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Title: Nosocomial infection in a paediatric intensive care unit : incidence, surveillance and sequelae
Author: Pollock, Evelyn M. M.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1990
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The study reports nosocomial infection rate of 7 infected patients per 100 patients admitted. As a percentage of the total, the most prevalent organisms are: coagulase negative staphylocci (32%), Pseudomonas aeruginosa (23%), Candida species (20%) and Staphylococcus aureus (9&37); the commonest sites of infection are: blood stream (36%), skin/eye drain site (22&37); respiratory tract (16&37); wound (15%) and urinary tract (9%). Severity of the underlying illness of admission, as measured by the PRISM scoring system, predicts a population at risk of developing nosocomial infection. Patients with admission PRISM scores of ≥10 are significantly more likely to acquire infection than those with scores < 10 (10.8% vs 3.6%, p < 0.001) andthis association holds through age, clinical speciality and length of stay. The sensitivity, specificity, positive and negative predictive values of a PRISM score ≥10 are 75%, 53%, 11% and 97% respectively. In post operative cardiac surgery patients non-wound infections account for 72&37 of the total nosocomial infections. With regard to wound infection; the most prevalent pathogenic organisms vary depending on whether surgery is closed ie. non bypass (Staph. aureus and coagulase negative staphylocci) or open ie. bypass (coagulase negative staphylococci, P. aeruginosa, Candida species and Staph. aureus). Risk factors for the acquisition of infection relate to specific operative procedures and to surgical technique particularly the presence of an open sternotomy wound in the post operative period. The system of infection surveillance recently introduced in the PICU (the Infection Control Sentinel Sheet; ICSS) compares favourably with daily bedside examination of patients plus daily review of in-patient charts. The ICSS, which requires only 20 minutes of surveillance time per day, detects 87&37 of nosocomially infected patients; 85&37 of infections at the three standard sites (blood, wound and urine); and 72% of infections at all of the 11 sites surveyed. Certain adverse effects of nosocomial infection are reported to occur in up to 40% of infected patients. A crude costing study of intravenous antibiotic required for treatment of nosocomial infection suggests that the minimum cost was Can 15,000 (approx 7,500). In conclusion, following a resume of the results of the individual studies, areas, where future research efforts might be focussed, are identified.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available