RESUMO
From a total of 26,603 admissions to the paediatric wards, 1360 paediatric nosocomial urinary tract infections (PNUTI) were identified during a 5-year retrospective chart review at the SFGH. The ages ranged from 3 days to 13 years, with 46% boys and 54% girls. The highest rates of PNUTI per service per 100 admissions were seen in the nursery (11.28) followed by paediatric surgery (2.89) and paediatric medicine (2.86). Although the greatest number of PNUTI occurred in the nursery, comparison between the years was not statistically significant. About 90% (1218 of 1360) of PNUTI occurred in catheterized patients. No documentation was found specifying the type of catheterization (intermittent or continuous). About 90% (1210 of 1360) of isolates were single organisms with Escherichia coli, Proteus mirabilis, Klebsiella spp. and Group B streptococci accounting for a total of approximately 70% of all pathogens. However, the composition of the most common isolate in each service differed. The most common isolate in the nursery was E. coli, in the paediatric medical and surgical services the most common isolates were Klebsiella spp. and Proteus mirabilis, respectively. Proteus mirabilis was isolated predominantly from boys with structural abnormality of the urethral tract. No PNUTIs were complicated by bacteraemia. The antibiotics with least effectiveness (in increasing order) for UTIs were cephalexin, ampicillin, trimethoprim, co-trimoxazole and tetracycline. The most effective antibiotics were nalidixic acid, gentamicin and amoxicillin-clavulanic acid.
Assuntos
Infecção Hospitalar/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adolescente , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Infecção Hospitalar/microbiologia , Feminino , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Trinidad e TobagoRESUMO
From a total of 26,603 admissions to the paediatric wards, 1360 paediatric nosocomial urinary tract infections (PNUTI) were identified during a 5-year retrospective chart review at the SFGH. The ages ranged from 3 days to 13 years, with 46 percent boys and 54 percent girls. The highest rates of PNUTI per service per 100 admissions were seen in the nursery (11.28) followed by paediatric surgery (2.89) and paediatric medicine (2.86). Although the greatest number of PNUTI occurred in the nursery, comparison between the years was not statistically significant. About 90 percent (1218 of 1360) of PNUTI occurred in catheterized patients. No documentation was found specifying the type of catheterization (intermittent or continuous). About 90 percent (1210 of 1360) of isolates were single organisms with Escherichia coli, Proteus mirabilis, Klebsiellla spp. and group B streptococci accounting for a total of approximately 70 percent of all pathogens. However, the composition of the most common isolate in each service differed. The most common isolate in the nursery was E. coli, in the paediatric medical and surgical services the most common isolates were Klebsiella spp. and Proteus mirabilis, respectively. Proteus mirabilis was isolated predominantly from boys with structural abnormality of the urethral tract. No PNUTIs were complicated by bacteraemia. The antibiotics with least effectiveness (in increasing order) for UTIs were cephalexin, ampicillin, trimethoprim, co-trimoxazole and tetracycline. The most effective antibiotics were nalidixic acid, gentamicin and amoxicillin-clavulanic acid.(AU)
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recém-Nascido , Adolescente , Lactente , Infecção Hospitalar/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Bacterianas/epidemiologia , Infecção Hospitalar/microbiologia , Hospitais de Ensino , Prevalência , Estudos Retrospectivos , Trinidad e TobagoRESUMO
OBJECTIVE: To assess the prevalence of nosocomial infections at a rural government hospital from 1992 to 1995. DESIGN: Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infections, cost to government, and infection control practices. SETTING: 653-bed rural hospital providing primary and tertiary care. PATIENTS: Patients admitted to the hospital between 1992 and 1995 who were found with hospital-acquired infections during their stay. INTERVENTIONS: None. RESULTS: Over the 4-year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 admissions) accounted for most nosocomial infections (42%), followed by postoperative wound infections (26.8%) with a rate of 2.6/100 admissions. Nosocomial pneumonias and bloodstream infections also were common with 13.2% and 8.0%, respectively. The highest rates occurred on the intensive-care unit for both pneumonia (26.4/100 admissions) and bloodstream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,000 annually (US $1=$6 Trinidad and Tobago). Poor infection control practices, inadequate handwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident. CONCLUSIONS: Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross-infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of overcrowding, thus further reducing cross-infection.
Assuntos
Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Países em Desenvolvimento , Hospitais Públicos , Hospitais Rurais , Controle de Infecções/métodos , Infecção Hospitalar/economia , Custos Hospitalares , Departamentos Hospitalares , Humanos , Incidência , Prevalência , Estudos Retrospectivos , Trinidad e TobagoRESUMO
OBJECTIVE: To assess the prevalence of nosocomial infections at a rural government hospital from 1992 to 1995. DESIGN: Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infection, cost to government, and infection control practices. SETTINGS: 653 bed rural hospital providing primary and tertiary care. PATIENTS: Patients admitted to the hospital between 1992 and 1995 who were found with hospital acquired infections during their stay. INTERVENTIONS: None. RESULTS: Over the 4 year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 admissions) accounted for most nosocomial infections (42 percent), followed by postoperative wound infections (26.8 percent) with a rate of 2.6/100 admissions. Nosocomial pneumonias and bloodstream infections also were common with 13.2 percent and 8.0 percent respectively. The highest rates occurred on the intensive care unit for both pneumonia (26.4/100 admissions) and bloodstream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,00 annually (US $1 = $6 Trinidad and Tobago). Poor infection control practices, inadequate handwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident. CONCLUSIONS: Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of overcrowding, thus further reducing cross-infection.(AU)