Healthcare Associated Infection in Paediatric Intensive Care Unit-A Tertiary Care Hospital Experience

Introduction: Healthcare Associated Infections (HAI) are those that are acquired in a health care setting or one that is acquired in the hospital environment by a patient who had been admitted to the hospital for a different reason. The HAI are one of a cause of increased morbidity and mortality of hospitalised patients, especially the ones admitted to an Intensive Care Unit (ICU). The study of incidence of HAI in the ICU of tertiary hospitals has been conducted previously with significant results but there is a lack of data exist regarding HAI in the Paediatric Intensive Care Unit (PICU). Hence a study was conducted in the PICU of a tertiary care hospital to estimate the incidence of HAI and study the clinical and microbiological profile, so as to acquire knowledge regarding the prevailing conditions in the PICU. The knowledge thus, obtained may then be applied in lowering the further incidence of HAI and serve to establish better patient care services. Aim: To estimate the incidence of HAI in the PICU of a tertiary care hospital and to study the clinical, microbiological profile and analyse the same to understand the probable risk factors involved, thereby developing effective infection control measures and strategies. Materials and Methods: A prospective, descriptive, observational study was conducted in the PICU of a tertiary care hospital over a period of one year (August 2013 to July 2014). The present study included children of the age group between 1 month and 12 years admitted in the PICU, who were suspected to have acquired HAI during the hospital stay. Relative frequencies of known risk factors like age, anaemia, malnutrition, and duration of PICU stay were studied in these patients. Microbiological culture and antimicrobial sensitivity were done by using standard techniques in the microbiological laboratory. Results: During the study period, out of the 588 patients admitted to PICU, a total of 68 (11.56%) developed one or more HAIs. It was found that the clinical outcome of the patients with HAI did not have any statistically significant relationship to the parameters such as age or sex distribution, nutritional status, degree of anaemia, duration of hospital stay or the site of HAI. But highly significant correlation was established between the duration of mechanical ventilation of a patient and reintubation with the clinical outcome of the patient. The most common HAI identified in the PICU was vascular site infection, identified in 41 patients, contributing to more than half (53%) of all the HAI. This was followed by ventilator related infections in 13 patients (17%), primary blood stream infections in 12 patients (16%) and the others that occurred in minor frequencies included those of the skin, pneumonias, infections of the urinary tract and surgical site. The most common microorganism isolated from the patients with HAI in the PICU was Klebsiella species. The antibiotic to which majority of microbial isolates including Klebsiella were sensitive was Amikacin. Conclusion: It is recommended to follow strict hand hygiene and aseptic precautions during intravascular catheterisation procedures. The antibiotic Amikacin may be considered in the empirical treatment of suspected HAI while culture reports are being awaited. The challenges for the future are to minimize HAI in the PICU and ensure better clinical outcome for all.