Download PDF
J Pediatr Intensive Care 2015; 04(02): 079-086
DOI: 10.1055/s-0035-1556750
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Preventable Health Care–Associated Infections in Pediatric Critical Care

Mary Jo Grant
1   Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, Utah, United States
,
Trudy Hardin-Reynolds
1   Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, Utah, United States
› Author Affiliations
Further Information

Publication History

15 September 2014

05 November 2014

Publication Date:
28 August 2015 (online)

    Permissions and Reprints

Abstract

Health care–associated infections (HAIs) account for a substantial portion of health care–acquired conditions that harm patients receiving medical care in the acute care setting. In this review, we will focus on four common HAIs: central line–associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, and catheter-associated urinary tract infections. The Centers for Disease Control and Prevention Web site provides additional detailed definitions and reporting criteria for each HAI. Integral to the definition of an HAI is the timing of the infection in relation to the placement of the indwelling device or surgical incision. Valid and reliable surveillance data are necessary to assess the effectiveness of prevention strategies and provide interfacility comparisons, and for pay-for-performance programs. The bundle concept, which utilizes a small set of evidence-based interventions, is integral to the prevention of HAIs.

Keywords

infection - nosocomial - ventilator-associated pneumonia - surgical site infections - catheter-related infection
 

  • References

  • 1 Yokoe DS, Anderson DJ, Berenholtz SM , et al; Society for Healthcare Epidemiology of America (SHEA). A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol 2014; 35 (8) 967-977
    CrossrefPubMedGoogle Scholar
  • 2 Centers for Disease Control and Prevention 2012 National and State Healthcare Associated Infections Progress Report Available at: www.cdc.gov/hai/progress-report/index.html . Accessed September 8, 2014
    PubMed
  • 3 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36 (5) 309-332
    CrossrefPubMedGoogle Scholar
  • 4 Centers for Disease Control and Prevention. CDC/NHSN surveillance definitions for specific types of infections. Available at: http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 5 Centers for Disease Control and Prevention. Healthcare-associated infections (HAI). Available at: http://www.cdc.gov/hai/ . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 6 Resar R, Griffin F, Haraden C, Nolan T. Using Care Bundles to Improve Health Care Quality. IHI Innovation Series White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2012
    Google Scholar
  • 7 Centers for Disease Control and Prevention Making Healthcare Safer. Reducing bloodstream infections. Available at: http://www.cdc.gov/vitalsigns/pdf/2011-03-vitalsigns.pdf . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 8 Centers for Disease Control and Prevention Central Line-Associated Bloodstream Infection (CLABSI) Event Available at: http://www.cdc.gov/nhsn/PDFs/pscManual/4PSCCALBScurrent.pdf . Accessed September 8, 2014
    PubMed
  • 9 Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014; 133 (6) e1525-e1532
    CrossrefPubMedGoogle Scholar
  • 10 O'Grady NP, Alexander M, Burns LA , et al; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52 (9) e162-e193
    CrossrefPubMedGoogle Scholar
  • 11 Dudeck MA, Horan TC, Peterson KD , et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011; 39 (5) 349-367
    CrossrefPubMedGoogle Scholar
  • 12 Patrick SW, Kawai AT, Kleinman K , et al. Health care-associated infections among critically ill children in the US, 2007-2012. Pediatrics 2014; 134 (4) 705-712
    CrossrefPubMedGoogle Scholar
  • 13 Norberg A, Christopher NC, Ramundo ML, Bower JR, Berman SA. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. JAMA 2003; 289 (6) 726-729
    CrossrefPubMedGoogle Scholar
  • 14 Mermel LA, Allon M, Bouza E , et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49 (1) 1-45
    CrossrefPubMedGoogle Scholar
  • 15 Flynn PM, Shenep JL, Stokes DC, Barrett FF. In situ management of confirmed central venous catheter-related bacteremia. Pediatr Infect Dis J 1987; 6 (8) 729-734
    CrossrefPubMedGoogle Scholar
  • 16 Hartman GE, Shochat SJ. Management of septic complications associated with Silastic catheters in childhood malignancy. Pediatr Infect Dis J 1987; 6 (11) 1042-1047
    CrossrefPubMedGoogle Scholar
  • 17 Centers for Disease Control and Prevention. Reduction in central line-associated bloodstream infections among patients in intensive care units-Pennsylvania. April 2001–March 2005 [cited 2014 Sept 8];54(40):1013–1016. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5440a2.htm . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 18 Centers for Disease Control and Prevention FAQS about “Catheter-Associated Bloodstream Infections.” 2012. Available at: http://www.cdc.gov/hai/pdfs/bsi/BSI_tagged.pdf . Accessed September 6, 2014
    PubMedGoogle Scholar
  • 19 Centers for Disease Control and Prevention FAQS about “Surgical Site Infections.” 2012. Available at: http://www.cdc.gov/HAI/pdfs/ssi/SSI_tagged.pdf . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 20 Centers for Disease Control and Prevention FAQS about “Ventilator-Associated Pneumonia.” 2012. Available at: http://www.cdc.gov/HAI/pdfs/vap/VAP_tagged.pdf . Accessed August 24, 2014
    PubMedGoogle Scholar
  • 21 Centers for Disease Control and Prevention FAQS about “Catheter-Associated Urinary Tract Infection.” 2012. Available at: http://cdc.gov/hai/pdfs/uti/CA-UTI_tagged.pdf . Accessed August 24, 2014
    PubMedGoogle Scholar
  • 22 Pageler NM, Longhurst CA, Wood M , et al. Use of electronic medical record-enhanced checklist and electronic dashboard to decrease CLABSIs. Pediatrics 2014; 133 (3) e738-e746
    CrossrefPubMedGoogle Scholar
  • 23 Magill SS, Edwards JR, Bamberg W , et al; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014; 370 (13) 1198-1208
    CrossrefPubMedGoogle Scholar
  • 24 Bigham MT, Amato R, Bondurrant P , et al. Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 2009; 154 (4) 582-587.e2
    CrossrefPubMedGoogle Scholar
  • 25 Brilli RJ, Sparling KW, Lake MR , et al. The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients. Jt Comm J Qual Patient Saf 2008; 34 (11) 629-638
    PubMedGoogle Scholar
  • 26 Centers for Disease Control and Prevention. Ventilator associated event (VAE). 2014. Available at: http://www.cdc.gov/nhsn/inpatient-rehab/vap/ . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 27 Centers for Disease Control and Prevention. Ventilator-associated pneumonia (VAP) event. 2011. Available at: http://www.cdc.gov/nhsn/PDSf/PSCManual . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 28 Cooper VB, Haut C. Preventing ventilator-associated pneumonia in children: an evidence-based protocol. Crit Care Nurse 2013; 33 (3) 21-29 , quiz 30
    CrossrefPubMedGoogle Scholar
  • 29 Coffin SE, Klompas M, Classen D , et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29 (Suppl. 01) S31-S40
    CrossrefPubMedGoogle Scholar
  • 30 Centers for Disease Control and Prevention CDC/NHSN Protocol Corrections. Clarification and additions. 2014. Available at: http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 31 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR ; Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Surgical Site Infection, 1999. Am J Infect Control 1999; 27 (2) 97-132 , quiz 133–134, discussion 96
    CrossrefPubMedGoogle Scholar
  • 32 Lo E, Nicolle LE, Coffin SE , et al. Strategies to prevent catheter-associated urinary tract infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 (5) 464-479
    CrossrefPubMedGoogle Scholar
  • 33 Centers for Disease Control and Prevention. National Healthcare Safety Network Report, Data Summary for 2011, Device-Associated Module. 2013. Available at: http://www.cdc.gov/nhsn/PDFs/dataStat/NHSN-Report-2011-Data-Summary.pdf . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 34 Centers for Disease Control and Prevention. Catheter-associated urinary tract infections. 2014. Available at: http://www.cod.gov/nhsn/PDSf/pscManual/7pscCAUTIcurrent.pdf . Accessed September 8, 2014
    PubMedGoogle Scholar
  • 35 Trautner BW, Darouiche RO. Role of biofilm in catheter-associated urinary tract infection. Am J Infect Control 2004; 32 (3) 177-183
    CrossrefPubMedGoogle Scholar
  • 36 Hooton TM, Bradley SF, Cardenas DD , et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010; 50 (5) 625-663
    CrossrefPubMedGoogle Scholar
  • 37 Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA ; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010; 31 (4) 319-326
    CrossrefPubMedGoogle Scholar
  • 38 Meddings J, Rogers MA, Krein SL, Fakih MG, Olmsted RN, Saint S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014; 23 (4) 277-289
    CrossrefPubMedGoogle Scholar
  • 39 Klompas M. Complications of mechanical ventilation—the CDC's new surveillance paradigm. N Engl J Med 2013; 368 (16) 1472-1475
    CrossrefPubMedGoogle Scholar