Nosocomial infections in a pediatric intensive care unit

In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infections/100 admissions). Primary bacteremias comprised 38% of PICU infections and lower respiratory infections comprised 15%. The remaining infections were divided equally among GI, skin, eye, upper respiratory, postoperative wounds, and other sites. Coagulase-negative staphylococci, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent pathogens. Surgical patients had similar rates of infection to medical patients. Patients in the first 2 yr of life, particularly those between 7 and 30 days of age, had the highest rate of infection. Onset of infection was more common after the first week in the PICU with 11% of patients staying 14 to 20 days, 27% of patients staying 21 to 27 days, 48% of patients staying 28 to 34 days, and 52% of patients staying more than 35 days before the onset of infection. The risk of nosocomial infection increases with arterial and central line use, prolonged intubation, ventilation, intracranial pressure monitoring, and paralysis.     

Nosocomial infections in a respiratory intensive care unit

A total of 250 consecutive admissions to an open-plan respiratory ICU were analyzed prospectively to identify the incidence of secondary hospital-acquired infections and possible predisposing factors. Despite preventative measures and a restricted antibiotic policy, 23.6% of patients developed secondary infections. Patients admitted after multiple trauma were the only diagnostic category of patients who showed a significantly increased incidence of secondary infections. The length of hospitalization and number of patients who had intubations or tracheostomies was higher in the group with secondary infection; the causal relationship was difficult to establish. Patients who were not intubated or tracheostomized did not develop secondary infection. Prior administration of antibiotics did not appear to influence the incidence of secondary infection. There was a significant increase in secondary infections in patients with a higher therapeutic intervention scoring system score. The predominant pathogens cultured were highly resistant Gram-negative organisms, particularly Acinetobacter sp. and Pseudomonas sp. Staphylococcus aureus was the most common Gram-positive pathogen. The ICU course was probably prolonged by the complication of nosocomial infection, which may have contributed to the deaths.     

Nosocomial sepsis in the neonatal intensive care unit

During a 12-month study of the causes of and risk factors for nosocomial sepsis in a neonatal intensive care unit (NICU), we detected 23 episodes of nosocomial sepsis in 20 of the 155 infants at risk who were hospitalized in the NICU for at least one week. The associated mortality was 20%. Gram-positive organisms accounted for 15 (65%) of the episodes. Low birth weight, multiple gestation, and prolonged hospitalization were significant risk factors for nosocomial sepsis by univariate analysis; together, these three factors correctly predicted 80% of the infants with sepsis and 82% of the control subjects. By logistic regression analysis, however, length of stay was not a significant risk factor, but rather a confounding variable that was highly associated with birth weight. Analysis of risk factors for nosocomial sepsis showed that previous antibiotic therapy placed an infant at risk for candidemia; assisted ventilation was a risk factor for sepsis caused by group D Streptococcus and Candida albicans. Sepsis was related to infected or malfunctioning intravascular catheters in nine of the 20 infants with sepsis. Further investigation to determine strategies for preventing nosocomial septicemia in the low birth weight infant is warranted.     

Eliminating catheter-related bloodstream infections in the intensive care unit

OBJECTIVE: To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs). DESIGN: Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU. SETTING: The Johns Hopkins Hospital. PATIENTS: All patients with a central venous catheter in the ICU. INTERVENTION: To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. MEASUREMENT: The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. MAIN RESULTS: Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and 1,945,922 dollars in additional costs per year in the study ICU. CONCLUSIONS: Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.     

Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit

Objective  

Identification of catheter-related bloodstream infection (CR-BSI) risk factors and determination of whether intervention related to identified risk factors would reduce CR-BSI rates.     

Prevention of central line-associated bloodstream infections in the neonatal intensive care unit: A literature review

Central line-associated bloodstream infections are a significant patient safety issue for newborns in the neonatal intensive care unit. Preventing these devastating and costly infections is a global priority for health organisations and key to minimising harm for this vulnerable population. The aim of this literature review is to explore and identify evidence-based prevention strategies for central line-associated blood stream infections in neonates. Thematic analysis of the literature revealed four effective prevention strategies: central line care bundles, consistent education, regular surveillance and dedicated vascular access teams. Evidence suggests that a combination of these evidence-based interventions is the most effective strategy; however, future research is required to establish the preferred skin antiseptic and to continue exploring new prevention strategies.     

Prevention of catheter-related bloodstream infections in the neonatal intensive care setting

Nosocomial infection causes substantial morbidity and mortality among neonates treated in the neonatal intensive care setting. Colonization and subsequent infection of central venous catheters leading to catheter-related bloodstream infection is among the most common causes of nosocomial sepsis in this patient population. Prevention of catheter-related bloodstream infection is a major challenge and numerous strategies have been attempted in this context with varying success. Given the dynamic epidemiology of nosocomial infection among neonates and the emergence of antimicrobial resistance, novel prevention strategies are urgently required.     

Prevention of catheter-related bloodstream infections in the neonatal intensive care setting

Nosocomial infection causes substantial morbidity and mortality among neonates treated in the neonatal intensive care setting. Colonization and subsequent infection of central venous catheters leading to catheter-related bloodstream infection is among the most common causes of nosocomial sepsis in this patient population. Prevention of catheter-related bloodstream infection is a major challenge and numerous strategies have been attempted in this context with varying success. Given the dynamic epidemiology of nosocomial infection among neonates and the emergence of antimicrobial resistance, novel prevention strategies are urgently required.     

Nosocomial infections in intensive care patients

Facilities must manage core system processes to minimize medication errors and other adverse outcomes, such as nosocomial infections. Characterization of specific risk factors for the development of nosocomial infections and efficacious evidence-based care interventions are expanding. Health care providers need to evaluate their patient populations and systems of care to minimize lack of knowledge, slips. and lapses in care and other system issues to assure that successful care practices are consistently used to minimize nosocomial infections.     

Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey

Objective To determine epidemiology and risk factors for nosocomial infections in intensive care unit (ICU).Design Prospective incidence survey.Setting An adult general ICU in a university hospital in western Turkey.Patients All patients who stayed more than 48 h in ICU during a 2-year period (2000–2001).Measurements and results The study included 434 patients (7394 patient-days). A total of 225 infections were identified in 113 patients (26%). The incidence and infection rates were 56.8 in 1000-patient days and 51.8%, respectively. The infections were pneumonia (40.9%), bloodstream (30.2%), urinary tract (23.6%) and surgical site infections (5.3%). Pseudomonas aeruginosa (22.6%), methicillin-resistant Staphylococcus aureus (22.2%) and Acinetobacter spp. (11.9%) were frequently isolated micro-organisms. Median length of stay with nosocomial infection and without were 13 days (Interquartile range, IQR, 20) and 2 days (IQR, 2), respectively (P<0.0001). In logistic regression analysis, mechanical ventilation [odds ratio (OR): 16.35; 95% confidence interval (CI): 8.26–32.34; P<0.0001), coma (OR: 15.04; 95% CI: 3.41–66.33; P=0.0003), trauma (OR: 10.27; 95% CI: 2.34–45.01; P=0.002), nasogastric tube (OR: 2.94; 95% CI: 1.47–5.90; P=0.002), tracheotomy (OR: 5.77; 95% CI: 1.10–30.20; P=0.04) and APACHE II scores 10–19 (OR: 10.80; 95% CI: 1.10–106.01; P=0.04) were found to be significant risk factors for nosocomial infection. Rate of nosocomial infection increased with the number of risk factors (P<0.0001). Mortality rates were higher in infected patients than in non-infected patients (60.9 vs 22.1%; P<0.0001).Conclusion These data suggest that, in addition to underlying clinical conditions, some invasive procedures can be independent risk factors for nosocomial infection in ICU.     

Procalcitonin as a marker of nosocomial infections in the neonatal intensive care unit

Objective To determine accuracy of procalcitonin concentrations for diagnosing nosocomial infections in critically ill neonates. Design Case-control study. Setting Neonatal intensive care unit of a teaching hospital. Patients Twenty-three neonates with nosocomial infection. Four controls matched for duration of hospital stay and birth date were chosen for each case patient. Measurements and results PCT concentrations were measured by the LUMItest procalcitonin kit at onset of signs of infection and after recovery. Range of PCT concentrations (ng/ml) was 2.0 to 249.1 in case patients and 0.08 to 1.0 in controls (sensitivity and specificity, 100%). PCT values returned to normal (<1.0 ng/ml) by day 3 to 7 of appropriate antibiotic therapy. Conclusions Measurement of PCT concentrations may be useful for early diagnosis and monitoring of infectious complications in neonates during their stay in the neonatal intensive care unit.     

Procalcitonin as a marker of nosocomial infections in the neonatal intensive care unit

Objective: To determine accuracy of procalcitonin concentrations for diagnosing nosocomial infections in critically ill neonates.¶Design: Case-control study.¶Setting: Neonatal intensive care unit of a teaching hospital.¶Patients: Twenty-three neonates with nosocomial infection. Four controls matched for duration of hospital stay and birth date were chosen for each case patient.¶Measurements and results: PCT concentrations were measured by the LUMItest procalcitonin kit at onset of signs of infection and after recovery. Range of PCT concentrations (ng/ml) was 2.0 to 249.1 in case patients and 0.08 to 1.0 in controls (sensitivity and specificity, 100 %). PCT values returned to normal (< 1.0 ng/ml) by day 3 to 7 of appropriate antibiotic therapy.¶Conclusions: Measurement of PCT concentrations may be useful for early diagnosis and monitoring of infectious complications in neonates during their stay in the neonatal intensive care unit.     

Nosocomial spread of linezolid-resistant Staphylococcus haemolyticus infections in an intensive care unit

This report documents the nosocomial spread for an 18-month period of a single clone of linezolid- and teicoplanin-resistant Staphylococcus haemolyticus associated primarily with catheter-related bacteremia in intensive care unit patients. All linezolid-resistant isolates had the same G2576T mutation in at least 1 copy of the 23S rRNA gene.