Short report
Device-associated infections in a paediatric intensive care unit in Pakistan

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Summary

This study assessed the effect of implementation of active infection control and surveillance on the occurrence of device-associated infections (DAIs) in a paediatric intensive care unit (PICU) from 2012 to 2015. There were 1378 patients, equating to 4632 patient-days, on the PICU, and 29 DAI episodes, giving an incidence rate of 2.1% and an incidence density rate of 6.26 per 1000 patient-days. The rates of central-line-associated bloodstream infections, ventilator-associated pneumonia and catheter-related urinary tract infections were 7/1000 central-line-days, 1.17/1000 ventilator-days and 0.24/1000 urinary-catheter-days, respectively. Despite the overall low rate of DAIs in the PICU, there was a relatively high rate of central-line-associated bloodstream infections.

Introduction

Critically ill children are at high risk of acquiring device-associated infections (DAIs) on paediatric intensive care units (PICUs). DAIs are a serious threat to patient safety, and are associated with increased treatment costs.1, 2 The Centers for Disease Control and Prevention and National Healthcare Safety Network (CDC-NHSN) have established diagnostic criteria for various DAIs, and determined the DAI rate per 1000 device-days which can be used for comparison between hospitals.3 The incidence rates of DAIs in PICUs in developing countries range from 2% to 27%,4, 5, 6 and limited data are available from Pakistan. The aim of this study was to describe the incidence and density of DAIs per 1000 device-days in a Pakistani PICU.

Section snippets

Methods

The medical records of all children who were admitted to, and acquired DAIs on, the PICU of Aga Khan University Hospital from January 21012 to December 2015 were reviewed retrospectively.

Results

Over the four-year study period, 1378 patients were admitted to the PICU for a total of 4632 days. Their mean age was 4.5 (standard deviation 4.29) years, and 69% were male. There were 29 DAI episodes, giving an overall rate of 2.1%. The crude infection rate was 2.1 per 100 patients, and the incidence density rate was 6.26 per 1000 patient-days. The distribution of DAIs was 83% (N=24) central-line-associated bloodstream infections (CLABSIs), 13.6% (N=4) ventilator-associated pneumonia (VAP) and

Discussion

To the authors' knowledge, this is the first surveillance report based on CDC-NHNS definitions on DAIs in a PICU in Pakistan. The device utilization ratio was relatively high, probably because only critically ill patients were admitted to the PICU due to the limited number of beds.5 The DAI rate was 2.1% and the incidence density rate was 6.26/1000 patient-days. Developing countries tend to report higher incidence rates of DAIs in all types of ICUs.8 However, some studies have found that

Conflict of interest statement

None declared.

Funding sources

None.

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