Data for this Review were identified by searches of PubMed, Medline, the authors' own databases, and references from relevant articles using the search terms “infection control”, “p(a)ediatric”, “cross infection”, or “nosocomial infection”, and the following: “neonate”, “children”, “drug resistance”, “drug therapy”, “varicella zoster virus”, “tuberculosis”, “pertussis”, “influenza virus”, “respiratory syncytial virus”, “parainfluenza”, “adenovirus”, “rotavirus”, “hand hygiene”,
ReviewInfection control in paediatrics
Introduction
The history of infection control is closely linked to the paediatric population. Ignácz Semmelweis not only made the association between hand hygiene and puerperal fever in women, but also noted its relation with perinatal infection rates.1 In response to the high incidence of infectious diseases on paediatric wards over the past century, several infection control measures have been implemented and tested in child-care settings before application to adult environments.2 In both adults and children, certain patients are particularly at risk of health-care-associated infections (HAI); among these are neutropenic patients and those in intensive care with indwelling devices. Other risk factors for HAI, such as close physical contact with health-care workers or stay in environments where antibiotic-resistant organisms are endemic, are common to adult and paediatric patients. Because of young age and the immaturity of their immune systems (figure 1), children are susceptible to infections that are prevented in older patients through vaccination or a more robust, innate immune response. Therefore, the nosocomial pathogens and most common HAI sites in children differ from those reported among adults. Children have fewer chronic or degenerative organ system disorders than adults,3 but present more often with congenital or acquired immune deficiencies as well as congenital syndromes. Close physical contact between children in communal rooms or play areas, between children and visitors such as parents and siblings, and uncontrolled fluids and bodily secretions also provide ample opportunities for infection spread.
Specific aspects of children's hospitals, such as shared rooms in general paediatric intensive care units (PICUs) instead of separate medical and surgical ICUs as for adults, toy-sharing, pet-visiting, and partial ambulatory care, also contribute to nosocomial infection risk.4 Infection control has a particularly important role in paediatric hospitals and is not a simple transposition of adult recommendations; it must take into account the specificity of the paediatric patients' needs and environment. This Review addresses issues that characterise infection control in paediatrics with a particular focus on some important differences with adults.
Section snippets
Epidemiology
Surveillance for HAI in paediatric populations usually depends on institutional or public-health requirements and commitment, and the available resources. Several studies have shown the benefit of surveillance through early detection and intervention during outbreaks, and also identification of centre-specific risk factors for HAI. Most paediatric institutions in developed countries use the US Centers for Disease Control and Prevention (CDC) definitions for nosocomial infections.5 These are
Different pathogens, different infections
HAIs among children differ from those seen among adults in several respects. Site and pathogen distribution vary according to age-group and setting (figure 2 and figure 3). Of note, the type of predominant pathogen in the neonatal setting has changed over time. Gram-negative organisms are major contributors to HAI in developing countries (figure 4).24, 35, 41, 48 By contrast, particularly in neonates,3, 49 the proportion of infections caused by coagulase-negative staphylococci has increased
Risk factors for infection
Paediatric and adult patients share common risk factors for HAIs, including exposure to intravascular devices, hyperalimentation, mechanical ventilation, and comorbidities, such as immune-compromising conditions. There are, however, additional risk factors inherent to children. When children, especially the young, encounter common pathogens such as respiratory syncytial virus (RSV) and rotavirus, it is often their first encounter. This immunological naivety not only affects the likelihood of
Effect of infection on length of stay, morbidity, and mortality
As in adult medicine, the cost and impact of paediatric HAI depends largely on the type of infection and the patient's underlying condition. In general, bloodstream infection carries the highest morbidity and mortality and neonates are the age-group at highest risk for poor outcome (table 2). For example, whereas bloodstream infection has an estimated attributable mortality of 3% in paediatric patients,17 the estimate is 11% among neonates with very low birthweight: crude mortality was 18% in
Special microorganisms
Certain organisms have a special role in paediatric infection control, either because they induce more pronounced disease in children or because of issues around acquisition and transmission. For example, children are often admitted to hospital with infections causing community epidemics such as respiratory and gastrointestinal viral infections.70 As a result, the hospitalised child serves as a potential source for the nosocomial transmission of typically community-associated pathogens in the
Specific subpopulations
Several issues related mainly to maturation of the immune system and normal child development are very relevant to paediatric infection control. The immunological naivety of children translates into an enhanced susceptibility to many infections with important health consequences as well as higher rates and longer duration of microorganism shedding. Child development requires close contact with care-givers, including parents and health-care workers, as well as other family members, particularly
Environment
As previously discussed, the developmental status of the paediatric patient has a crucial role in HAI acquisition risk. As part of normal development, children interact closely with their environment and this poses unique risks for infection. For instance, chewing can present a risk when practised by the babies on dialysis catheters.99 Some specific paediatric environmental concerns are addressed below.
Antimicrobial drug resistance in paediatrics
The emergence and dissemination of antimicrobial-resistant organisms is a crucial concern in paediatrics and is closely related to the use of antimicrobial agents, as in the adult setting.114, 115 The Intensive Care Antimicrobial Resistance Epidemiology project and the NNIS data that report on the use of these agents in participating adult and paediatric ICUs in the USA have shown that third-generation cephalosporins are by far the most commonly used antimicrobials, followed by parenteral
Hand hygiene
Hand hygiene is considered the simplest and most effective measure to prevent cross-transmission of microorganisms and HAI.46, 137 Many reports have documented the transmission of viruses or bacteria in paediatric hospitals by health-care workers.138 Unfortunately, professionals appear to have difficulties in performing hand hygiene procedures and compliance below 50% has been repeatedly reported.139 Non-compliance with hand hygiene practices and the effect of promotional programmes have often
Conclusion
Infection control has a particularly important role in paediatric hospitals and there is a pressing need to develop guidelines and preventive measures targeted specifically at the paediatric setting. Paradoxically, the challenges for the future are linked to the evolution of modern medicine. Over the past decade, the development of sophisticated life-support technology has resulted in a substantial increase of extremely low birthweight premature infants at high risk for nosocomial infection and
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Surface sampling within a pediatric ward—how multiple factors affect cleaning efficacy
2020, American Journal of Infection ControlCitation Excerpt :A wide diversity of contaminants have been isolated from public areas in other studies within the clinical environment.21-23 Within the pediatric environment, patient interaction is more likely to occur within communal areas due to the nature of the patient subset and unique surface interactions, such as sitting and playing on the floor and interacting with toys and other sensory objects.16 Our data indicate that surfaces having the greatest interaction with patients and their parents or guardians were the most contaminated following cleaning (Fig 1c).
Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey
2017, The Lancet Infectious DiseasesCitation Excerpt :Our results show that the burden of health-care-associated infections in childhood is highest in the first year of life and demonstrate the importance of bloodstream infections as the most common type of infections in children. Lower respiratory tract infections and surgical-site infections were more frequent in older age groups and the distribution of infections in children aged 5 years or older was close to the distribution of health-care-associated infections in adults.1,3,9,10 These findings suggest that age-adapted strategies are needed for infection prevention and control in paediatric settings, with focus on the prevention of bloodstream infections.
Probiotics Use in Infectious Disease (Respiratory, Diarrhea, and Antibiotic-Associated Diarrhea)
2017, The Microbiota in Gastrointestinal Pathophysiology: Implications for Human Health, Prebiotics, Probiotics, and DysbiosisHealth care-associated infection surveillance in a tertiary neonatal intensive care unit: A prospective clinical study after moving to a new building
2016, American Journal of Infection ControlFrequency of hand contact with hospital surfaces in hospitalized pediatric patients
2024, Boletin Medico del Hospital Infantil de Mexico