Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-29T13:28:29.149Z Has data issue: false hasContentIssue false

Device-Associated Infections among Neonatal Intensive Care Unit Patients: Incidence and Associated Pathogens Reported to the National Healthcare Safety Network, 2006–2008

Published online by Cambridge University Press:  02 January 2015

Susan N. Hocevar*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Jonathan R. Edwards
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Teresa C. Horan
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Gloria C. Morrell
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Martha Iwamoto
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Fernanda C. Lessa
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Road NE, MS A-35, Atlanta, GA 30333 (shocevar@cdc.gov)

Abstract

Objective.

To describe rates and pathogen distribution of device-associated infections (DAIs) in neonatal intensive care unit (NICU) patients and compare differences in infection rates by hospital type (children's vs general hospitals).

Patients and Setting.

Neonates in NICUs participating in the National Healthcare Safety Network from 2006 through 2008.

Methods.

We analyzed central line–associated bloodstream infections (CLABSIs), umbilical catheter–associated bloodstream infections (UCABs), and ventilator-associated pneumonia (VAP) among 304 NICUs. Differences in pooled mean incidence rates were examined using Poisson regression; nonparametric tests for comparing medians and rate distributions were used.

Results.

Pooled mean incidence rates by birth weight category (750 g or less, 751–1,000 g, 1,001–1,500 g, 1,501–2,500 g, and more than 2,500 g, respectively) were 3.94, 3.09, 2.25, 1.90, and 1.60 for CLABSI; 4.52, 2.77, 1.70, 0.91, and 0.92 for UCAB; and 2.36, 2.08, 1.28, 0.86, and 0.72 for VAP. When rates of infection between hospital types were compared, only pooled mean VAP rates were significantly lower in children's hospitals than in general hospitals among neonates weighing 1,000 g or less; no significant differences in medians or rate distributions were noted. Pathogen frequencies were coagulase-negative staphylococci (28%), Staphylococcus aureus (19%), and Candida species (13%) for bloodstream infections and Pseudomonas species (16%), S. aureus (15%), and Klebsiella species (14%) for VAP. Of 673 S. aureus isolates with susceptibility results, 33% were methicillin resistant.

Conclusions.

Neonates weighing 750 g or less had the highest DAI incidence. With the exception of VAP, pooled mean NICU incidence rates did not differ between children's and general hospitals. Pathogens associated with these infections can pose treatment challenges; continued efforts at prevention need to be applied to all NICU settings.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Klevens, RM, Edwards, JR, Richards, CL Jret al.Estimating health care–associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160166.Google Scholar
2.Scott, RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Published 2009. Updated November 2, 2011. Accessed December 1, 2011.Google Scholar
3. Centers for Disease Control and Prevention. Vital Signs, http://www.cdc.gov/vitalsigns/HAI/. Accessed November 29, 2011.Google Scholar
4.Baltimore, RS. Neonatal nosocomial infections. Semin Perinatol 1998;22(1):2532.Google Scholar
5.Martin, JA, Hamilton, BE, Ventura, SJ, et al.Births: final data for 2009. Natl Vital Stat Rep 2011;60(1):170.Google Scholar
6.Bizzarro, MJ, Sabo, B, Noonan, M, et al.A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010;31(3):241248.Google Scholar
7.Schulman, J, Stricof, R, Stevens, TP, et al.Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127(3):436444.Google Scholar
8.Gaynes, RP, Edwards, JR, Jarvis, WR, Culver, DH, Tolson, JS, Martone, WJ. Nosocomial infections among neonates in high-risk nurseries in the United States: National Nosocomial Infections Surveillance System. Pediatrics 1996;98(3 pt 1):357361.Google Scholar
9.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36(5):309332.Google Scholar
10.American Academy of Pediatrics. Levels of neonatal care. Pediatrics 114(5):13411347.Google Scholar
11. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. NHSN Patient Safety Component Manual. http://www.cdc.gov/nhsn/TOC_PSCManual.html. Accessed June 25, 2011.Google Scholar
12. Centers for Disease Control and Prevention. Current CLIA Regulations, http://wwwn.cdc.gov/clia/regs/toc.aspx. Accessed July 20, 2011.Google Scholar
13.Edwards, JR, Peterson, KD, Andrus, ML, Dudeck, MA, Pollock, DA, Horan, TC. National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36(9):609626.Google Scholar
14.O'Grady, NP, Alexander, M, Burns, LA, et al.Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):e162e193.Google Scholar
15.Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al.Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32(10):20142020.Google Scholar
16.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):27252732.Google Scholar
17.Bryant, KA, Zerr, DM, Huskins, WC, Milstone, AM. The past, present, and future of healthcare-associated infection prevention in pediatrics: catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 2010;31(suppl 1):S27S31.Google Scholar
18.Miller, MR, Griswold, M, Harris, JM IIet al.Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics 2010;125(2):206213.Google Scholar
19.Foster, CB, Sabella, C. Health care–associated infections in children. JAMA 2011;305(14):14801481.Google Scholar
20.Stoll, BJ, Hansen, NI, Sanchez, PJ, et al.Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatrics 2011;127(5):817826.Google Scholar
21.Hidron, AI, Edwards, JR, Patel, J, et al; National Healthcare Safety Network Team and Participating National Healthcare Safety Network Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29(11):9961011.Google Scholar
22.Miller, MR, Niedner, MF, Huskins, WC, et al.Reducing PICU central line–associated bloodstream infections: 3-year results. Pediatrics 2011;128(5):e1077e1083.Google Scholar
23.Lessa, FC, Edwards, JR, Fridkin, SK, Tenover, FC, Horan, TC, Gorwitz, RJ. Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995–2004. Pediatr Infect Dis J 2009;28(7): 577581.Google Scholar
24. History of children's hospitals. National Association of Children's Hospitals and Related Institutions website, http://www.childrenshospitals.net/AM/Template.cfmfSection=Facts_and_Trends&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=12693. Accessed November 29, 2011.Google Scholar