The Impact of a Quality Improvement Intervention to Reduce Nosocomial Infections in a PICU*

Esteban, Elisabeth; Ferrer, Ricard; Urrea, Mireya; Suarez, David L.; Rozas, Librada; Balaguer, Mònica; Palomeque, A.; Jordán, Iolanda

doi:10.1097/pcc.0b013e31828a87cc

Cited by 49 publications

(47 citation statements)

References 24 publications

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“…10 A Spanish PICU reported a reduction in CAUTIs associated with implementation of a nosocomial infection prevention bundle, although the CAUTI rates were markedly elevated in this unit (23.3 infections per 1000 urinary catheterdays) before implementation. 11 Our bundle, which focused on minimizing the inappropriate use of urinary catheters and improving adherence to aseptic technique when placing or manipulating a catheter, relied on 2 of the most common elements of adult CAUTI prevention bundles, consistent with our assumption that the pathogenesis of adult and pediatric CAUTI is similar. However, unlike reports in adults, 18 we did not note a marked reduction in device utilization with the This study has several limitations.…”

Section: Discussionmentioning

confidence: 78%

“…7,8 Two pediatric facilities recently reported CAUTI reductions associated with a hospital-wide initiative to eliminate serious harm 10 and a PICU initiative to reduce device-associated infections. 11 Recognizing that 65% to 70% of CAUTIs are considered preventable, 12 we initiated a hospital-wide CAUTI prevention effort in July of 2010. At that time, our hospital' s overall CAUTI rate was significantly higher than the national pooled mean for PICUs (5.4 vs 2.2 infections per 1000 catheter-days).…”

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confidence: 99%

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Reducing Catheter-Associated Urinary Tract Infections: A Quality-Improvement Initiative

et al. 2014

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BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are among the most common health care–associated infections in the United States, yet little is known about the prevention and epidemiology of pediatric CAUTIs. METHODS: An observational study was conducted to assess the impact of a CAUTI quality improvement prevention bundle that included institution-wide standardization of and training on urinary catheter insertion and maintenance practices, daily review of catheter necessity, and rapid review of all CAUTIs. Poisson regression was used to determine the impact of the bundle on CAUTI rates. A retrospective cohort study was performed to describe the epidemiology of incident pediatric CAUTIs at a tertiary care children’s hospital over a 3-year period (June 2009 to June 2012). RESULTS: Implementation of the CAUTI prevention bundle was associated with a 50% reduction in the mean monthly CAUTI rate (95% confidence interval: −1.28 to −0.12; P = .02) from 5.41 to 2.49 per 1000 catheter-days. The median monthly catheter utilization ratio remained unchanged; ∼90% of patients had an indication for urinary catheterization. Forty-four patients experienced 57 CAUTIs over the study period. Most patients with CAUTIs were female (75%), received care in the pediatric or cardiac ICUs (70%), and had at least 1 complex chronic condition (98%). Nearly 90% of patients who developed a CAUTI had a recognized indication for initial catheter placement. CONCLUSIONS: CAUTI is a common pediatric health care–associated infection. Implementation of a prevention bundle can significantly reduce CAUTI rates in children.

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Section: Discussionmentioning

confidence: 78%

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confidence: 99%

Reducing Catheter-Associated Urinary Tract Infections: A Quality-Improvement Initiative

et al. 2014

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“…Data were collected with the approval of the Hospital's Ethical Committee. The database used in this study was collected as part of a quality improvement intervention study to reduce nosocomial infections in the PICU (Esteban et al, 2013).…”

Section: Methodsmentioning

confidence: 99%

Sex differences in children with severe health conditions: Causes of admission and mortality in a Pediatric Intensive Care Unit

Esteban

Bujaldon

Esparza

et al. 2015

American J Hum Biol

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“…Sepsis or bacteremia with a predominance of Gram-negative bacilli is the most common nosocomial infection and has critical consequences due to the increase in mortality rates [1]. Pediatric patients, mainly those who are critically ill in the intensive care unit, are particularly vulnerable to acquiring nosocomial bloodstream infections (NBSIs) [2,3]. Moreover, immunocompromised patients often develop multiorgan dysfunction and require mechanical ventilation or renal replacement therapy [4].…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Resistance of Gram-Negative Bacilli Isolated from Pediatric Patients with Nosocomial Bloodstream Infections in a Mexican Tertiary Care Hospital

et al. 2013

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Background: Gram-negative bacilli are the most common bacteria causing nosocomial bloodstream infections (NBSIs) in Latin American countries. Methods: The antibiotic resistance profiles of Gram-negative bacilli isolated from blood cultures in pediatric patients with NBSIs over a 3-year period in a tertiary care pediatric hospital in Mexico City were determined using the VITEK-2 system. Sixteen antibiotics were tested to ascertain the resistance rate and the minimum inhibitory concentration using the Clinical Laboratory Standards Institute (CLSI) broth micro-dilution method as a reference. Results: A total of 931 isolates were recovered from 847 clinically significant episodes of NBSI. Of these, 477 (51.2%) were caused by Gram-negative bacilli. The most common Gram-negative bacilli found were Klebsiella pneumoniae (30.4%), Escherichia coli (18.9%), Enterobacter cloacae (15.1%), Pseudomonas aeruginosa (9.9%), and Acinetobacter baumannii (4.6%). More than 45 and 60% of the K. pneumoniae and E. coli isolates, respectively, were resistant to cephalosporins, and 64% of the E. coli isolates were resistant to fluoroquinolones. A. baumannii exhibited low rates of resistance to antibiotics tested. In the E. cloacae and P. aeruginosa isolates, no rates of resistance higher than 38% were observed. Conclusions: In this study, we found that the proportion of NBSIs due to antibiotic-resistant organisms is increasing in a tertiary care pediatric hospital of Mexico.

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The Impact of a Quality Improvement Intervention to Reduce Nosocomial Infections in a PICU*

Abstract: A multifaceted quality improvement intervention reduced nosocomial infection rates, hospital length of stay, and mortality in our PICU. The effects of the intervention were sustained over time.

Cited by 49 publications

References 24 publications

Reducing Catheter-Associated Urinary Tract Infections: A Quality-Improvement Initiative

Reducing Catheter-Associated Urinary Tract Infections: A Quality-Improvement Initiative

Sex differences in children with severe health conditions: Causes of admission and mortality in a Pediatric Intensive Care Unit

Antibiotic Resistance of Gram-Negative Bacilli Isolated from Pediatric Patients with Nosocomial Bloodstream Infections in a Mexican Tertiary Care Hospital

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