Survey shows need for more consistency in monitoring children's nosocomial infection rates

By Robert Roos,
icanNEWS staff

icanNEWS –- A survey of 50 children's hospitals across the United States shows a need for more consistent methods of monitoring nosocomial infection (NI) rates in critically ill children so that benchmark rates can be determined and better prevention measures developed, according to a report in the June issue of the American Journal of Infection Control.

The survey of hospitals participating in the Pediatric Prevention Network (PPN) focused on infection surveillance in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). The results showed a wide range of infection rates as well as differences in surveillance methods.

"Our results indicate that the frequency of NICU and PICU NI surveillance, the populations and the sites of infection surveyed, and the denominators used to calculate and report rates varied among US children's hospitals," states the report by Ben H. Stover, RN, of Kosair Children's Hospital in Louisville, Ky., and colleagues.

The Centers for Disease Control and Prevention (CDC) and the National Association of Children's Hospitals and Related Institutions (NACHRI) set up the PPN in 1997 to assess the surveillance and control of NIs and identify measures for reducing adverse outcomes. In 1998, NACHRI sent the 74-item survey to the infection control practitioner at each of the 50 PPN hospitals. Forty-three hospitals completed the surveys.

ICPs at 41 of the 43 hospitals (95%) reported using National Nosocomial Infections Surveillance (NNIS) system definitions, and all 43 reported active NI surveillance in the ICUs in 1997. The respondents provided 1997 NI rate data for 33 NICUs and 35 PICUs.

"Nineteen children's hospitals provided NICU NI rate data in one or more formats suitable for comparison," the report says. For NICUs, the median overall NI rate for the 17 hospitals reporting this variable was 8.9 per 1,000 patient-days, with a range of 4.6 to 18.1. The median rate of bloodstream infections (BSIs) for 19 hospitals was 8.6 per 1,000 central venous catheter (CVC)–days (range, 0.0 to 16.2), and the median for ventilator-associated pneumonia (VAP) for 19 reporting hospitals was 2.5 per 1,000 ventilator-days (range, 0.0 to 18.1). No NNIS medians were available for comparison with these figures.

PICU infection rate data were provided by 24 hospitals in formats suitable for comparison, the report states. The median overall NI rate for 20 hospitals was 13.9 per 1,000 patient-days (range, 1.1 to 31.4). The BSI rate per 1,000 CVC-days for 23 hospitals was 8.5 (range, 0.0 to 18.5), as compared with an NNIS median of 7.1. For VAP per 1,000 ventilator-days, 24 hospitals had a median of 3.7 (range, 0.0 to 10.1); the NNIS median was 4.2. For urinary tract infections per 1,000 urinary catheter–days, the rate for 15 reporting hospitals was 5.4 (range, 0.0 to 24.2), as compared with 4.8 for the NNIS.

The report notes that NICU and PICU NI rates stratified by device-day and (for NICUs) birth-weight group have been shown to be valid for interhospital comparisions. "However, despite CDC recommendations since 1990 to use such rates, NI surveillance data from most children's hositals were not stratified in this manner," the authors say. They also noted that many hospitals did not conduct NI surveillance year-round; only five hospitals reported 12 months of comprehensive PICU and NICU rates for all the requested surveillance categories.

"A systematic approach to NI case identification and standardized surveillance for NI at children's hospitals is of critical importance," the authors conclude. They recommend collaborative studies to refine NI definitions specific to neonates and children, to define optimal NICU and PICU NI surveillance intensity, and to establish comparative reporting methods.

Stover BH, Shulman ST, Bracher DF, et al. Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units. Am J Infect Control 2001;29(3):152-7 Abstract (includes link to full text for AJIC subscribers).

First published (June 19, 2001) on icanPREVENT.com. Copyright 2001, ican INC.

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