Detecting pediatric nosocomial infections: how do infection control and quality assurance personnel compare?
OBJECTIVE
To compare how well infection control (IC) and quality assurance (QA) personnel in a specialty setting identify the presence, type (nosocomial or community-acquired), and (if nosocomial) site of infection.


METHODS
In 1994, we mailed a survey that included 21 pediatric case histories to IC and QA personnel in pediatric settings in the United States (children's hospitals and medical school-affiliated hospitals with pediatric wards of > 30 beds). From the case histories presented, the respondents were asked to determine whether an infection was present and, if so, whether it was nosocomial or community-acquired. If the infection was nosocomial, the respondent was asked to determine the site of the infection (e.g., urinary tract, bloodstream).


RESULTS
From the 289 hospitals to which surveys were mailed, 131 respondents (45.3%) completed 212 surveys. Of the 212 returned surveys, 120 (56.6%) were completed by IC personnel and 92 (43.4%) were completed by QA personnel. Among the 183 respondents from acute care pediatric settings, 92.3% of IC personnel (96/104) and 54.4% of QA personnel (43/79) correctly identified at least 75% of the nosocomial infections (n = 14; p < 0.0001). IC and QA personnel were similar in ability to identify community-acquired infection (88/104 vs 70/79, respectively; p = 0.436). IC personnel were significantly more likely than QA personnel to accurately identify the following sites of infection: respiratory tract infection without secondary bloodstream infection, necrotizing enterocolitis, urinary tract infection with and without secondary bloodstream infection, primary bloodstream infection, surgical site infection, gastroenteritis, esophagitis, and clinical sepsis.


CONCLUSIONS
Overall, IC personnel were more accurate than QA personnel in determining whether a nosocomial infection was present and in correctly determining most sites of infection. Both IC and QA personnel had difficulty identifying venous infection and respiratory tract infection with secondary bloodstream infection. Both IC and QA personnel could thus benefit from more concise definitions or further training in detection of these sites of nosocomial infections. In addition, QA personnel did not perform overall as well as IC personnel in identifying nosocomial infections and their sites; this finding suggests the need for QA personnel to be provided specific training on detection of nosocomial infections and validation of their ability to do so. Nosocomial infection surveillance should be the responsibility of those trained and proved capable of detecting these infections.
Simonds
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Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Horan
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TC
Kelley
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Jarvis
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WR
D002648:Child; D003428:Cross Infection / Q000175:diagnosis* / Q000517:prevention & control; D003625:Data Collection; D019538:Health Care Surveys; D006748:Hospital Departments; D006776:Hospitals, Pediatric; D006801:Humans; D017053:Infection Control / Q000592:standards*; D016357:Infection Control Practitioners / Q000592:standards*; D011159:Population Surveillance; D011785:Quality Assurance, Health Care / Q000592:standards*; D014481:United States