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Reduction of nosocomial infection during pediatric intensive care by protective isolation
B S Klein1, W H Perloff, D G Maki
1Department of Medicine, University of Wisconsin Medical School, Madison.
Insights
Simple protective isolation using gowns and gloves significantly reduced nosocomial infections in critically ill children. This intervention delayed colonization and lowered daily infection rates without compromising care.
Area of Science:
- Infection Control
- Pediatric Intensive Care
- Hospital-Acquired Infections
Background:
- Nosocomial infections pose a significant risk to pediatric patients in intensive care units.
- Mechanical ventilatory support and prolonged intensive care are risk factors for infection.
- Effective infection prevention strategies are crucial for vulnerable pediatric populations.
Purpose of the Study:
- To evaluate the efficacy of simple protective isolation in reducing nosocomial bacterial and fungal infections.
- To assess the impact of protective isolation on colonization timing and infection rates in pediatric intensive care.
Main Methods:
- Randomized controlled trial involving 70 non-immunosuppressed children requiring mechanical ventilation and intensive care.
- Intervention group received protective isolation with disposable gowns and non-sterile gloves.
- Control group received standard care; infection incidence and colonization were monitored.
Main Results:
- Protective isolation significantly delayed nosocomial colonization (median 7 vs. [not specified] days; P < 0.01).
- Isolated patients experienced a longer interval to first infection (median 20 vs. 8 days; P = 0.04) and lower daily infection rates (2.2 times lower; P = 0.007).
- Fewer infection days were observed in the isolation group (13% vs. 21%; P = 0.001), with benefits most pronounced after seven days.
Conclusions:
- Simple protective isolation with disposable gowns and gloves is effective in reducing nosocomial infections in high-risk pediatric intensive care patients.
- The intervention is well-tolerated and does not impede the delivery of care or patient handling.
- Protective isolation represents a valuable strategy for infection control in prolonged pediatric intensive care settings.
Abstract:
To determine whether simple protective isolation reduces the incidence of nosocomial bacterial and fungal infection during pediatric intensive care, we randomly assigned 70 children who were not immuno-suppressed and who required mechanical ventilatory support and three or more days of intensive care to receive standard care (n = 38) or protective isolation (n = 32) with use of disposable, non-waven, polypropylene gowns and nonsterile latex gloves. Risk factors predisposing patients to infection were comparable in the two groups. Nosocomial colonization occurred later among isolated patients (median, vs. 7 days; P less than 0.01) and was associated with subsequent infection in 12 patients, as compared with 12 patients given standard care (P = 0.01). Among patients who were isolated, the interval before the first infection was significantly longer than (median, 20 vs. 8 days; P = 0.04), the daily infection rate was 2.2 times lower than (95 percent confidence interval, 1.2 to 4.0; P = 0.007), and there were fewer days with fewer (13 percent vs. 21 percent; P = 0.001). The benefit of isolation was most notable after seven days of intensive care. Isolation was well tolerated by patients and their families. Regular monitoring showed that the children in each group were touched and handled comparably often by hospital personnel and family members. We conclude that the use of disposable, high-barrier gowns and gloves for the care of selected, high-risk children who require prolonged intensive care significantly reduces the incidence of nosocomial infection, is well tolerated, and does not compromise the delivery of care.