Eva Teszner

Risk factors for catheter-associated bloodstream infections in a Pediatric Cardiac Intensive Care Unit.

BACKGROUND Catheter-associated bloodstream infections (CA-BSIs) are an important complication of care in children hospitalized with complex congenital heart disease; however, little is known about risk factors for CA-BSI in these patients. METHODS We conducted a retrospective nested case-control study in the 26-bed Cardiac Intensive Care Unit (CICU) at the Childrens Hospital of Philadelphia.We identified all primary CA-BSIs in the CICU between January 1, 2004 and June 30, 2005. Controls were selected from rosters of CICU patients that were admitted during the same time period. Incidence density sampling was used to match cases and controls on time at risk. Data on demographic features and clinical characteristics were abstracted from the medical record. In addition, detailed data on exposures to medical devices, interventions, and therapeutic agents were gathered during a 4-day period immediately before the onset of infection (cases) or study entry (controls). RESULTS We identified 59 children who developed a CA-BSI. The median time from catheter insertion to onset of infection was 9 days. Over half of infections were caused by gram positive organisms. On multivariable analysis, only tunneled catheters emerged as an independent risk factor for infection. CONCLUSION In this study population, tunneled catheters were associated with a higher risk of CA-BSI, possibly because of the catheter material. Additionally, we did not find that the burden of catheters and medical devices was associated with an increased risk of infection. Because most CA-BSIs in our study population occurred > or =7 days after catheter insertion, strict attention to aseptic technique when using or dressing a catheter might reduce CA-BSI rates in the pediatric CICU.

Risk Adjustment for Surgical Site Infection After Median Sternotomy in Children

OBJECTIVE To determine whether the National Nosocomial Infections Surveillance (NNIS) System risk index adequately stratified a population of pediatric patients undergoing cardiac surgery according to the risk of developing surgical site infection (SSI). DESIGN A retrospective, case-control study. SETTING An urban tertiary care childrens hospital. PATIENTS Patients who had a median sternotomy performed between January 1, 1995, and December 31, 2003, were eligible for inclusion in the study. For all case patients, medical records were reviewed to verify that all patients met the case definition for SSI. Control subjects were chosen randomly from among all patients who underwent median sternotomy during the study period who did not develop SSI. RESULTS Thirty-eight patients with SSI and 172 patients without SSI were included. One hundred six patients (50%) were male. The median patient age was 4 months. The sensitivity of the NNIS risk index with cutoff scores of 0 to 1 and 2 to 3 was 20%. The distribution of patients with SSI for an NNIS risk index score of 0 was 0%; for a score of 1, 80%; for a score of 2, 20%; and for a score of 3, 0%. The distribution of patients without SSI for a scores of 0 was 4%; for a score of 1, 87%; for a score of 2, 9%; and for a score of 3, 0%. The area under the receiver-operating characteristic curve (AUC) of the original NNIS risk index was 0.57. The modified risk indices did not perform significantly better, with an AUC range of 0.58 to 0.73. CONCLUSIONS The NNIS risk index did not adequately stratify pediatric patients undergoing median sternotomy according to their risk of developing an SSI. Various modifications to the risk index yielded only slightly higher AUC values.

Pediatric Severe Sepsis/Septic Shock Associated with Healthcare-Associated Infections

Despite focused prevention efforts, healthcare-associated infections (HAIs) remain common. A recent point-prevalence survey estimated that on any given day, 1 in 25 hospitalized patients in the United States has an HAI. HAIs increase the length of hospital stay, risk of mortality, and cost of hospital stay. Sepsis causes serious morbidity among children, and studies suggest that hospital-onset vs community-onset sepsis may be associated with an increased risk of mortality. Recent pediatric-specific collaboratives aim to improve outcomes of children who develop sepsis. Little is known about the relationship between HAI and hospital-onset sepsis although these preventable conditions may be linked. Many children with chronic medical conditions require frequent hospitalizations and rely upon medical devices. These same children are at highest risk for sepsisrelated death. Despite significant morbidity and mortality, the epidemiology of severe sepsis/septic shock associated with HAI remains poorly characterized. In this study, we aimed to determine the epidemiology of pediatric HAI-associated sepsis (HAI sepsis).

900Present or Absent on Admission: Impact of Change in National Healthcare Safety Network Surveillance Definitions

Healthcare Safety Network Surveillance Definitions Lauren Farrell, MS, MLS(ASCP); Margaret Gilman, CIC; Eva Teszner, RN, CIC; Susan E. Coffin, MD, MPH; Julia Shaklee Sammons, MD, MSCE; Infection Prevention and Control, The Children’s Hospital of Philadelphia, Philadelphia, PA; Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Department of Infection Prevention and Control, The Children’s Hospital of Philadelphia, Philadelphia, PA