Incidence Of Hospital Acquired Infections In Patients Admitted To Paediatric Emergency Ward Of A Tertiary Care Centre: A One Year Longitudinal Study

Abstract

Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality among critically ill patients of all age groups. This prospective surveillance study was performed to estimate the burden of HAIs in a paediatric emergency department of a tertiary care multispecialty hospital. For developing countries, active surveillance is essential to reduce the burden of HAIs in high risk groups. Objectives: 1. To know the incidence rate of HAI in patients admitted to Paediatric emergency ward. 2. To isolate and identify bacteria causing HAI with special emphasis on Antibiotic sensitivity. Materials and Methods: The prospective study was conducted in a twelve-bedded paediatric emergency ward of a tertiary care hospital for one year. Patients were assessed daily during their stay in emergency ward. Detailed data including the clinical diagnosis, invasive device usage, Length of stay (LOS), antibiotics administered and clinical outcome was taken for children who were admitted in emergency unit for more than 48 hours. All statistical analysis was performed using software (STATA 9.0 Corp. College Station, TX, USA). Clinical outcome variable in the form of length of stay was calculated using Mann Whitney Standard U test. Results: Of the 410 patients, 5 patients developed 8 episodes of HAI, which is a crude incidence rate (CIR) of 1.95%. Crude incidence rate of VAP, CLABSI and CAUTI was 33.33%, 16.6% and 0% respectively. Incidence density of site specific HAI was found to be 0% for CAUTI, 8.7% for CLABSI, 24.53% for VAP and 16.4% for SSI. The mean LOS of admitted patients was 7.43 days and 49.8 + 30.73 days in patients who developed HAI. Acinetobacter baumanni, Citrobacter freundii and Klebsiella pneumoniae were the most common isolated pathogens in HAI patients. 7 out of 8 pathogens in HAI patients were found to be multi drug resistant. Conclusion: The incidence rate HAI in paediatric emergency ward is 1.95%. Gram negative bacilli are the predominant pathogen causing HAI, with VAP being the most common type of HAI. Length of stay is found to be the major risk factor for acquiring HAI, among the factors studied. Multi drug resistance further narrows down the possibility of recovery, though all the patients in this study have recovered.