[Surveillance of nosocomial infections: prospective study in a pediatric intensive care unit. Background, patients and methods].
BACKGROUND, PATIENTS AND METHODS: From November 1997 through May 1998, the incidence of nosocomial infections was studied prospectively in a 10-bed multidisciplinary pediatric intensive care unit in Germany. A standardized surveillance [SEKI] system based on the National Nosocomial Infection Surveillance [NNIS] System of the Centers for Disease Control and Prevention [CDC] was used. The CDC definitions for nosocomial infections were adapted to the current practice of pediatric intensive care in Germany. Infection rates were calculated as infections per 100 patients, per 1000 patient-days, and per 1000 device-days (central venous catheters, urinary-catheters, and mechanical ventilation).


RESULTS
Fifteen nosocomial infections were recorded in 201 patients during 1035 patient-days. The overall nosocomial infection rates were 7.5/100 patients and 14.5/1000 patient-days. Device-associated nosocomial infection rates for urinary-catheters and mechanical ventilation were 7.2/1000 utilization-days and thus below the 75th percentile of the last NNIS report. Central line infection rates were 10.7/1000 utilization days and therefore above the 75th percentile of the NNIS data (10.2/1000). The median length-of-stay was 5.1 days.


CONCLUSIONS
Surveillance data are indispensable for internal and external quality control, and prospective surveillance of nosocomial infections should become an essential component of hospital infection control programs in pediatric intensive care in Germany. The standardized calculation of (device utilization ratios and) device-specific infection rates yields results which can be compared with national and international surveillance data. SEKI meets the criteria of a practice oriented, prospective and standardized surveillance system. Considerable efforts for collecting and interpreting the required data should be balanced against the benefit of prevention of nosocomial infections in this population of critically ill persons.
Simon
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A
Universitäts-Kinderklinik Bonn. Dr.med.A.Simon@at-online.de
Bindl
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L
Kramer
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MH
D002405:Catheterization, Central Venous / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods* / Q000592:standards*; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011159:Population Surveillance; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012307:Risk Factors; D014546:Urinary Catheterization / Q000706:statistics & numerical data