Incidence of hospital acquired infections in paediatric emergency unit–A one year longitudinal observational study

Abstract

Background: Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality in critically ill children. This prospective surveillance study was performed to estimate the burden of HAIs in a paediatric emergency department of a tertiary care hospital. Objectives: First, to know the incidence rate of HAIs in patients admitted to pediatric emergency and second, to isolate and identify bacteria causing HAIs with special emphasis on their antibiotic sensitivity. Methods: The prospective study was conducted in a fourteen-bedded paediatric emergency of a tertiary care hospital for one year. Patients were assessed daily during their stay in emergency ward. Data pertaining to device usage, length of stay (LOS), antibiotic usage, clinical outcome was recorded for the patients admitted for more than 48 hours. On clinical suspicion of HAI appropriate samples were investigated for bacterial infection and their antibiotic susceptibility was analysed. Statistical analysis was expressed in percentages and outcome variables were calculated using Mann Whitney U test. Results: Of the 410 patients, 5 patients developed 8 episodes of HAI with crude incidence rate (CIR) of 1.95%. Ventilator associated pneumonia (VAP) was the commonest HAI. The mean LOS of patients with HAI was 49.8 + 30.73 days. Gram negative bacilli were the most common isolated pathogens in the HAI subset. Multidrug resistance trait was seen in most of the isolates. Conclusions: Low CIR in the study population can be attributed to aggressive initial empirical antibiotic management of all patients and limited stay in emergency unit. In congruence with other studies, mean LOS of HAI patients was very high. Key Message: Prevention of HAI is a team work, wherein each health care provider should follow the hospital protocol. Length of hospital stay and instrumentation were found to be the major risk factors for HAI. Microbiology laboratory support facilitates timely identification of the pathogen and an effective management of HAI.