院感染部位的主要致病菌分布变迁。结果 医院感染患儿共1 991例（2 022例次）,男1 212例（60.9%）,中位年龄2.0(0.6,5.0)岁（1 d至17岁）。前后3年［(2012~2014) vs (2015~2017)］比较,医院感染患儿的性别和发病季节差异均无统计学意义,年龄分布差异有统计学意义（P<0.001）。①排在前4位的医院感染部位依次为下呼吸道（28.8%）、胃肠道（25.7%）、上呼吸道（25.2%）和血流感染（10.4%）。后3年较前3年,医院下呼吸道和血流感染的构成比明显上升（P分别为0.016和0.012）。新生儿科以血流感染为主（49.1%）,PICU以下呼吸道感染为主（69.6%）,儿内科的感染部位主要是呼吸道（58.7%）,儿外科中枢神经系统、泌尿道及手术部位感染构成比较新生儿、PICU和儿内科均高。②微生物送检率为81.8%（1 655/2 022）,共检出病原阳性标本821份（49.3%）。检出的病原体以革兰阴性菌(394%)和病毒(34.8%)为主,其次为革兰阳性菌(17.9%)和真菌(6.9%)。前后3年比较,革兰阴性菌检出构成比下降（45.2% vs 34.6%,P=0.002）,革兰阳性菌检出构成比上升（13.8% vs 21.3%,P=0.005）。病原菌检出率首位为肺炎克雷伯菌（14.0%）,主要引起下呼吸道（44.0%）和血流感染（44.0%）;排在第2位的是鲍曼不动杆菌（13.4%）,75.0%的菌株引起下呼吸道感染。结论 不同科室的医院感染部位构成不同。PICU和新生儿科需尤其关注医院获得性肺炎和血流感染。应减少或避免侵入性操作以及合理使用抗生素,尽可能减少耐药菌的产生与传播。     

Radiology reporting in an academic children's hospital: what referring physicians think

Transcribed reports are the radiologist's most conspicuous and enduring product, yet relatively little investigation of report quality has been undertaken by radiologists. This paper reports the results of a survey of 266 referring physicians in an academic children's hospital regarding their needs and assessments of the quality of radiology reporting. The results outline the range and relative importance of report features from referring physicians' points of view, provide specific suggestions for how to improve reporting performance, and generally indicate that reporting should receive more attention in training and practice than it currently does. Received: 6 July 1999 Accepted: 28 October 1999