scholarly journals Device-associated infections rates in pediatrics and neonatal intensive care units in El Salvador: Findings of the INICC

2011 ◽  
Vol 5 (06) ◽  
pp. 445-451 ◽  
Author(s):  
Lourdes Dueñas ◽  
Ana Bran de Casares ◽  
Victor Daniel Rosenthal ◽  
Lilian Jesús Machuca
Keyword(s):  
Intensive Care ◽  
Infection Control ◽  
El Salvador ◽  
Neonatal Intensive Care ◽  
Pediatric Intensive Care ◽  
Central Line ◽  
International Standards ◽  
Neonatal Icu ◽  
Hygiene Compliance ◽  
Health Care Associated Infection

Introduction: This study aimed to determine the rate of device-associated, health care-associated infection (DA-HAI), the excess in length of stay, the mortality, and the hand hygiene compliance in a pediatric intensive care unit (PICU) and a neonatal ICU (NICU) in a hospital member of the International Infection Control Consortium (INICC) in El Salvador. Methodology: A prospective cohort, active DA-HAI surveillance study was conducted on patients admitted in the pediatric and neonatal ICUs from January 2007 to November 2009. The protocol and methodology implemented were developed by INICC. Data were collected in the participating ICUs, and analyzed at INICC headquarters by proprietary software. DA-HAI rates were recorded by applying the definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network. Results: Of 1,145 patients hospitalized in the PICU for 9,517 days, 177 acquired DA-HAIs (overall rate 15.5%), and 18.6 DA-HAIs per 1,000 ICU-days. Furthermore, 1,270 patients hospitalized in the NICU for 30,663 days acquired 302 DA-HAIs (overall rate 23.8%), and 9.8 DA-HAIs per 1,000 ICU-days. The central line-associated bloodstream infection (CLA-BSI) rates in the NICU and PICU were 9.9 and 10.0 per 1,000 catheter-days respectively. The ventilator-associated pneumonia (VAP) rate was 16.1 per 1,000 ventilator-days in the NICU and 12.1 in the PICU.The catheter-associated urinary tract infection (CAUTI) rate was 5.8 per 1,000 catheter-days in the PICU. Conclusions: DA-HAI rates in the PICU and NICU of our hospital were higher than international standards; infection control programs including surveillance and antibiotic policies must be a priority in El Salvador. 

Improving Influenza Immunization Rates Among Healthcare Workers Caring for High-Risk Pediatric Patients

2004 ◽  
Vol 25 (11) ◽  
pp. 912-917 ◽  
Author(s):  
Kristina A. Bryant ◽  
Beth Stover ◽  
Linda Cain ◽  
Gail L. Levine ◽  
Jane Siegel ◽  
...  
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Infection Control ◽  
Intensive Care Units ◽  
Healthcare Workers ◽  
Neonatal Intensive Care ◽  
Pediatric Intensive Care ◽  
Vaccination Rates ◽  
Influenza Immunization ◽  
Immunization Rates

AbstractObjective:To assess influenza vaccination rates of healthcare workers (HCWs) in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and oncology units in Pediatric Prevention Network (PPN) hospitals.Participants:Infection control practitioners and HCWs in NICUs, PICUs, and oncology units.Methods:In November 2000, posters, electronic copies of a slide presentation, and an influenza fact sheet were distributed to 32 of 76 PPN hospitals. In January 2001, a survey was distributed to PPN hospital participants to obtain information about the immunization campaigns. On February 7, 2001, a survey of influenza immunization was conducted among HCWs in NICU, PICU, and oncology units at participating hospitals.Results:Infection control practitioners from 19 (25%) of the 76 PPN hospitals completed the surveys. The median influenza immunization rate was 43% (range, 12% to 63%), with 7 hospitals exceeding 50%. HCWs (n = 1,123) at 15 PPN hospitals completed a survey; 53% of HCWs reported receiving influenza immunization. Immunization rates varied by work site: 52% in NICUs and PICUs compared with 60% in oncology units. Mobile carts and PPN educational fact cards were associated with higher rates among these subpopulations (P < .001) (361 [63%] of 575 vs 236 [44%] of 541 for mobile carts; 378 [60%] of 633 vs 219 [45%] of 483 for fact cards).Conclusion:Despite delayed distribution of influenza vaccine during the 2000–2001 season, immunization rates at 7 hospitals and among HCWs in high-risk units exceeded the National Association of Children's Hospitals and Related Institutions goal of 50%.

scholarly journals Targeting Risk Factors for the Control of Central Line-Associated Bloodstream Infection in the Neonatal Intensive Care Unit: A Single Tertiary Center Experience

2021 ◽  
Vol 28 (3) ◽  
pp. 116-123
Author(s):  
Jiyoon Jeong ◽  
Yoojin Kwun ◽  
Min-ju Kim ◽  
Sang-Ho Choi ◽  
Euiseok Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Infection Control ◽  
Neonatal Intensive Care Unit ◽  
Bloodstream Infection ◽  
Neonatal Intensive Care ◽  
Central Line ◽  
High Risk Infants

Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU).Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed.Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P=0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004).Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.

Findings of the International Nosocomial Infection Control Consortium (INICC), Part III Effectiveness of a Multidimensional Infection Control Approach to Reduce Central Line—Associated Bloodstream Infections in the Neonatal Intensive Care Units of 4 Developing Countries

2013 ◽  
Vol 34 (03) ◽  
pp. 229-237 ◽  
Author(s):  
Victor Daniel Rosenthal ◽  
Lourdes Dueñas ◽  
Martha Sobreyra-Oropeza ◽  
Khaldi Ammar ◽  
Josephine Anne Navoa-Ng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Rate Ratio ◽  
Neonatal Intensive Care ◽  
Phase 1 ◽  
Central Line ◽  
Neonatal Intensive Care Units ◽  
Phase 2 ◽  
Control Approach

Objective.To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce central line-associated bloodstream infection (CLABSI) rates.Setting.Four neonatal intensive care units (NICUs) of INICC member hospitals from El Salvador, Mexico, Philippines, and Tunisia.Patients.A total of 2,241 patients hospitalized in 4 NICUs for 40,045 bed-days.Methods.We conducted a before-after prospective surveillance study. During Phase 1 we performed active surveillance, and during phase 2 the INICC multidimensional infection control approach was implemented, including the following practices: (1) central line care bundle, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CLABSI rates, and (6) performance feedback of infection control practices. We compared CLABSI rates obtained during the 2 phases. We calculated crude stratified rates, and, using random-effects Poisson regression to allow for clustering by ICU, we calculated the incidence rate ratio (IRR) for each follow-up time period compared with the 3-month baseline.Results.During phase 1 we recorded 2,105 CL-days, and during phase 2 we recorded 17,117 CL-days. After implementation of the multidimensional approach, the CLABSI rate decreased by 55%, from 21.4 per 1,000 CL-days during phase 1 to 9.7 per 1,000 CL-days during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33–0.63]). The IRR was 0.53 during the 4–12-month period and 0.07 during the final period of the study (more than 45 months).Conclusions.Implementation of a multidimensional infection control approach was associated with a significant reduction in CLABSI rates in NICUs.

Findings of the International Nosocomial Infection Control Consortium (INICC), Part III Effectiveness of a Multidimensional Infection Control Approach to Reduce Central Line—Associated Bloodstream Infections in the Neonatal Intensive Care Units of 4 Developing Countries

2013 ◽  
Vol 34 (3) ◽  
pp. 229-237 ◽  
Author(s):  
Victor Daniel Rosenthal ◽  
Lourdes Dueñas ◽  
Martha Sobreyra-Oropeza ◽  
Khaldi Ammar ◽  
Josephine Anne Navoa-Ng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Rate Ratio ◽  
Neonatal Intensive Care ◽  
Phase 1 ◽  
Central Line ◽  
Neonatal Intensive Care Units ◽  
Phase 2 ◽  
Control Approach

Objective.To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce central line-associated bloodstream infection (CLABSI) rates.Setting.Four neonatal intensive care units (NICUs) of INICC member hospitals from El Salvador, Mexico, Philippines, and Tunisia.Patients.A total of 2,241 patients hospitalized in 4 NICUs for 40,045 bed-days.Methods.We conducted a before-after prospective surveillance study. During Phase 1 we performed active surveillance, and during phase 2 the INICC multidimensional infection control approach was implemented, including the following practices: (1) central line care bundle, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CLABSI rates, and (6) performance feedback of infection control practices. We compared CLABSI rates obtained during the 2 phases. We calculated crude stratified rates, and, using random-effects Poisson regression to allow for clustering by ICU, we calculated the incidence rate ratio (IRR) for each follow-up time period compared with the 3-month baseline.Results.During phase 1 we recorded 2,105 CL-days, and during phase 2 we recorded 17,117 CL-days. After implementation of the multidimensional approach, the CLABSI rate decreased by 55%, from 21.4 per 1,000 CL-days during phase 1 to 9.7 per 1,000 CL-days during phase 2 (rate ratio, 0.45 [95% confidence interval, 0.33–0.63]). The IRR was 0.53 during the 4–12-month period and 0.07 during the final period of the study (more than 45 months).Conclusions.Implementation of a multidimensional infection control approach was associated with a significant reduction in CLABSI rates in NICUs.

Impact of Mandatory Public Reporting of Central Line–Associated Bloodstream Infections on Blood Culture and Antibiotic Utilization in Pediatric and Neonatal Intensive Care Units

2015 ◽  
Vol 36 (8) ◽  
pp. 878-885 ◽  
Author(s):  
Kelly B. Flett ◽  
Al Ozonoff ◽  
Dionne A. Graham ◽  
Thomas J. Sandora ◽  
Gregory P. Priebe
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Neonatal Intensive Care ◽  
Central Line ◽  
Public Reporting ◽  
Neonatal Intensive Care Units ◽  
Central Venous ◽  
Antibiotic Utilization ◽  
Neonatal Icu ◽  
Pediatric Icu

BACKGROUNDAs mandatory public reporting of healthcare-associated infections increases, there is concern that clinicians could attempt to decrease rates by avoiding the diagnosis of reportable infections.OBJECTIVETo determine whether blood culture and antibiotic utilization changed after mandatory public reporting of central line–associated bloodstream infection (CLABSI).DESIGNInterrupted time-series of blood culture and antibiotic rates before and after state-specific implementation of mandatory public reporting. We analyzed data from pediatric and neonatal intensive care units (ICUs) at 17 children’s hospitals that contributed to the Pediatric Health Information System administrative database. We used multivariable regression with generalized linear mixed-effects models to determine adjusted rate ratios (ARRs) after implementation of mandatory public reporting. We conducted subgroup analysis on patients with central venous catheters. To assess temporal trends, we separately analyzed data from 4 pediatric hospitals in states without mandatory public reporting.RESULTSThere was no significant effect of mandatory public reporting on rates of blood culture (pediatric ICU ARR, 1.03 [95% CI, 0.82–1.28]; neonatal ICU ARR, 1.06 [0.85–1.33]) or antibiotic utilization (pediatric ICU ARR, 0.86 [0.72–1.04]; neonatal ICU ARR, 1.09 [0.87–1.35]). Results were similar in the subgroup of patients with central venous catheter codes. Hospitals with and without mandatory public reporting experienced small decreases in blood culture and antibiotic use across the study period.CONCLUSIONSMandatory public reporting of central line–associated bloodstream infection did not impact blood culture and antibiotic utilization, suggesting that clinicians have not shifted their practice in an attempt to detect fewer infections.Infect Control Hosp Epidemiol 2015;36(8):878–885

Surveillance for central-line–associated bloodstream infections: Accuracy of different sampling strategies

2018 ◽  
Vol 39 (10) ◽  
pp. 1210-1215
Author(s):  
Elani Kourkouni ◽  
Georgia Kourlaba ◽  
Evangelia Chorianopoulou ◽  
Grammatiki-Christina Tsopela ◽  
Ioannis Kopsidas ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Neonatal Intensive Care ◽  
Intraclass Correlation ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Percentage Error ◽  
Sampling Strategies ◽  
Monitoring Method

AbstractBackgroundActive daily surveillance of central-line days (CLDs) in the assessment of rates of central-line–associated bloodstream infections (CLABSIs) is time-consuming and burdensome for healthcare workers. Sampling of denominator data is a method that could reduce the time necessary to conduct active surveillance.ObjectiveTo evaluate the accuracy of various sampling strategies in the estimation of CLABSI rates in adult and pediatric units in Greece.MethodsDaily denominator data were collected across Greece for 6 consecutive months in 33 units: 11 adult units, 4 pediatric intensive care units (PICUs), 12 neonatal intensive care units (NICUs), and 6 pediatric oncology units. Overall, 32 samples were evaluated using the following strategies: (1) 1 fixed day per week, (2) 2 fixed days per week, and (3) 1 fixed week per month. The CLDs for each month were estimated as follows: (number of sample CLDs/number of sampled days) × 30. The estimated CLDs were used to calculate CLABSI rates. The accuracy of the estimated CLABSI rates was assessed by calculating the percentage error (PE): [(observed CLABSI rates − estimated CLABSI rates)/observed CLABSI rates].ResultsCompared to other strategies, sampling over 2 fixed days per week provided the most accurate estimates of CLABSI rates for all types of units. Percentage of estimated CLABSI rates with PE ≤±5% using the strategy of 2 fixed days per week ranged between 74.6% and 88.7% in NICUs. This range was 79.4%–94.1% in pediatric onology units, 62.5%–91.7% in PICUs, and 80.3%–92.4% in adult units. Further evaluation with intraclass correlation coefficients and Bland-Altman plots indicated that the estimated CLABSI rates were reliable.ConclusionSampling over 2 fixed days per week provides a valid alternative to daily collection of CLABSI denominator data. Adoption of such a monitoring method could be an important step toward better and less burdensome infection control and prevention.

scholarly journals Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

2016 ◽  
Vol 29 (6) ◽  
pp. 373
Author(s):  
Jorge Rodrigues ◽  
Andrea Dias ◽  
Guiomar Oliveira ◽  
José Farela Neves
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous ◽  
Group 2

<p><strong>Introduction:</strong> To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate.<br /><strong>Material and Methods:</strong> A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 <em>versus</em> group 2).<br /><strong>Results:</strong> Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter.<br /><strong>Discussion:</strong> After multidimensional strategy implementation there was no reported central-line associated bloodstream infection<br /><strong>Conclusions:</strong> Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.</p>

Resuscitation and Withdrawal of Therapy in Pediatric Intensive Care

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 961-963
Author(s):  
RICHARD B. MINK ◽  
MURRAY M. POLLACK
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Pediatric Intensive Care ◽  
New Haven ◽  
Hammersmith Hospital ◽  
Hospital Deaths ◽  
Withdrawal Of Therapy ◽  
Haven Hospital

Although issues concerning withdrawal and limitation of life support are commonly discussed,1-6 actual practices in pediatrics are largely unknown and are limited to neonatal intensive care unit (ICU) studies. In the neonatal ICUs at Yale-New Haven Hospital and at Hammersmith Hospital, 14% and 30%, respectively, of all deaths followed withdrawal of care.7,8 In adult ICUs, limitation and/or withdrawal of therapy is common,9 and in one investigation, resuscitation was not attempted immediately before ICU death in nearly two-thirds of cases.10 Nonetheless, many physicians believe that most hospital deaths occur only after all resuscitative attempts have failed,6,11,12 and others believe that resuscitative efforts neither are indicated nor desirable in many cases.1,13

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