Medical invasive devices utilization and nosocomial infection incidence rates associated to these devices, estimated through standardized prospective surveillance in a pediatric intensive care unit from Bucharest municipality

Time and Setting: study was conducted during 2005-2006 time period, in the pediatric intensive care unit of the “Grigore Alexandrescu” university clinic, Bucharest, Romania. Objectives: (a) estimate the medical invasive devices’ utilizations rates and also the incidence rates of the nosocomial infection (NI) temporally associated with these devices, and (b) interpret the meaning of observed rates by comparing with the expected distributions provided by National Nosocomial Infection Surveillance System (NNISS), of the Center for Disease Control and Prevention (CDC), USA. Methods: descriptive prospective study of a cohort (n=2593) represented by patients consecutively admitted in the pediatric intensive care unit of an important pediatric university clinic from Bucharest municipality; the NNISS methodology has been used for data collecting, calculating rates and interpretation of the results. Results: standardized rates of utilization (exposure days by patient-days) of mechanical ventilator, central vascular catheter and urinary catheter were: 0.11, 0.17 and 0.33 respectively; the standardized incidence rates of NI temporally associated with urinary catheterization, mechanical ventilation and central vascular catheterization were: 0.0, 3.6 and 9.3 cases per 1000 days of exposure to correspondent device. Empirical comparison of the observed rates in our unit with expected distributions reported by NNISS suggested the following: (a) devices utilization: mechanical ventilator and central vascular catheterization appear as underutilized (most probably by inappropriate (but unavoidable) including in the study cohort of those patients (usually after ordinary surgery) admitted in PICU only for a short time of enhanced surveillance, but not necessary for invasive support of failed biological functions/systems and (b) device associated NI incidence: on one hand, the urinary tract infection appears as underreported (detecting failure) and on the other hand, the incidence of bloodstream infection was positioned between the percentiles 75th and 90th of the expected distribution, being a matter of concern (although not true outlier). Conclusions: 1) Nosocomial infection rates observed in our study are reasonably fitted into the NNISS distributions. 2) Underutilization of some medical invasive devices found in our study is merely reflecting the local rules, then true deviations from medical practice standards. 3) By comparing with expected distributions, the standardized prospective NI surveillance in pediatric ICU allows comprehensive evaluation of the infection control program’s quality, enables implementation of proper corrective measures and their effective evaluation.