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PubMedDate not supplied

Rationale and methods for a statewide, prospective surveillance system for the identification and prevention of nosocomial infections.

Review of current methods of surveillance for nosocomial infection indicates that prospective surveillance of patients on a daily basis is the most accurate and valid method. In this paper, we detail such a method. Samples of hospitalized patients for surveillance are based on a fixed period of observation in each patient-care area. Data are collected on a detailed, standardized daily log that emphasize the recording of primary clinical data. Such a system is practical and is acceptable to infection control practitioners. Representative samples of patients are obtained. The utility of such a system for identifying preventable risk factors for the development and evaluation of programs of prevention is being tested in 12 acute-care hospitals in Rhode Island.

Cross Infection↗

PubMed2005

Evaluation of human-to-human transmission of monkeypox from infected patients to health care workers.

BACKGROUND: In 2003, human monkeypox was first identified in the United States. The outbreak was associated with exposure to infected prairie dogs, but the potential for person-to-person transmission was a concern. This study examines health care worker (HCW) exposure to 3 patients with confirmed monkeypox. METHODS: Exposed HCWs, defined as HCWs who entered a 2-m radius surrounding case patients with confirmed monkeypox, were identified by infection-control practitioners. A self-administered questionnaire and analysis of paired serum specimens determined exposure status, immune response, and postexposure signs and symptoms of monkeypox. RESULTS: Of 81 exposed HCWs, 57 (70%) participated in the study. Among 57 participants, 40 (70%) had > or =1 unprotected exposure; none reported signs or symptoms consistent with monkeypox illness. One exposed HCW (2%), who had been vaccinated for smallpox within the past year, had serological evidence of recent orthopoxvirus infection; acute- and convalescent-phase serum specimens tested positive for anti-orthopoxvirus IgM. No exposed HCWs had signs and symptoms consistent with monkeypox. CONCLUSION: More than three-quarters of exposed HCWs reported at least 1 unprotected encounter with a patient who had monkeypox. One asymptomatic HCW showed laboratory evidence of recent orthopoxvirus infection, which was possibly attributable to either recent infection or smallpox vaccination. Transmission of monkeypox likely is a rare event in the health care setting.

Adult↗

PubMed1989

Antimicrobial monitoring and evaluation.

Effective antimicrobial use is an essential component of patient care. Drug use evaluation should include the prophylactic, therapeutic, and empiric use of antimicrobials. The infection control practitioner has the unique knowledge and skills in epidemiology to be effective in the monitoring and evaluation process. This review outlines a variety of techniques to monitor and evaluate trends in the use of antimicrobial agents in health care facilities. Methods related to antimicrobial monitoring and evaluation are summarized.

Anti-Bacterial Agents↗

PubMed1979

Development of a statewide program for surveillance and reporting of hospital-acquired infections.

In 1974, a statewide program was begun to improve surveillance of nosocomial infection in Virginia hospitals. Infection control practitioners were trained at the University of Virginia Hospital, Charlottesville, and were encouraged to submit monthly surveillance reports for analysis. In the first three years of the project, 141 students from 65 hospitals within the state attended a two-week basic course, with eight to 10 students per class. Of the 98 Virginia hospitals that sent students, 75 (73%) submitted monthly reports. The consistency of reporting (number of monthly reports received divided by the number of possible reporting months) was 83%. The sensitivity of reported data was estimated in comparative daily prospective surveys to be 69% for participating hospitals, and the specificity was 99%. The crude infection rate for the first 1.1 million patients at risk was 3.3%.

Cross Infection↗

PubMed1983

Recommendations for pregnant employee interaction with patients having communicable infectious diseases.

The transmission of communicable infectious diseases from hospitalized patients to health care providers is a well-documented phenomenon. This occurrence is of particular concern when the health care worker is a pregnant female and there is worry about the development of a congenital infection or transmission of infection at the time of delivery. Infection control practitioners and Employee Health Service personnel are often consulted by pregnant hospital employees who are concerned about interacting with patients having communicable infectious diseases, and appropriate advice is sought. Since it has often been necessary in the past to consult numerous resources in order to respond to these issues, we have compiled recommendations that can serve as a reference to help ICPs and Employee Health Service personnel deal with these situations.

Cross Infection↗

PubMed2003

Assessment of a selective surveillance method for detecting nosocomial infections in patients in the intensive care department.

BACKGROUND: The implementation of a time- and cost-effective system for the surveillance of the nosocomial infection (NI) is a challenge for infection control practitioners. OBJECTIVES: The aim of this study was to assess the sensitivity and the time reduction using a selective surveillance method (SSM) for the detection of NIs in comparison with a reference surveillance method (RSM). METHODS: During a 12-month period, surveillance was performed prospectively in 4 intensive care departments on a rotating basis. Using the RSM, NIs were identified by prospective chart reviews performed twice a week combined with weekly infectious disease ward rounds. In the SSM, surveillance was reduced to microbiologic data and participation in the weekly infectious disease ward rounds followed by selective chart review. RESULTS: In all, 578 patients amounting to 3597 patient-days were included in the study. In total, 78 NIs among 56 patients were identified. The overall sensitivity of the SSM compared with the RSM was 93.6% (73 of 78 NIs). The sensitivity of the SSM for the most important device-associated NIs (pneumonia, bloodstream infections, and urinary tract infections) was 96.3% (52 of 54 NIs) and 87.5% (21 of 24 NIs) for other NIs. Time required using the SSM was 1.3 hours compared with 4.1 hours per 10 beds per week (P =.0001) with the RSM. CONCLUSIONS: Within our setting, a SSM with restriction to microbiology reports and participation in the infectious disease ward rounds detected NIs with a high sensitivity and a remarkable time reduction.

Cross Infection↗

PubMed1996

Reuse in sterile sites of single-use medical devices: how common is this in Australia?

OBJECTIVE: To determine to what extent Australian hospitals reuse in sterile sites medical devices labelled "single use only"; to assess the adequacy of cleaning and sterilising procedures before reuse; and to estimate the possible incidence of cross-infection and the costs of not reusing these devices. DESIGN: A self-administered questionnaire survey. SETTING: All Australian hospitals (419) with more than 45 beds and undertaking medical and surgical procedures. METHODS: Questionnaires were sent to hospital infection control practitioners in 1994 requesting information about reuse in sterile sites of single-use medical devices, the extent of reuse, the cleaning and sterilising processes involved, and the reasons for reuse. RESULTS: Responses were received from 168 hospitals (40%). Reuse occurred in 64 (38%), and another 33 hospitals had been reusing medical devices 12 months before our survey (i.e., 97/168 hospitals [58%] were either reusing them at the time of our survey or had been doing so 12 months previously). More large (> 300 beds) metropolitan public hospitals (9/14; 64%) reported reusing than did smaller (50/143; 41%) or private hospitals (15/47; 32%). At six of the 64 hospitals where reuse occurred, the process of cleaning and/or sterilization of these devices was not satisfactory; from the information we received, both cleaning and sterilization were satisfactory in only 38 hospitals (59%). Examination of the 14 most commonly reuse devices showed that the structure of 13 of these may compromise cleaning (and therefore sterilization). The main reason given for reuse was cost saving. Assuming a 2% prevalence of transmissible infections in blood, and an infection transmission risk of 1/500, we estimate that each year in Australia there may be 40 cases of cross-infection for every one million procedures performed with reused devices (0.004%). CONCLUSIONS: Reuse of medical devices labelled "single use only" is common in Australian hospitals. Most devices appear to be unsuitable for reuse. Complete cessation of this practice of reusing single-use medical devices would stop potential cross-infection, but this would cost and estimated $2.5 million or more per case prevented

Australia↗

PubMed1999

[The important role of the microbiology laboratory in treating patients with infectious diseases and in controlling hospital infections].

It is very important for the microbiology laboratory to provide the clinician with information about microbiology laboratory tests results as soon as possible, since this data is strongly connected to treating patients with infectious diseases appropriately, as well as with performing adequate hospital infection control. Therefore, the microbiology laboratory should always have a good relationship and good communication with the clinician and infection control practitioner. For this purpose, it would be beneficial for the microbiology laboratory staff to attend the doctor's round to see patients with infectious diseases, or to attend the patients management conferences in the wards. In most hospitals in Japan, microbiology laboratories are closed on holidays. But the microbiology laboratory should be available for at least some important tests, such as the identification and susceptibility testing of blood cultures isolates on holidays in order to facilitate treatment of patients with serious infectious diseases by appropriate antimicrobial therapy.

Bacterial Infections↗

PubMed1998

The costs of healthcare worker respiratory protection and fit-testing programs.

OBJECTIVE: We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB). DESIGN: The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study. SETTING: Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB. RESULTS: During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526). CONCLUSIONS: Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB.

Cross Infection↗

PubMed1995

Needlestick/sharps injuries and HIV exposure among health care workers. National estimates based on a survey of U.S. hospitals.

Exposure to HIV in the workplace is a major concern for health care workers. The greatest risk for bloodborne pathogen transmission is associated with percutaneous injuries involving hollow-bore needles contaminated with patient blood. Limited data are available about how many sharps injuries (SIs) and needlesticks (NSs) occur in the United States, with estimates ranging from 100,000 to 1 million injuries per year. We conducted a survey of 100 infection control practitioners located at randomly selected U.S. hospitals to assess the number of SIs or NSs occurring during 1990; 65 (65%) responded. The mean number of NS/SIs reported was 45, with a mean of 1.1 known HIV-related NS/SIs. The underreporting rate was estimated to be 18.5%. Assuming that the hospitals provided exact numbers of injuries and were representative of the approximately 5,100 U.S. hospitals, then about 252,000 NS/SIs were reported in U.S. hospitals in 1990 (95% CI = 193,000-312,000). If the under-reporting rate was 33% to 66%, then the point estimate for the total number of NS/SIs ranges from 378,000 to 756,000. Similar extrapolation involving the reported number of NS/SIs contaminated with blood from an HIV-infected patient yields an estimate of 5,610 exposures in 1990 (95% CI = 1,300-8,300). The number of U.S. hospital workers sustaining NS/SIs with potential exposure to HIV appears to be considerable. Efforts to reduce the risk of bloodborne pathogen transmission from NS/SIs are warranted.

Bias↗

PubMed2006

Measurement and feedback of infection control process measures in the intensive care unit: Impact on compliance.

BACKGROUND: Infection control process measures provide actionable and measurable indicators for performance improvement. OBJECTIVE: To determine the relationship between the measurement and feedback of selected infection control process measures and compliance with infection control practices. METHODS: We measured selected infection control process measures (hand hygiene, femoral catheter use as a proportion of all central venous catheter (CVC) days and proportion of head of bed elevations) in the medical respiratory intensive care unit (ICU) (MRICU) and the surgical trauma ICU (STICU). All data were collected by trained infection control practitioners. Baseline data were obtained April through June 2004. Baseline hand hygiene data were obtained from May to June. Follow-up observations were obtained from July 2004 through March 2005. Both baseline and follow-up observations were reported to the units' leadership. The data were reviewed for improvement in compliance with process measures. Differences in proportions were analyzed for statistical significance by the chi(2) test. RESULTS: There was a statistically significant improvement in the head of bed elevation rates: 54.9% versus 98.4% (P < .001) for the MRICU and 46.5% versus 77.2% (P < .001) for the STICU, respectively. There was also a statistically significant decline in femoral catheter rates in both ICUs: 17.8% versus 10% (P = .001) in the MRICU and 8.4% versus 3% (P < .001) in the STICU, respectively. There was no significant improvement in hand hygiene rates in either ICU: 31.8% versus 39.3% (P = .1) in the MRICU and 50% versus 50.3% (P = .9) in the STICU, respectively. CONCLUSION: Feedback of process measures lowered the use of femoral catheters and improved the proportion of elevated head of beds in 2 ICUs, but there was no significant improvement in hand hygiene.

Catheterization, Central Venous↗

PubMed2005

Antimicrobial stewardship programs in health care systems.

Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources.

Anti-Bacterial Agents↗

PubMed1987

Diffusion and adoption of CDC guidelines for the prevention and control of nosocomial infections in US hospitals.

Since 1981, the Centers for Disease Control (CDC) has been publishing Guidelines for the Prevention and Control of Nosocomial Infections as a useful reference tool in infection control. The extent to which practices recommended by CDC to reduce hospital-acquired infections have been successfully diffused and adopted were evaluated in a stratified random sample of 445 US hospitals that were sent a questionnaire in 1985. The data suggest that over 84% of infection control practitioner respondents (78% response rate) are aware of each guideline, although small hospitals (less than 50 beds) are least likely to be aware of the guidelines or to have reviewed them thoroughly. Adoption of the recommendations remains far from universal, ranging from 23% to 75% for 16 specific recommendations investigated. Smaller hospitals were significantly less likely than large hospitals to have adopted each suggested policy. Recommendations that carried Category I rankings were more likely to be adopted, as were those procedures that had cost-savings implications.

Centers for Disease Control and Prevention, U.S.↗

PubMed2001

Monitoring adherence to Standard Precautions.

BACKGROUND: Health care workers (HCWs) do not consistently follow Standard Precautions (SP). This is a serious problem because inadequate compliance is associated with increased blood exposure thus predisposing HCWs to bloodborne pathogen transmission. METHODS: The primary goal of this study was to identify institutional factors associated with adequacy of HCW training to monitor coworkers' adherence to SP. Surveys were sent to all community hospital infection control practitioners (ICPs) in Iowa and Virginia. ICPs indicated on a 5-point Likert scale, ranging from strongly disagree to strongly agree, their assessment of HCW training adequacy. Data from another statewide survey of HCWs in Iowa were assessed to validate this outcome measure. Multiple logistic regression models were developed to identify predictors of assessed training adequacy. Independent variables included methods of education, training, approaches to SP compliance assessment, provision of SP reinforcement by clinical leaders, and organizational data. RESULTS: A total of 149 institutions (62%) participated. Models of training program adequacy varied across occupations. Management commitment to SP training programs, leadership support, frequency of providing bloodborne pathogen information, and safety climate were important institutional predictors of assessed adequacy of training. The outcome was validated by demonstrating an association between the ICPs' assessment of HCW training and workers who reported having sufficient information to comply with SP (P <.05). CONCLUSIONS: Institutional safety climate, leadership support, and frequency of education play an important role in HCWs' training adequacy to monitor coworkers' adherence to SP. Occupational groups should be considered independently when strategies are developed to increase compliance. Interventions based on modifiable factors identified by this study may reduce bloodborne pathogen exposure among HCWs.

Blood-Borne Pathogens↗

PubMed1998

Methicillin-resistant Staphylococcus aureus: a questionnaire and microbiological survey of nursing and residential homes in Barking, Havering and Brentwood.

The study determined the policies and procedures for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) and its prevalence among nursing and residential homes, and evaluated whether certain home characteristics such as bed size, staffing level, and type of home are related to the prevalence of MRSA. A 21-questionnaire survey, with primarily categorical responses, was mailed to the home managers of all the 121 nursing and residential homes in the district, following which a simple, stratified random sample of 28 (23.14%) homes was taken and all agreeing residents screened from multiple sites for MRSA. Seventy-seven (63.6%) homes returned a completed questionnaire, 13 (46.4%) of whom agreed to participate in the microbiological study. The response rates for returning questionnaires and agreeing to participate in the microbiological study were similar for nursing and residential homes (65% vs. 60%; 67% vs. 40%; P = 0.12; P = 0.62), respectively. Nursing homes had a mean bed size of 30 (95% Confidence Interval (CI) 17-43), not significantly different from residential homes of 23 (95% CI 18-27; P = 0.26). The nursing homes employed a mean of 8.6 (95% CI 4.7-12.5) staff nurses per home; significantly higher than residential homes with a mean of 1.6 (95% CI 0.3-2.8; P = 0.006). No significant differences in mean number of home care assistants employed per home (22.8; 95% CI 12.4-33.13; and 14.4; 95% CI 11.83-16.90; P = 0.098, for nursing and residential homes, respectively) were observed. None of the homes had employed infection control practitioners. Only four (6.8%) of the responding homes stated that MRSA was a problem. Nursing homes were not significantly more likely to have admission policies for colonized person than residential homes (10/13 vs. 40/55, P = 1.00). Of the fifty-five (71.4%) homes who had admission policies, 40 (72.7%) stated that persons colonized/infected with MRSA would not be accepted, while 12 (21.8%) would accept such persons in single-room isolation and/or barrier nursing. Greater proportions of residential homes than nursing homes would not accept admission of persons with documented MRSA colonization (30/35 vs. 4/10, P = 0.007). Four (9.1%) homes (three nursing) had identified a total of five residents colonized/infected with MRSA in 5 years prior to the survey. Two hundred and forty-six residents were screened (552 sites), two (0.81%) of whom were found to be colonized in the nose (one resident) and in the groin (two residents) with MRSA, giving a 2-month weighted point prevalence rate of 0.14% (95% CI 0.01-0.26%). We conclude that in our district the nursing staffing levels and control measures vary widely within these homes, while the prevalence of residents who are colonized/infected with MRSA is lower than in other areas. We suggest that the exclusion admission policy for MRSA positive patients should be abandoned and targeted infection control programmes be instituted.

Carrier State↗

PubMed2006

Risk factors for surgical site infections in older people.

OBJECTIVES: To identify risk factors for surgical site infection (SSI) in older people and to test a priori hypotheses regarding particular variables and SSI risk. DESIGN: Case-control study. SETTING: Duke University Medical Center and seven community hospitals in North Carolina and Virginia. PARTICIPANTS: Elderly patients (> or =65) who underwent surgery between 1991 and 2002 at the study hospitals. Cases were elderly patients with SSI; controls were elderly operative patients without SSI. Infection control practitioners prospectively identified patients. MEASUREMENTS: Data were collected retrospectively. Case patients who developed SSI were compared with control patients who did not develop SSI. RESULTS: Five hundred sixty-nine SSI cases were identified, and 589 uninfected controls were selected. In multivariate analysis, independent predictors of SSI included obesity (odds ratio (OR)=1.77, 95% confidence interval (CI)=1.34-2.32), chronic obstructive pulmonary disease (COPD) (OR=1.66, 95% CI=1.17-2.34), and a wound class classified as contaminated or dirty (OR=1.65, 95% CI=1.01-2.72). Having private insurance was associated with lower risk (OR=0.29, 95% CI=0.12-0.68). CONCLUSION: This study identified several independent predictors of SSI in older people, including comorbid conditions (COPD and obesity), perioperative variables (wound class), and socioeconomic factors (private insurance, which was associated with lower risk). The results from this study can be used to design and implement interventions for SSI prevention in high-risk older people.

Age Factors↗

PubMed1995

Postdischarge surgical site infection surveillance.

OBJECTIVE: To evaluate three methods for conducting post-discharge surgical site infection (SSI) surveillance. DESIGN: Patients undergoing in-patient and day-patient surgery were prospectively randomized to one of three surveillance methods: group 1, patient questionnaire (mailed back); group 2, surgeon follow-up card; or group 3, patient questionnaire (telephoned by an infection control practitioner [ICP]). There were 200 in-patients and 200 day-patients randomized to each group. Evaluation of SSI was conducted 30 days postoperatively. SETTING: A 760-bed tertiary care teaching hospital. RESULTS: Questionnaires were sent home with 350 patients. Fifteen in-patients and 35 day-patients were excluded; 15 in-patients and 17 day-patients returned questionnaires early (fewer than three weeks postoperation), leaving 54 of 185 in-patients (29.2%) and 25 of 165 day-patients (15.2%) with timely returns. Seven (three in-patients and four day-patients) reported symptoms of SSI. Surgeons received cards for 400 patients; cards were returned for 118 of 203 in-patients (58.1%) and 142 of 197 day-patients (72.1%). Twelve (seven in-patients and five day-patients) were reported to have developed SSI. ICPS telephoned 332 patients; 187 of 196 in-patients (95.4%) and 107 of 126 day-patients (84.9%) were reached in six or fewer attempts. Four in-patients and 74 day-patients were lost due to cancellation of surgery or no surgical incision. Fourteen (10 in-patients and four day-patients) reported symptoms of SSI. For group 1 patients, ICPS spent 17 h distributing questionnaires and instructing staff; for group 2, ICPs spent no time distributing material; and for group 3, ICPS spent at least 8 h completing data forms, 16.5 h on the telephone and 33 h conducting demographic data retrieval from the hospital computer. CONCLUSIONS: In this setting, surgeon follow-up cards were the most efficient and reliable method for conducting postdischarge SSI surveillance. They provided a good rate of return and were time efficient, and wound evaluation was done by trained professionals using standard criteria for diagnosis of postoperative SSI.

Aftercare↗

PubMed2002

Surveillance of ventilator-associated pneumonia in very-low-birth-weight infants.

BACKGROUND: Surveillance of ventilator-associated pneumonia (VAP) is an essential part of quality patient care. Very-low-birth-weight (VLBW) infants, many with tracheal microbial colonization and bronchopulmonary dysplasia (BPD), comprise a difficult group in whom to make a diagnosis of pneumonia with the Centers for Disease Control and Prevention (CDC) criteria for infants younger than 1 year. OBJECTIVE: Our objective was to retrospectively compare VAP surveillance diagnoses made by the hospital infection control practitioner (ICP) with those made by a panel of experts with the same clinical and laboratory evidence and supportive radiologic data. A secondary objective was to compare radiologic diagnosis of pneumonia made by the general hospital radiologists, by the panel of experts, and by a pediatric radiologist from another hospital. STUDY POPULATION: Thirty-seven VLBW infants identified as at risk for VAP by the ICP on the basis of a positive bacterial tracheal culture and the application of CDC criteria for the definition of pneumonia were studied. METHODS: Clinical and laboratory evidence and routine radiologic reports made by the general radiologist were reviewed independently by a panel of experts composed of 3 experienced neonatologists. Chest x-rays from the day before, day of, and day after the surveillance date were reviewed separately by the 3 neonatologists and also by a pediatric radiologist. RESULTS: After inter-reader reliability was found satisfactory (kappa's coefficient, 0.47-0.75; P <.05), the panel of neonatologists determined that the 37 VLBW infants represented 4 distinct clinical categories. Group 1 comprised 12 airway-colonized infants, aged 14 to 30 days, who on the surveillance date, albeit intubated, were asymptomatic, not treated with antibiotics, and survived. Group 2 comprised 11 airway-colonized infants, aged 7 to 42 days, who presented with equivocal clinical, laboratory, or radiologic signs of VAP and survived. Group 3 comprised 7 airway-colonized infants, aged 14 to 21 days, who were acutely ill (3 died) and had clinical and laboratory evidence of nosocomial bloodstream infection (BSI) but no radiologic signs of pneumonia. Group 4 comprised 7 infants, aged 14 to 28 days, who were acutely ill (4 died) and had clinical and laboratory evidence of infection and radiologic changes consistent with VAP. Radiologic Findings: General radiologists, neonatologists, and the pediatric radiologist agreed that none of the asymptomatic airway-colonized infants (Group 1) had VAP. General radiologists reported signs suggestive of pneumonia in 8 of 11 infants (Group 2), a finding not corroborated by the others. Everybody agreed on the absence of radiologic pneumonia in 6 of 7 patients with nosocomial BSI (Group 3) and on the presence of signs consistent with pneumonia in the remaining 7 infants (Group 4). CONCLUSION: Surveillance diagnosis of VAP in VLBW infants is difficult because current CDC definitions are not specific for this population. Isolated positive tracheal culture alone does not distinguish between bacterial colonization and respiratory infection. Clinical and laboratory signs of VAP, mostly nonspecific, can be found in other conditions such as bronchopulmonary dysplasia and nosocomial BSI. Routine radiologic reports suggestive of pneumonia in airway-colonized infants without definitive clinical and laboratory evidence of infection could be misleading. To improve accuracy, surveillance diagnosis of VAP in special populations such as VLBW infants should be reformulated; meanwhile, ICPs should seek consultation with experienced clinicians for interpretation of data.

Bronchopulmonary Dysplasia↗