Abstract
The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections. This was a prospective surveillance study. Data were collected from January 2005 until December 2007 in three pediatric intensive care units. All patients aged between 1 month and 18 years hospitalized in units for more than 48 hours were included in the study. The patients were divided into preintervention (2006) and postintervention (2007) groups. The multimodal intervention included education of the staff and implementation of evidence-based infection control measures. A total of 755 children were included in the study. Major risk factors for nosocomial infections were identified: mechanical ventilation, central line, intracranial pressure device, and tracheostomy. Overall, the incidence rate (15.6 vs. 7.5 cases per 100 patients, P=0.002), incidence density (19.1 vs. 10.4 cases per 1000 patient-days, P=0.015), and the incidence of pneumonia (5.6 vs. 1.9 per 100 patients, P=0.016) have decreased in the postintervention as compared with the preintervention group. The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016). There was no significant difference in survival time by the presence of nosocomial infection (83.67 patient-days without vs. 74.33 patient-days with infection, P>0.05) The most important risk factors for nosocomial infections were mechanical ventilation, central line, intracranial pressure device, and tracheostomy. After the multimodal intervention, there was a statistically significant decrease in the incidence rates of nosocomial infections and the risk reduction for ventilator-associated pneumonia. No significant impact of nosocomial infections on mortality was determined.
Highlights
Nosocomial infections (NIs) are a significant problem resulting in socioeconomic burden; it is a preventable problem on average
The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016)
Incidence rate of NIs ranges from 4% to 10% in hospitals and from 6.1% to 23.6% in pediatric intensive care units (ICUs), and it is associated with a high number of deaths and increased direct costs through an increase in hospital stays and development of resistant bacteria [1,2,3,4,5,6,7]
Summary
Nosocomial infections (NIs) are a significant problem resulting in socioeconomic burden; it is a preventable problem on average. Incidence rate of NIs ranges from 4% to 10% in hospitals and from 6.1% to 23.6% in pediatric intensive care units (ICUs), and it is associated with a high number of deaths and increased direct costs through an increase in hospital stays and development of resistant bacteria [1,2,3,4,5,6,7]. Children are even more susceptible to NIs, because of additional risk factors [3, 7,8,9]. The risk reduction using a stepwise approach can be successful in infection prevention and can reduce the NI incidence rates in pediatric ICUs [10, 11]. The accurate evaluation of NI-associated attributable mortality is substantial. Using survival analysis methods rather than logistic regression allows us to avoid timedependent bias and overestimation of an attributable mortality [12, 13]
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