title: Evaluation of a new method of detection of nosocomial infection in the pediatric intensive care unit: the Infection Control Sentinel Sheet System.
abstract: To improve the efficiency of nosocomial infection detection, a highly structured system combining initial reporting by the bedside night nurse of symptoms possibly related to infection with follow-up by the infection control nurse (ICN) was developed: The Infection Control Sentinel Sheet System (ICSSS). Between July 1, 1987 and February 28, 1988, a prospective comparison of results obtained through ICSSS and daily bedside observation/chart review by a full-time trained intensivist was undertaken in the pediatric intensive care unit (PICU). Ratios of nosocomial infections and nosocomially-infected patients were 15.8 and 7.0 respectively among 685 admissions; included are seven infections identified only through the ICSSS so that the "gold standard" became an amalgamation of the two systems. The sensitivity for detection of nosocomially-infected patients by bedside observation/chart review and ICSSS was 100% and 87% respectively. The sensitivity for detection of standard infections (blood, wound and urine) was 88% and 85% respectively. The sensitivity for detection of nosocomial infections at all sites was 94% and 72% respectively. Missed infections were minor (e.g., drain, skin, eye), required physician diagnosis (e.g., pneumonia), were not requested on the sentinel sheet (SS) (e.g., otitis media), related to follow-up of deceased patients or were minor misclassifications or failures to associate with device (e.g., central-line related). Daily PICU surveillance by the ICN required only 20 minutes a day. The ICSSS appears highly promising and has many unmeasured benefits.
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: E L
authors.initials: EL
authors.lastname: Ford-Jones
authors.forename: C M
authors.initials: CM
authors.lastname: Mindorff
authors.forename: E
authors.initials: E
authors.lastname: Pollock
authors.forename: R
authors.initials: R
authors.lastname: Milner
authors.forename: D
authors.initials: D
authors.lastname: Bohn
authors.forename: J
authors.initials: J
authors.lastname: Edmonds
authors.forename: G
authors.initials: G
authors.lastname: Barker
authors.forename: R
authors.initials: R
authors.lastname: Gold
mesh_terms: D015982:Bias; D002170:Canada; D003428:Cross Infection / Q000175:diagnosis* / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D005069:Evaluation Studies as Topic; D006801:Humans; D015994:Incidence; D015278:Intensive Care Units, Pediatric; D008722:Methods; D009730:Nursing Assessment; D009733:Nursing Diagnosis; D009737:Nursing Records; D011446:Prospective Studies; D012680:Sensitivity and Specificity