Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units
Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units
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DOI：
10.1067/mic.2001.115407
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发表时间：
2001-06-01
影响因子：
4.9
通讯作者：
Jarvis, WR
中科院分区：
文献类型：
--
作者：
Stover, BH;Shulman, ST;Jarvis, WR
背景：几乎没有关于美国儿童医院新生儿或儿科重症监护病房医院感染(NIS)的数据。儿科预防网络(PPN)的建立是为了改善儿科患者医院感染的特征，开发和测试减少医院感染的干预措施。方法：1998年对50家参与调查的儿童医院进行了调查，以确定医院感染的监测方法和新生儿重症监护病房(NICU)和儿科重症监护病房(PICU)1997年的医院感染率。采用标准化表格收集数据，用SPSS for Windows进行录入和分析。结果：43家(86%)儿童医院收回了完整的问卷。所有报告都进行了NICU和PICU医院感染监测(范围为2-12个月；中位数为12个月)。19家儿童医院以一种或多种适合比较的格式提供了NICU医院感染率数据。用于计算NICU医院感染率的分母各不相同：按病人日报告的总医院感染率为17例；报告的中心静脉导管(CVC)血流感染(BSI)为19例；按患者日报告的BSI为8例。16家儿童医院报告了按CVC天数和出生体重队列分层的NICU BSI数据，12家报告了按出生体重队列划分的呼吸机相关性肺炎(VAP)。24家儿童医院以一种或多种适合比较的格式报告了PICU医院感染率数据。用于PICU医院感染率计算的分母也各不相同：20个按患者日报告的总医院感染率：23个按CVC日报告的BSI率，10个按患者日报告的BSI率；24个按呼吸机日报告的VAP；15个报告的尿管感染(UTIs)。在NICU和PICU，平均每1000个病人日的总医院感染率分别为8.9和13.9。出生体重(2500克、1501-2500克、1001-1500克和小于或等于1000GI)的NICU NI设备相关比率的中位数分别为BSI 4.4、4.7、8.9和12.6，VAP为0.9、1.1、4.9和3.5。每1000个设备日的PICU医院感染率中位数BSI为6.5，VAP为3.7，UTI为5.4。结论：不同医院进行NICU或PICU医院感染监测的月数不同。报告的NICU和PICU医院感染率因医院而异；一些医院报告了总体医院感染率，另一些则集中在一个或多个特定的感染部位(腿部感染、BSI或肺炎)。许多人没有提供按出生体重分组的NICU设备相关比率。用于计算设备相关感染率的分母也不同，医院报告的要么是病人日，要么是设备日。这些发现表明，有必要确定差异的原因，并在儿童医院确定最佳的M监测方法，以便进行有效的医院间医院感染率比较。
Background: Few data are available on nosocomial infections (NIs) in US children's hospitals' neonatal or pediatric intensive care units. The Pediatric Prevention Network (PPN) was established to improve characterization of NIs in pediatric patients and to develop and test interventions to decrease NI.Methods: Fifty participating children's hospitals were surveyed in 1998 to determine NI surveillance methods used and neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) 1997 NI rates. Data were collected on standardized forms and entered and analyzed by using SPSS for Windows.Restults: Forty-three (86%) children's hospitals returned a completed questionnaire. All reported conducting NICU and PICU NI surveillance (range, 2-12; median, 12 months). Nineteen children's hospitals provided NICU NI rate data in one or more formats suitable for comparison. Denominators used for NICU NI rate calculations varied: 17 reported overall NI by patient-days; 19 reported bloodstream infection (BSI) by central venous catheter (CVC)-days, and 8 reported BSI by patient-days. Sixteen (16) children's hospitals reported NICU BSI data stratified by CVC-days and birth-weight cohort, and ventilator-associated pneumonia (VAP) by birth weight cohort was reported by 12. Twenty-four children's hospitals reported PICU NI rate data in one or more formats suitable for comparison. Denominators used for PICU NI rate calculations also varied: 20 reported overall NI rates by patient-days: 23 reported BSI rates by CVC-days, and 10 reported BSI rates by patient-days; 24 reported VAP by ventilator-days; and 15 reported urinary tract infections (UTIs) by urinary catheter-days. Median overall NI rates per 1000 patient days were 8.9 in NICUs and 13.9 in PICUs. Median NICU NI device-associated rates by birth weight (> 2500 g, 1501-2500 g, 1001-1500 g, and less than or equal to 1000 gi were BSI 4.4, 4.7, 8.9, and 12.6, and VAP 0.9, 1.1, 4.9, and 3.5, respectively. Median PICU NI rates per 1000 device days were 6.5 for BSI, 3.7 for VAP; and 5.4 for UTI.Conclusions: The number of months that NICU or PICU NI surveillance was conducted varied among hospitals. Reported NICU and PICU NI rates varied by hospital; some reported overall NI rates, and others focused on one or more particular sites of infection leg, BSI or pneumonia). Many did not provide NICU device-associated rates stratified by birth-weight group. Denominators used to calculate device-associated infection rates also varied, with hospitals reporting either patient-days or device-days. These findings suggest the need to determine reasons for variations and to identify optimal M surveillance methods at children's hospitals so that valid interhospital NI rate comparisons can be made.