Bir Üniversite Hastanesinde Pediyatrik Sağlık Bakımı ile İlişkili Enfeksiyon Sürveyansı: Altı Aylık Prospektif İzlem

Abstract

Amaç: Sağlık bakımı ile ilişkili enfeksiyon SBİE hastalarda artmış morbidite, mortalite ve maliyete neden olur ve hastanede yatan hastalarda en sık görülen komplikasyondur. Bu çalışmada, SBİE epidemiyolojisini, etken mikroorganizmaları ve direnç özelliklerini saptamak amaçlandı.Gereç ve Yöntem: İstanbul Üniversitesi İstanbul Tıp Fakültesi Hastanesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı servislerinde 1 Ocak 2010 - 30 Haziran 2010 tarihleri arasında yatan hastalar değerlendirmeye alındı. Dosya kayıtları, hemşire gözlemleri, radyoloji, mikrobiyoloji ve diğer tanı yöntemlerine ait raporlar incelenerek elde edilen veriler prospektif olarak toplandı.Bulgular: Çalışma süresi olan altı aylık dönemde 1900 hasta değerlendirilmiş olup, 176 hastada SBİE saptanmıştır. SBİE sıklığı tüm servislerde %9.3 %0.9-%28.1 , insidans yoğunluğu 10.86 0.82-24.86 / 1000 hasta günü saptandı. SBİE en sık sırasıyla yenidoğan yoğun bakım ünitesi, çocuk yoğun bakım ünitesi, hematoloji-onkoloji servisi & kemik iliği transplant ünitesi ve nöroloji servisinde görüldü. En sık görülen SBİE sırasıyla kan dolaşımı enfeksiyonu, pnömoni ve gastrointestinal sistem enfeksiyonlarıydı. Hastane enfeksiyonu yaşla ters ilişkili bulundu. Diğer risk faktörleri hastanede yatış süresi, girişimsel işlemler, ko-morbid hastalıklar, transfüzyon, antiasit kullanımı olarak belirlendi. Etken mikroorganizma 2 saptanan hastane enfeksiyonu olgularının %53’ünden gram-negatif bakteriler, %28’inden gram-pozitif bakteriler sorumluydu.Sonuç: SBİE sürveyansı; sorunların tanınması ve analiz edilmesi, enfeksiyon kontrol önlemlerinin hedefe yöneltilmesi ve geri bildirim yapılmasını sağlayan, SBİE azaltılmasında önemli bir basamaktır

Keywords

• Hastane enfeksiyonu,çocuk,sürveyans,risk faktörleri

Surveillance of Pediatric Health Care Associatedm Infection in a University Hospital: Six-Years of Prospective Follow-up

Abstract

Objective: Health care-associated infections HAIs increase patient morbidity, mortality and cost, and are the most common complications in hospitalised patients. The aim of this study was to determine the epidemiology, causative microorganisms, and resistance patterns of HAIs.Material and Method: Patients hospitalised between January 1, 2010 and June 30, 2010 in Istanbul University Faculty of Medicine Department of Children’s Health and Diseases were included in the study. Data in patient files, nursery observation charts, reports of radiology, microbiology and other diagnostic methods were investigated, and the data obtained were prospectively collected.Results: In the study period of six months, 1900 patients were evaluated and HAIs were detected in 176 patients. The frequency of HAIs in all services combined was 9.3% 0.9%-28.1% and incidence density was 10.86/1000 0,82-24.86/1000 patient days. HAIs were most frequently seen in neonatal intensive care unit, paediatric intensive care unit, haematology-oncology ward & bone marrow transplantation unit and neurology wardin order of decreasing frequency. The most frequently seen HAIs were blood stream infections, pneumonia and gastrointestinal system infections, respectively. The incidence of HAIs was found to be reversely related with age. Other risk factors were length of hospital stay, invasive interventions, co-morbid diseases, transfusion, antacid use. Gram-negative bacteria were responsible for 53% and gram-positive bacteria for 28% of nosocomial infections where the causative microorganisms were detected. Conclusion: HAIs surveillance is an important step for decreasing the hospital infection rates by recognising and analysing the problems, giving feed-back, directing the infection control measures toward the target

Keywords

• Hospital infection,child,surveillance,risk factors

References

1. Burke JP. Infection control - a problem for patient safety. N Engl J Med 2003;348:651-56. http://dx.doi.org/10.1056/NEJMhpr020557
2. Jarvis Wr. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552-7. http://dx.doi.org/10.2307/30141291
3. thacker SB, Berkelman rl. Public health surveillan- ce in the United States. Epidemiol Rev 1988;10:164- 90.
4. Horan tc, Andrus M, Dudeck MA. CDC/NHSN. Surveillance definition of health care-associated infec- tion and criteria for specific types of infections in the acute care setting, Am J Infect Control 2008;36:309- 32. http://dx.doi.org/10.1016/j.ajic.2008.03.002
5. Karabey S, Eraksoy H, Kaptı H. İstanbul Üniversitesi İstanbul Tıp Fakültesi hastane enfeksiyonu prevalans çalışması 2003 yılı sonuçları. Hast İnfeks Derg 2004; 8:71.
6. Hacımustafaoğlu M, çelebi S, tuncer E, Özkaya G, çakır D, Bozdemir şE. Çocuk kliniği ve çocuk yoğun bakım ünitesi hastane enfeksiyonları sıklığı. Çocuk Enf Derg 2009;3:112-7.
7. Özçetin M, Ulaş Saz E, Karapınar B, Özen S, Aydemir ş, Vardar F. Hastane enfeksiyonları; sıklığı ve risk faktörleri. Çocuk Enf Derg 2009;3:49-53.
8. Soysal A, toprak D, Yavuz B, ve ark. Marmara Üniversitesi pediatri servisinde nozokomiyal enfeksi- yonların retrospektif incelemesi: 2003-2005 yılları, http://www.millipediatri.org.tr/ bildiriler/PP-453.htm (ulaşım Şubat 2011).

9. Saçar S, toprak Kavas S, Asan A, cevahir n, Serin S, turgut H. Pamukkale Üniversite Hastanesinde has- tane anfeksiyonları sürveyansı: Üç yıllık analiz. Enfeksiyon Derg 2008;22:15-21.
10. Yaşa o, Ergüven M, laloğlu F. İstanbul Göztepe Eğitim ve Araştırma Hastanesi Çocuk Kliniğinde yapı- lan nokta prevalans çalışması. 2007; 1: P:18.
11. Mühlemann K, Franzini c, Aebi c, et al. Prevalence of nosocomial infections in Swiss children’s hospitals. Hosp Epidemiol 2004;25:765-71. http://dx.doi.org/10.1086/502474
12. raymond J. Epidemiology of nosocomial infections in pediatrics. Pathol Biol 2000;48:879-84.
13. Ford-Jones El, Mindorff cM, langley JM, et al. Epidemiologic study of 4684 hospital-acquired infecti- ons in pediatric patients. Pediatr Infect Dis J 1989;8: 668-75. http://dx.doi.org/10.1097/00006454-198910000-00002
14. campins M, Vaqué J, rosselló J, et al. Nosocomial infections in pediatric patients: a prevalence study in Spanish hospitals. EPINE Working Group. Am J Infect Control 1993;21:58-63. http://dx.doi.org/10.1016/0196-6553(93)90225-S
15. de Gentile A, rivas n, Sinkowitz-cochran rl, et al. Nosocomial infections in a children’s hospital in Argentina: impact of a unique infection control inter- vention program. Infect Control Hosp Epidemiol 2001; 22:762-66. http://dx.doi.org/10.1086/501859
16. Buettcher M, Heininger U. Prospective surveillance of nosocomial viral infections during and after hospita- lization at a university children’s hospital. Pediatr Infect Dis J 2010;29:950-6. http://dx.doi.org/10.1097/INF.0b013e3181e32d97
17. cavalcante SS, Mota E, Silva lr, teixeira lF, cavalcante lB. Risk factors for developing nosocomi- al infections among pediatric patients. Pediatr Infect Dis J 2006;25:438-45. http://dx.doi.org/10.1097/01.inf.0000217377.54597.92
18. Grisaru-Soen G, Sweed Y, lerner-Geva l, et al. Nosocomial bloodstream infections in a pediatric inten- sive care unit: 3-year survey. Med Sci Monit 2007;13: 251-7.
19. Perlman SE, Saiman l, larson El. Risk factors for late-onset healthcare-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 2007;35:177-82. http://dx.doi.org/10.1016/j.ajic.2006.01.002
20. Mireya UA, Marti Po, Xavier KV, cristina lo, Miguel MM, Magda cM. Nosocomial infections in pediatric and neonatal intensive care units. J Infect 2007;54:212-20. http://dx.doi.org/10.1016/j.jinf.2006.03.023
21. Posfay-Barbe KM, Zerr DM, Pittet D. Infection control in paediatrics. Lancet Infect Dis 2008;8:19-31. http://dx.doi.org/10.1016/S1473-3099(07)70310-9
22. Soysal A, toprak D, Yavuz B ve ark. Marmara Üniversitesi Tıp Fakültesi pediatri servisinde 2004 yılı nozokomiyal enfeksiyonları. Hast İnfeks Derg 2006;10: 143-8.
23. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 thro- ugh June 2004, issued October 2004. Am J Infect Control 2004;32:470-85. http://dx.doi.org/10.1016/j.ajic.2004.10.001
24. Girou E, Stephan F, novara A, Safar M, Fagon JY. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998;157:1151-8. http://dx.doi.org/10.1164/ajrccm.157.4.9701129
25. de leon-rosales SP, Molinar-ramos F, Dominguez- cherit G, rangel-Frausto MS, Vazquez-ramos VG. Prevalence of infections in intensive care units in Mexico: a multicenter study. Crit Care Med 2000;28: 1316-21. http://dx.doi.org/10.1097/00003246-200005000-00010
26. Brady Mt. Health care-associated infections in the neonatal intensive care unit. Am J Infect Control 2005;33:268-75. http://dx.doi.org/10.1016/j.ajic.2004.11.006
27. rosenthal VD, Guzman S, orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003;31:291-5. http://dx.doi.org/10.1067/mic.2003.1
28. Yapıcıoğlu H, Özcan K, Sertdemir Y, et al. HealthCare-associated Infections in a Neonatal Intensive Care Unit in Turkey in 2008: Incidence and Risk Factors, A Prospective Study. J Trop Pediatr 2010;3:157-64.
29. Turkish Neonatal Society; Nosocomial Infections Study Group. Nosocomial infections in neonatal units in Turkey: epidemiology, problems, unit policies and opi- nions of healthcare workers. Turk J Pediatr 2010; 52:50-7.
30. Simon A, Bindl l, Kramer MH. Surveillance of nosocomial infections: prospective study in a pediatric intensive care unit. Background, patients and methods. Klin Padiatr 2000;212(1):2-9. http://dx.doi.org/10.1055/s-2000-9643
31. Abramczyk Ml, carvalho WB, carvalho ES, Medeiros EA. Nosocomial infection in a pediatric intensive care unit in a developing country. Braz J Infect Dis 2003;7(6):375-80. http://dx.doi.org/10.1590/S1413-86702003000600004
32. Türkiye Hastane Enfeksiyonları Sürveyans Raporu 2006-2007. Hast İnfeks Derg 2004;13:215-69.
33. http://hastaneenfeksiyonlari.rshm.gov.tr (ulaşım Şubat 2011).
34. Urrea M, Pons M, Serra M, latorre c, Palomeque A. Prospective incidence study of nosocomial infecti- ons in a pediatric intensive care unit. Pediatr Infect Dis J 2003;22:490-4. http://dx.doi.org/10.1097/01.inf.0000069758.00079.d3
35. Becerra Mr, tantaleán JA, Suárez VJ, Alvarado Mc, candela Jl, Urcia Fc. Epidemiologic surveil- lance of nosocomial infections in a Pediatric Intensive Care Unit of a developing country. BMC Pediatr 2010; 10:66. http://dx.doi.org/10.1186/1471-2431-10-66
36. Hautemanière A, Florentin A, Hartemann P, Hunter Pr. Identifying possible deaths associated with noso- comial infection in a hospital by data mining. Am J Infect Control 2011;39:118-22. http://dx.doi.org/10.1016/j.ajic.2010.04.216