Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology.
OBJECTIVE
to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN).


METHODS
this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa.


RESULTS
a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%.


CONCLUSIONS
there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV.
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Electronic address: ferreira.jnt@gmail.com.
Janita
J
Ferreira
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Maria C F
MC
Bouzada
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Lenize A de
LA
Jesus
Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Maria da Conceição Werneck
Mda C
Cortes
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Guilherme A
GA
Armond
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Wanessa T
WT
Clemente
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Lêni M
LM
Anchieta
Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Roberta M C
RM
Romanelli
D001724:Birth Weight; D001938:Brazil / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D062665:Epidemiological Monitoring; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D017053:Infection Control / Q000592:standards*; D007363:Intensive Care Units, Neonatal; D009359:Neonatology; D017064:Process Assessment, Health Care / Q000592:standards*; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000453:epidemiology*
Epidemiological surveillance; Infection; Infecção hospitalar; Neonato; Neonatologia; Neonatology; Newborn; Vigilância epidemiológica