Infection Control Policies and Hospital-Associated Infections Among Surgical Patients: Variability and Associations in a Multicenter Pediatric Setting

Abstract

ABSTRACT. Background. Hospital-associated infections are an important cause of patient morbidity and death. Little is known about the variability of infection rates and infection control practices among pediatric hospitals.Methods. This cross-sectional study was performed with the Pediatric Health Information System database, which includes demographic and diagnostic data for 35 freestanding, noncompeting, children's hospitals, and with data from a survey of the hospitals, which yielded additional information on infection control policies and practices. Patients undergoing elective surgical procedures were included in this study.Results. Of the 35 eligible hospitals, 31 (89%) chose to participate in the survey component of this study. A total of 48 278 patients met the inclusion criteria for the study; 2.3% of these patients had respiratory infections and 0.8% had gastrointestinal infections. The frequency of patients diagnosed with respiratory or gastrointestinal infections varied considerably among the hospitals and ranged from <1% to 6%. Certain infection control processes also varied among the hospitals during the study period. For instance, of the 31 hospitals, 12 monitored hand hygiene, 19 had administrative support of hand hygiene, and 16 had alcohol hand gel present for the entire study period. The presence of alcohol hand gel for the entire study was strongly and independently associated with lower odds of gastrointestinal infections (adjusted odds ratio: 0.64; 95% confidence interval: 0.49-0.85).Conclusions. H ospital-associated infections represent a serious and growing health problem. 1,2 The Centers for Disease Control and Prevention (CDC) estimates that ϳ2 million people acquire hospital-associated infections each year and that ϳ90 000 of these patients die as a result of their infections. A variety of hospital-based strategies aimed at preventing such infections have been proposed, and some have been tested. On the basis of such data and expert opinion, the CDC has developed and regularly updates specific guidelines aimed at preventing the transmission of pathogens within the hospital setting. 3 An important component of these guidelines involves hand hygiene. 4 How broadly these recommendations have been implemented in pediatric hospitals is not known. Moreover, despite the quantity of data supporting the use of infection control measures to prevent hospital-associated infections, there have been few multicenter studies examining the variability of infection rates and infection control policies among institutions and investigating which infection control measures might be more important, especially in pediatric settings. Therefore, we conducted this study with 3 objectives, ie, (1) to describe the variation in the infection control practices in a large diverse sample of children's hospitals, (2) to describe the variation in the rates of hospital-associated infections in these institutions, and (3) to determine which infection control policies were associated with lower rates of hospital-associate...

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