The Impact of a Quality Improvement Intervention to Reduce Nosocomial Infections in a PICU

摘要

Nosocomial infections (NIs) are a potential cause of morbidity and mortality. Several institutions such as the World Health Organization and the Institute for Healthcare Improvement consider prevention of NI, a priority to improve the safety of patient care, and they conduct campaigns to achieve it. Currently, most NIs are considered preventable adverse events.Children admitted to the PICU are particularly vulnerable to NIs because of their immunocompromise and the high prevalence of use of invasive devices during their stabilization. The prevalence of NI in PICU patients ranges from 5% to 23.6% (1-4). Central line-associated bloodstream infection (CLABSI) is the most common NI reported in children, followed by ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI) (1, 5). NIs increase mortality, morbidity, and costs (1, 6-8). A point prevalence survey (1) from the Pediatric Prevention Network reported a longer median PICU stay in patients with NI than in those without (8 vs 2 days, respectively) and a longer median hospital stay (9.5 vs 4 days). Furthermore, children with PICU-acquired infections had a higher age-adjusted risk of death within 4 weeks of the survey (relative risk, 3.4; 95% CI, 1.7-6.5).