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An epidemiologic study of nosocomial infections in a pediatric long-term care facility
J H Vermaat1, E Rosebrugh, E L Ford-Jones
1Bloorview Children's Hospital, Toronto, Ontario, Canada.
Insights
Hospital-acquired infections are common in pediatric long-term care, with respiratory infections being most frequent. Understanding these specific infection rates is crucial for effective control strategies in these unique patient populations.
Area of Science:
- Pediatric Healthcare
- Infectious Disease Epidemiology
- Long-Term Care Medicine
Background:
- Hospital-acquired (nosocomial) infections pose a significant challenge in healthcare settings.
- Pediatric long-term care facilities have unique patient populations and care requirements.
- Understanding infection patterns is vital for patient safety and effective treatment.
Purpose of the Study:
- To determine the incidence and types of hospital-acquired infections in pediatric long-term care facilities.
- To identify common pathogens associated with these infections.
- To provide data for improving infection control in this specific setting.
Main Methods:
- Prospective cohort study design.
- Data collected from all patients in an 87-bed pediatric long-term care facility.
- Infection rates analyzed per 1000 patient days.
Main Results:
- A high incidence of infection was observed, affecting 40.1% of patients.
- Respiratory infections were most common (41.6%), followed by urinary tract infections (31.0%).
- Common pathogens included Escherichia coli, Enterococcus, and Staphylococcus.
Conclusions:
- Infection rates and types in pediatric long-term care differ from acute care settings.
- Physicians need to be aware of specific infection epidemiology in their patient populations.
- Effective control requires adherence to existing strategies and novel approaches, particularly for respiratory infections and catheterization-related issues.
Objective:
To determine the incidence of hospital-acquired (nosocomial) infection in pediatric long-term care facilities.
Design:
Prospective cohort.
Setting:
An 87-bed pediatric long-term care facility.
Patients:
All patients receiving long-term care at Bloorview Children's Hospital during the study period.
Results:
Infection developed in 40.1% of patients (n = 456). The nosocomial infection rate per 1000 patient days (mean, 7.84) varied substantially, from 1.66 in May 1988 to 16.37 day in April, 1989. The proportional frequencies of infections were as follows: respiratory, 41.6% (37.0% upper, 4.6% lower); urinary tract, 31.0%; skin, 15.6% (gastric tube site 5.0%, other 10.6%), eyes, 6.4%; gastrointestinal, 3.5%; and other, 1.5%. Of those infections for which an organism was recovered (48.5%), pathogens included Escherichia coli (22.5%), Enterococcus (14.8%), Staphylococcus (14.8%), Streptococcus (11.2%), Klebsiella (10.5%), Pseudomonas (10.1%), Proteus (4.3%), yeast (4.3%), Salmonella (0.7%), Clostridium difficile (0.4%), and other (6.2%).
Conclusions:
The incidence and nature of infections in pediatric long-term care facilities differs from those in acute care facilities. Physicians should become familiar with the infection rates in the populations whom they treat. Control requires compliance with currently recognized effective strategies as well as innovative practical approaches to respiratory disease. Behavioral problems related to frequent clean, intermittent catheterization in young adults need to be addressed.