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Nosocomial infections in a pediatric residential care facility

https://doi.org/10.1016/j.ajic.2011.08.007Get rights and content

Background

Nosocomial infections have rarely been characterized in pediatric residential care facilities. The purpose of this study is to assess the frequency of and risk factors for infectious diseases in pediatric residential care facilities over a 1-year period and to contrast them with other pediatric extended care facilities.

Methods

A retrospective chart review was performed at a pediatric residential care facility dedicated exclusively to children with severe physical and mental disabilities. Incidence rates of infection were collected on a census of 109 residents from January 1 through December 31, 2009. Infectious diseases were classified using ICD-9-CM codes. PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched to identify similar studies.

Results

In 2009, the overall incidence rate of infection was 6.21 per 1,000 resident-days of care, with the most frequent being streptococcal or staphylococcal skin infections (1.11 per 1,000 resident-days) and the least frequent being conjunctivitis (0.16 per 1,000 resident-days). Extensive literature reviews yielded 2 published studies that evaluated infections in pediatric extended care facilities; these studies exhibited distinct prevalences of infectious diseases when compared with the current study.

Conclusion

Studies examining nosocomial infections should not consider pediatric extended care facilities as 1 single entity given the heterogeneity among these facilities.

Section snippets

Setting

The Commonwealth of Virginia, a Mid-Atlantic state with an estimated population of 7,882,590 persons in 2009,10 houses 1 of approximately 100 state-of-the-art residential care facilities for children with severe physical and mental disabilities in the United States. Pediatric residential care facilities, such as St. Mary's Home for Disabled Children (SMHDC) located in Norfolk, Virginia, house children from newborns through 22 years of age. Occupants of these facilities are generally known as

Results

This study includes 109 residents at SMHDC identified on January 1, 2009, and followed through December 31, 2009. The total cumulative census for the study period was 37,819 resident-days of care, ranging from 37 to 365 days per person. The mean age (±standard deviation) of residents was 13.6 ± 5.85 years (no difference in age between males and females) with a male to female ratio of 1.06. The resident population had substantial levels of debilitating conditions including history of seizures

Discussion

To our knowledge, this is the first study to examine nosocomial infection rates in a pediatric residential care facility and the first among pediatric extended care facilities to calculate incidence rates. The lack of such information makes it difficult for extended care facilities to make external comparisons and judge whether its endemic rate exceeds that of other comparable facilities.

For extended care facilities that predominantly serve the adult population, rates of nosocomial infections

Acknowledgment

The authors thank the management staff at SMHDC and Irene David (medical records department) for their valuable support and review of the questionnaire and manuscript.

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    In addition, studies from western countries have demonstrated a direct link between levels of training for the staff and infection rates.13 Using soap, water, antiseptic, or alcohol-based hand rubs is the single most important effective measure to reduce the risks of cross infection15 and has been shown to be very effective.4,7 In addition, the use of gloves and gown and sanitized stethoscopes and thermometers after each use has also been suggested.4

Conflicts of interest: None to report.

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