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Risk factors for healthcare-associated infection in a pediatric intensive care unit
Maria Júlia Gonçalves de Mello1, Maria de Fátima Pessoa Militão de Albuquerque, Heloísa Ramos Lacerda
1Professor Fernando Figueira Institute of Mother and Child, Recife, Brazil. jcorreiajmello@gmail.com
Insights
Young children and prolonged ventilator use are key risk factors for healthcare-associated infections (HAI) in pediatric intensive care units (PICUs). Reducing exposure to extrinsic factors, especially ventilator duration, is crucial for HAI prevention strategies.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Hospital-acquired infections
Background:
- Healthcare-associated infections (HAIs) pose a significant threat to vulnerable patients in pediatric intensive care units (PICUs).
- Identifying modifiable risk factors is essential for developing effective HAI prevention strategies in this high-risk population.
Purpose of the Study:
- To identify intrinsic and extrinsic risk factors associated with first-onset healthcare-associated infections (HAIs) in a pediatric intensive care unit (PICU).
Main Methods:
- A prospective cohort study was conducted in a medical-surgical PICU.
- Daily surveillance was performed on 870 pediatric patients (ages 0-18) over 5773 patient-days.
- Multivariate logistic regression analysis was used to determine risk factors for first-onset HAI.
Main Results:
- The cumulative incidence of HAI was 41.7%, with a density of 62.9 per 1000 patient-days.
- Key risk factors for HAI included younger age (under 2 years), prolonged ventilator duration, blood product transfusion, glucocorticoid use, and H2 blocker use.
- Each identified extrinsic risk factor independently explained approximately 30% of the risk for HAI.
Conclusions:
- Reducing exposure to extrinsic risk factors is critical for HAI prevention in PICUs.
- Interventions targeting ventilator use, including limiting its duration, should be prioritized in HAI control strategies.
- Younger age and specific medical interventions are significant risk factors for HAI in the PICU setting.
Objective:
Identify risk factors for first-onset healthcare-associated infection (HAI) in a pediatric intensive care unit (PICU).
Design:
Prospective cohort study.
Setting:
Medical-surgical PICU in a hospital for patients in the public healthcare system.
Patients:
From January 2005 to June 2006, daily surveillance was carried out on 870 patients ages 0 to 18 yrs during their stay in the PICU through to 48 hrs after discharge (5773 patient-days).
Measurements And Main Results:
In 256 admissions, there were 363 episodes of HAI, with a cumulative incidence of 41.7% and a density of 62.9 of 1000 patient-days. Intrinsic and extrinsic factors were investigated and measured until occurrence of first-onset HAI (diagnosed according to Nosocomial Infection Surveillance System criteria) or until discharge or death. In the multivariate logistic regression analysis, risk factors for first-onset HAI in the PICU (controlled for length of stay) were as follows: age under 2 years (odds ratio [OR]), 1.80; 95% confidence interval [CI]), 1.30-2.49); days on ventilator duration (OR, 1.16; 95% CI, 1.08-1.25); transfused blood products (OR, 1.49; 95% CI, 1.08-2.06), glucocorticoids (OR, 1.45; 95% CI, 1.04-2.02) and H2 blockers (OR, 1.47; 95% CI, 1.05-2.06).
Conclusions:
Efforts toward a reduction in the exposure to extrinsic risk factors should be made, as each of these factors separately explains 30% of the risk of HAI. Interventions directed at processes related to the use of a ventilator and limitations on its duration of use should be a priority in HAI control strategies, as each day of ventilator use increases the risk of HAI.
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