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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Healthcare Associated Infection in Paediatric Intensive Care Unit-A Tertiary Care Hospital Experience
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Healthcare Associated Infection in Paediatric Intensive Care Unit-A Tertiary Care Hospital Experience

机译：儿科重症监护室的医疗保健相关感染-三级医院的经验

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Healthcare Associated Infections (HAI) are those that are acquired in a health care setting or one that is acquired in the hospital environment by a patient who had been admitted to the hospital for a different reason. The HAI are one of a cause of increased morbidity and mortality of hospitalised patients, especially the ones admitted to an Intensive Care Unit (ICU). The study of incidence of HAI in the ICU of tertiary hospitals has been conducted previously with significant results but there is a lack of data exist regarding HAI in the Paediatric Intensive Care Unit (PICU). Hence a study was conducted in the PICU of a tertiary care hospital to estimate the incidence of HAI and study the clinical and microbiological profile, so as to acquire knowledge regarding the prevailing conditions in the PICU. The knowledge thus, obtained may then be applied in lowering the further incidence of HAI and serve to establish better patient care services.Aim: To estimate the incidence of HAI in the PICU of a tertiary care hospital and to study the clinical, microbiological profile and analyse the same to understand the probable risk factors involved, thereby developing effective infection control measures and strategies.Materials and Methods: A prospective, descriptive, observational study was conducted in the PICU of a tertiary care hospital over a period of one year (August 2013 to July 2014). The present study included children of the age group between 1 month and 12 years admitted in the PICU, who were suspected to have acquired HAI during the hospital stay. Relative frequencies of known risk factors like age, anaemia, malnutrition, and duration of PICU stay were studied in these patients. Microbiological culture and antimicrobial sensitivity were done by using standard techniques in the microbiological laboratory.Results: During the study period, out of the 588 patients admitted to PICU, a total of 68 (11.56%) developed one or more HAIs. It was found that the clinical outcome of the patients with HAI did not have any statistically significant relationship to the parameters such as age or sex distribution, nutritional status, degree of anaemia, duration of hospital stay or the site of HAI. But highly significant correlation was established between the duration of mechanical ventilation of a patient and reintubation with the clinical outcome of the patient. The most common HAI identified in the PICU was vascular site infection, identified in 41 patients, contributing to more than half (53%) of all the HAI. This was followed by ventilator related infections in 13 patients (17%), primary blood stream infections in 12 patients (16%) and the others that occurred in minor frequencies included those of the skin, pneumonias, infections of the urinary tract and surgical site. The most common microorganism isolated from the patients with HAI in the PICU was Klebsiella species. The antibiotic to which majority of microbial isolates including Klebsiella were sensitive was Amikacin.Conclusion: It is recommended to follow strict hand hygiene and aseptic precautions during intravascular catheterisation procedures. The antibiotic Amikacin may be considered in the empirical treatment of suspected HAI while culture reports are being awaited. The challenges for the future are to minimize HAI in the PICU and ensure better clinical outcome for all.
机译：医疗保健相关感染（HAI）是在医疗机构中获得的，或者是因其他原因而入院的患者在医院环境中获得的那些。 HAI是导致住院患者，尤其是重症监护病房（ICU）住院患者发病率和死亡率增加的原因之一。先前已经对三级医院ICU中HAI的发病率进行了研究，并取得了显著成果，但是在儿科重症监护病房（PICU）中缺乏有关HAI的数据。因此，在一家三级医院的PICU中进行了一项研究，以估计HAI的发生率并研究其临床和微生物学特征，从而获得有关PICU中当前状况的知识。因此，所获得的知识可用于降低HAI的进一步发病率，并有助于建立更好的患者护理服务。目标：评估三级医院PICU中HAI的发生率并研究临床情况，微生物概况并进行分析，以了解可能的危险因素，从而制定有效的感染控制措施和策略。材料与方法：在三级医院的PICU中进行了前瞻性，描述性，观察性研究一年（2013年8月至2014年7月）。本研究包括PICU收治的1个月至12岁的年龄组儿童，他们怀疑在住院期间感染了HAI。在这些患者中研究了已知风险因素（例如年龄，贫血，营养不良和PICU住院时间）的相对频率。结果：在研究期间，接受PICU的588例患者中，共有68例（11.56％）发生了一种或多种HAI。发现HAI患者的临床结局与诸如年龄或性别分布，营养状况，贫血程度，住院时间或HAI部位等参数没有统计学上的显着关系。但是，在患者的机械通气时间和再插管时间与患者的临床结果之间建立了高度显着的相关性。在PICU中最常见的HAI是在41名患者中发现的血管部位感染，占全部HAI的一半以上（53％）。其次是呼吸机相关感染13例（17％），原发性血液感染12例（16％），其他次要频率包括皮肤，肺炎，尿路和手术部位的感染。从PICU的HAI患者中分离出的最常见的微生物是克雷伯菌。对大多数微生物分离株（包括克雷伯菌）敏感的抗生素是丁胺卡那霉素。结论：建议在血管内插管过程中严格遵守手部卫生和无菌预防措施。在等待培养报告的同时，可将抗生素阿米卡星用于可疑HAI的经验治疗。未来的挑战是最大程度地减少PICU中的HAI，并确保所有人获得更好的临床结果。

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