title: An epidemiologic study of nosocomial infections in a pediatric long-term care facility.
abstract: OBJECTIVE
  To determine the incidence of hospital-acquired (nosocomial) infection in pediatric long-term care facilities.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  An 87-bed pediatric long-term care facility.
  
  
  METHODS
  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.
authors.affiliation: Bloorview Children's Hospital, Toronto, Ontario, Canada.
authors.forename: J H
authors.initials: JH
authors.lastname: Vermaat
authors.forename: E
authors.initials: E
authors.lastname: Rosebrugh
authors.forename: E L
authors.initials: EL
authors.lastname: Ford-Jones
authors.forename: J
authors.initials: J
authors.lastname: Ciano
authors.forename: J
authors.initials: J
authors.lastname: Kobayashi
authors.forename: G
authors.initials: G
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000145:classification / Q000150:complications / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003428:Cross Infection / Q000145:classification / Q000150:complications / Q000453:epidemiology*; D006763:Hospitals, Chronic Disease / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies