ABSTRACT
Background: Nosocomial infections [NI] have been associated with significant morbidity and attributed mortality, as well as increased healthcare costs. Relatively few data on congenital cardiac surgical ICU NI have been reported from developing countries. Little is known about the epidemiology of NI following congenital cardiac surgery in Egypt. The aims of the present study were: [a] to estimate the incidence rate and types of NI among children admitted to Pediatric Surgical Cardiac ICU in Cairo University Children's Hospital [Egypt] and [b] to estimate the mortality rate related to congenital cardiac surgery and identify its contributing risk factors
Participants and methods: A follow-up study in the period between 1 January 2009 and 1 January 2010 included all patients admitted to the Pediatric Surgical Cardiac ICU in Cairo University, Abo El Reesh Children's Specialized Hospital [Egypt]. Data were collected for each patient during the preoperative, intraoperative, and postoperative periods. Certain infection control procedures were carried out in certain months
Results: Of 175 patients, NI were identified in 119 [68%]. Poor hand hygiene was associated with increased NI in certain months of the study duration. NI were significantly higher at a younger age [median 9 [5-30] months, P<0.03]. Mortality was found in 54 patients, that is, 31% of the study population. Mortality was significantly observed with younger age, higher complexity score for congenital cardiac lesions, prolonged cardiopulmonary bypass and ischemic times, NI, prolonged mechanical ventilation, prolonged central line insertion, and the use of total parenteral nutrition. Mortality among the NI patients was found in 44 of 119 [37%]. On carrying out a multivariate analysis, Acute Physiology and Chronic Health Evaluation II score [P<0.001, odds ratio [OR] 1.13, 95% confidence interval [CI] 1-1.2], age [P<0.001, OR 0.3, 95% CI 0.2-0.4], and prolonged duration of mechanical ventilation [P<0.03, OR 2.8, 95% CI 1.1-7.2] were identified as risk factors of mortality
Conclusion and recommendations: NI rate and subsequent mortality were high among cases followed up during the period from 1 January 2009 to 1 January 2010 in the University Children's Hospital [Cairo, Egypt]. Early surgical interference, enforcement of proper infection control practices, especially hand hygiene, can reduce NI and trials for early extubation from mechanical ventilation might improve outcome following congenital cardiac surgery in pediatrics
Subject(s)
Humans , Male , Female , Thoracic Surgery/trends , Risk Factors , Fatal Outcome , Follow-Up StudiesABSTRACT
To determine the rate of device-associated healthcare-associated infections [DA-HAIs] at a respiratory intensive care unit [RICU] and in the pediatric intensive care units [PICUs] of member hospitals of the International Nosocomial Infection Control Consortium [INICC] in Egypt. A prospective cohort DA-HAI surveillance study was conducted from December 2008 to July 2010 by applying the methodology of the INICC and the definitions of the NHSN-CDC. In the RICU, 473 patients were hospitalized for 2930 d and acquired 155 DA-HAIs, with an overall rate of 32.8%. There were 52.9 DA-HAIs per 1000 ICU-days. In the PICUs, 143 patients were hospitalized for 1535 d and acquired 35 DA-HAIs, with an overall rate of 24.5%. There were 22.8 DA-HAIs per 1000 ICU-days. The central line-associated blood stream infection [CLABSI] rate was 22.5 per 1000 line-days in the RICU and 18.8 in the PICUs; the ventilator-associated pneumonia [VAP] rate was 73.4 per 1000 ventilator-days in the RICU and 31.8 in the PICUs; and the catheter-associated urinary tract infection [CAUTI] rate was 34.2 per 1000 catheter-days in the RICU. DA-HAIs in the ICUs in Egypt pose greater threats to patient safety than in industrialized countries, and infection control programs, including surveillance and guidelines, must become a priority