Risk factors for healthcare-associated infection in a pediatric intensive care unit.
OBJECTIVE
Identify risk factors for first-onset healthcare-associated infection (HAI) in a pediatric intensive care unit (PICU).


METHODS
Prospective cohort study.


METHODS
Medical-surgical PICU in a hospital for patients in the public healthcare system.


METHODS
From January 2005 to June 2006, daily surveillance was carried out on 870 patients ages 0 to 18 yrs during their stay in the PICU through to 48 hrs after discharge (5773 patient-days).


RESULTS
In 256 admissions, there were 363 episodes of HAI, with a cumulative incidence of 41.7% and a density of 62.9 of 1000 patient-days. Intrinsic and extrinsic factors were investigated and measured until occurrence of first-onset HAI (diagnosed according to Nosocomial Infection Surveillance System criteria) or until discharge or death. In the multivariate logistic regression analysis, risk factors for first-onset HAI in the PICU (controlled for length of stay) were as follows: age under 2 years (odds ratio [OR]), 1.80; 95% confidence interval [CI]), 1.30-2.49); days on ventilator duration (OR, 1.16; 95% CI, 1.08-1.25); transfused blood products (OR, 1.49; 95% CI, 1.08-2.06), glucocorticoids (OR, 1.45; 95% CI, 1.04-2.02) and H2 blockers (OR, 1.47; 95% CI, 1.05-2.06).


CONCLUSIONS
Efforts toward a reduction in the exposure to extrinsic risk factors should be made, as each of these factors separately explains 30% of the risk of HAI. Interventions directed at processes related to the use of a ventilator and limitations on its duration of use should be a priority in HAI control strategies, as each day of ventilator use increases the risk of HAI.
de Mello
Maria Júlia Gonçalves
MJ
Professor Fernando Figueira Institute of Mother and Child, Recife, Brazil. jcorreiajmello@gmail.com
de Albuquerque
Maria de Fátima Pessoa Militão
Mde F
Lacerda
Heloísa Ramos
HR
Barbosa
Maria Tereza Serrano
MT
de Alencar Ximenes
Ricardo Arraes
RA
D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors