Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-12T22:28:15.071Z Has data issue: false hasContentIssue false
  • English
  • Français

Surveillance for Nosocomial and Central Line-Related Infections Among Pediatric Hematology-Oncology Patients

Published online by Cambridge University Press:  02 January 2015

Arne Simon ,
Gudrun Fleischhack ,
Carola Hasan ,
Udo Bode ,
Steffen Engelhart  and
Michael H. Kramer
Arne Simon
Affiliation:
Department of Pediatric Hematology and Oncology, University of Bonn, Bonn, Germany
Gudrun Fleischhack
Affiliation:
Department of Pediatric Hematology and Oncology, University of Bonn, Bonn, Germany
Carola Hasan
Affiliation:
Department of Pediatric Hematology and Oncology, University of Bonn, Bonn, Germany
Udo Bode
Affiliation:
Department of Pediatric Hematology and Oncology, University of Bonn, Bonn, Germany
Steffen Engelhart
Affiliation:
Institute for Hygiene, University of Bonn, Bonn, Germany
Michael H. Kramer*
Affiliation:
Institute for Hygiene, University of Bonn, Bonn, Germany
*
Field Epidemiology Training Program, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640, Japan
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the incidence of all nosocomial infections (NIs) in pediatric hematology-oncology patients, as well as central venous access device (CVAD)-associated infections acquired during home care.

Design:

Prospective surveillance study.

Setting:

The Pediatric Hematology and Oncology Department at the University Hospital Bonn.

Patients:

All patients admitted from January through October 1998 (surveillance period).

Methods:

Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System.

Results:

A total of 143 patients were hospitalized for 3,701 days (776 admissions) during the surveillance period. Of the 40 NIs detected, 26 were CVAD-related, with 21 bloodstream infections (BSIs) and 5 local infections. Four were Clostridium difficile-associated diarrheal illnesses, 3 were pneumonias, and 7 were other infections. The incidence of NIs was 10.8 per 1,000 patient-days (5.2 NIs/100 admissions). The overall CVAD-related BSI rate was 7.4 per 1,000 utilization days, without a significant difference between implanted infusion ports and tunneled catheters. In addition, 7 CVAD-related infections occurred during home care. All 8 BSIs associated with tunneled catheters and 13 (76%) of the 17 BSIs associated with ports were acquired nosocomially. For inpatients and outpatients combined, the exit sites of tunneled catheters were more likely to become locally infected than were the needle entry sites of ports (relative risk, 8.0; P=.007). In 30 (75%) of the 40 NIs, the affected patients had severe neutropenia (<500/mm3) at the time of infection.

Conclusions:

Most NIs in the pediatric hematology-oncology patients were associated with CVAD devices. Although many infections in this high-risk population may not be preventable through infection control measures, the careful evaluation of specific infection rates permits the identification of risk factors that may be targeted by infection control programs. Prospective surveillance for NIs on pediatric oncology units is an indispensable tool for this internal quality control.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 9 , September 2000 , pp. 592 - 596
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Albano, EA, Pizzo, PA. Infectious complications in childhood acute leukemias. Pediatr Clin North Am 1988;35:873–901.Google Scholar
2. Pizzo, PA, Rubin, M, Freifeld, A, Walsh, TJ. The child with cancer and infection, I: empiric therapy for fever and neutropenia, and preventive strategies. J Pediatr 1991;119:679–694.Google Scholar
3. Pizzo, PA, Rubin, M, Freifeld, A, Walsh, TJ. The child with cancer and infection, II: nonbacterial infections. J Pediatr 1991;119:845–857.CrossRefGoogle ScholarPubMed
4. Pizzo, PA. Management of fever in patients with cancer and chemotherapy induced neutropenia. N Engl J Med 1993;328:1323–1332.Google Scholar
5. Katz, JA, Mustafa, MM. Management of fever in granulocytopenic children with cancer. Pediatr Infect Dis J 1993;12:330–339.Google Scholar
6. Holzel, H, de Saxe, M. Septicemia in pediatric intensive care patients at the Hospital for Sick Children, Great Ormond Street. J Hosp Infect 1992;22:185–195.Google Scholar
7. Möttönen, M, Uhari, M, Lanning, M, Tuokko, H. Prospective controlled survey of viral infections in children with acute lymphoblastic leukemia during chemotherapy. Cancer 1995;75:1712–1717.Google Scholar
8. Carlisle, PS, Gucalp, R, Wiernik, PH. Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993;14:320–324.CrossRefGoogle ScholarPubMed
9. Morrison, VA, Peterson, BA, Bloomfield, CD. Nosocomial septicemia in the cancer patient: the influence of central venous access devices, neutropenia and type of malignancy. Med Pediatr Oncol 1990;18:209–216.Google Scholar
10. Rotstein, C, Cummings, KM, Nicolaou, AL, Lucey, J, Fitzpatrick, J. Nosocomial infection rates at an oncology center. Infect Control Hosp Epidemiol 1988;9:13–19.Google Scholar
11. Doullioud, D, Combe, F, Latour, JF, Chauvin, F, Bigot, P. Incidence of nosocomial infections in an anticancer center: clinical and bacteriological data. Bull Cancer 1990;77:893–900.Google Scholar
12. Velasco, E, Santos Thuler, LC, de St Martins, CA, de Castro Dias, LM, Goncalves, VM. Nosocomial infections in an oncology intensive care unit. Am J Infect Control 1997;26:458–462.Google Scholar
13. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1998, issued June 1998. Am J Infect Control 1998;26:522–533.Google Scholar
14. Van Hoff, J, Berg, AT, Seashore, JH. The effect of right atrial catheters on infectious complications of chemotherapy in children. J Clin Oncol 1990;8:1255–1262.Google Scholar
15. Kellerman, S, Shay, DK, Howard, J, Feusner, J, Rosenberg, J, Vugia, DJ, et al. Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices. J Pediatr 1996;129:711–717.CrossRefGoogle Scholar
16. Creutzig, U, Henze, G, eds. Diagnostic and Therapeutic Standards in Pediatric Oncology. Munich, Germany: Zuckerschwerdt Verlag; 1997.Google Scholar
17. Tollemar, J, Höckersted, K, Ericzon, BG, Jalamko, H, Ringden, O. Liposomal amphotericin B prevents invasive fungal infections in liver transplant recipients. Transpl 1995;59:45–50.Google Scholar
18. Conneally, E, Cafferkey, MT, Daly, PA, Keane, DT, McCann, SR. Nebulized amphotericin B as prophylaxis against invasive aspergillosis in granulocytopenic patients. Bone Marrow Transplant 1990;5:403–406.Google Scholar
19. Loo, VG, Bertrand, C, Dixon, C, Vitye, D, DeSalis, B, McLean, APH, et al. Control of construction-associated nosocomial aspergillosis in an antiquated hematology unit. Infect Control Hosp Epidemiol 1996;17:360–364.Google Scholar
20. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC Definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
21. Simon, A. Abteilung für allgemeine Pädiatrie und Poliklinik. Zentrum für Kinder heilkunde der Universität Bonn. http://www.meb.unibonn.de/institute/zenkin/hyg/hyg.html.Google Scholar
22. Mathers, LH, Frankel, LR. Stabilization of the critically ill child. In: Behrman, RE, Kliegman, RM, Jenson, HB, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, PA: WB Saunders Company; 1999:252 (Table 64.5).Google Scholar
23. Emori, TG, Culver, DH, Horan, TC. National Nosocomial Infections Surveillance (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
24. The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of intravascular device-related infections. Am J Infect Control 1996;24:262–293.Google Scholar
25. Flynn, PM, Shenep, JL, Strokes, DC, Barrett, FF. In situ management of confirmed central venous catheter-related bacteriemia. Pediatr Infect Dis J 1987;6:729–734.Google Scholar
26. Kellerman, S, Chans, J, Jarvis, W. Use of urokinase in pediatric hematology/oncology patients. Am J Infect Control 1998;26:502–506.Google Scholar
27. Lange, B, Weiman, M, Feuer, EJ, Jakobowski, D, Bilodeau, J, Stallings, VA, et al. Impact of changes in catheter management on infectious complications among children with central venous catheters. Infect Control Hosp Epidemiol 1997;18:326–332.Google Scholar
28. Wolfhagen, MJ, Meijer, K, Fluit, AC, Torensma, R, Bruinsma, RA, Fleer, A, et al. Clinical significance of Clostridium difficile and its toxins in feces of immunocompromised children. Gut 1994;35:1608–1612.Google Scholar
29. Burgner, D, Siarakas, S, Eagles, G, McCarthy, A, Bradbury, R, Stevens, M. A prospective study of Clostridium difficile infection and colonization in pediatric oncology patients. Pediatr Infect Dis J 1997;16:1131–1134.CrossRefGoogle ScholarPubMed
30. Gerding, D, Johnson, S, Peterson, L, Mulligan, M, Silva, J. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
31. Gorelick, MH, Owen, WC, Seibel, NL, Reaman, GH. Lack of association between neutropenia and the incidence of bacteremia associated with indwelling central venous catheters in febrile pediatric cancer patients. Pediatr Infect Dis J 1991;10:506–510.Google Scholar
32. Lucas, KG, Brown, AE, Armstrong, D, Chapman, D, Heller, G. The identification of febrile, neutropenic children with neoplastic disease at low risk for bacteriemia and complications of sepsis. Cancer 1996;77:791–798.3.0.CO;2-V>CrossRefGoogle Scholar