Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania.
OBJECTIVE
The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections.


METHODS
This was a prospective surveillance study. Data were collected from January 2005 until December 2007 in three pediatric intensive care units. All patients aged between 1 month and 18 years hospitalized in units for more than 48 hours were included in the study. The patients were divided into preintervention (2006) and postintervention (2007) groups. The multimodal intervention included education of the staff and implementation of evidence-based infection control measures.


RESULTS
A total of 755 children were included in the study. Major risk factors for nosocomial infections were identified: mechanical ventilation, central line, intracranial pressure device, and tracheostomy. Overall, the incidence rate (15.6 vs. 7.5 cases per 100 patients, P=0.002), incidence density (19.1 vs. 10.4 cases per 1000 patient-days, P=0.015), and the incidence of pneumonia (5.6 vs. 1.9 per 100 patients, P=0.016) have decreased in the postintervention as compared with the preintervention group. The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016). There was no significant difference in survival time by the presence of nosocomial infection (83.67 patient-days without vs. 74.33 patient-days with infection, P>0.05)


CONCLUSIONS
The most important risk factors for nosocomial infections were mechanical ventilation, central line, intracranial pressure device, and tracheostomy. After the multimodal intervention, there was a statistically significant decrease in the incidence rates of nosocomial infections and the risk reduction for ventilator-associated pneumonia. No significant impact of nosocomial infections on mortality was determined.
Unit of Pediatric Intensive Care, Clinic of Children's Diseases, Hospital of Kaunas University of Medicine, Eiveniu 2, Kaunas, Lithuania. vaidasg@freemail.lt
Vaidotas
V
Gurskis
Jolanta
J
Asembergiene
Rimantas
R
Kevalas
Jolanta
J
Miciuleviciene
Alvydas
A
Pavilonis
Rolanda
R
Valinteliene
Algirdas
A
Dagys
D000293:Adolescent; D000367:Age Factors; D002405:Catheterization, Central Venous / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D017053:Infection Control / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008097:Lithuania; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects