Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units.
BACKGROUND
Few data are available on nosocomial infections (NIs) in US children's hospitals' neonatal or pediatric intensive care units. The Pediatric Prevention Network (PPN) was established to improve characterization of NIs in pediatric patients and to develop and test interventions to decrease NI.


METHODS
Fifty participating children's hospitals were surveyed in 1998 to determine NI surveillance methods used and neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) 1997 NI rates. Data were collected on standardized forms and entered and analyzed by using SPSS for Windows.


RESULTS
Forty-three (86%) children's hospitals returned a completed questionnaire. All reported conducting NICU and PICU NI surveillance (range, 2-12; median, 12 months). Nineteen children's hospitals provided NICU NI rate data in one or more formats suitable for comparison. Denominators used for NICU NI rate calculations varied: 17 reported overall NI by patient-days; 19 reported bloodstream infection (BSI) by central venous catheter (CVC)-days, and 8 reported BSI by patient-days. Sixteen (16) children's hospitals reported NICU BSI data stratified by CVC-days and birth-weight cohort, and ventilator-associated pneumonia (VAP) by birth weight cohort was reported by 12. Twenty-four children's hospitals reported PICU NI rate data in one or more formats suitable for comparison. Denominators used for PICU NI rate calculations also varied: 20 reported overall NI rates by patient-days; 23 reported BSI rates by CVC-days, and 10 reported BSI rates by patient-days; 24 reported VAP by ventilator-days; and 15 reported urinary tract infections (UTIs) by urinary catheter-days. Median overall NI rates per 1000 patient days were 8.9 in NICUs and 13.9 in PICUs. Median NICU NI device-associated rates by birth weight (>2500 g, 1501-2500 g, 1001-1500 g, and </=1000 g) were BSI 4.4, 4.7, 8.9, and 12.6, and VAP 0.9, 1.1, 4.9, and 3.5, respectively. Median PICU NI rates per 1000 device days were 6.5 for BSI; 3.7 for VAP; and 5.4 for UTI.


CONCLUSIONS
The number of months that NICU or PICU NI surveillance was conducted varied among hospitals. Reported NICU and PICU NI rates varied by hospital; some reported overall NI rates, and others focused on one or more particular sites of infection (eg, BSI or pneumonia). Many did not provide NICU device-associated rates stratified by birth-weight group. Denominators used to calculate device-associated infection rates also varied, with hospitals reporting either patient-days or device-days. These findings suggest the need to determine reasons for variations and to identify optimal NI surveillance methods at children's hospitals so that valid interhospital NI rate comparisons can be made.
Stover
B H
BH
Infection Control, Kosair Children's Hospital, Louisville, KY 40202, USA.
Shulman
S T
ST
Bratcher
D F
DF
Brady
M T
MT
Levine
G L
GL
Jarvis
W R
WR
D001724:Birth Weight; D002404:Catheterization; D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods; D012121:Respiration, Artificial; D014481:United States / Q000453:epidemiology