Hülya MARAŞ, Ayper SOMER, Murat SÜTÇÜ, Manolya ACAR, Nuran SALMAN

Bir Üniversite Hastanesinde Pediyatrik Sağlık Bakımı ile İlişkili Enfeksiyon Sürveyansı: Altı Aylık Prospektif İzlem

Amaç: Sağlık bakımı ile ilişkili enfeksiyon SBİE hastalarda artmış morbidite, mortalite ve maliyete neden olur ve hastanede yatan hastalarda en sık görülen komplikasyondur. Bu çalışmada, SBİE epidemiyolojisini, etken mikroorganizmaları ve direnç özelliklerini saptamak amaçlandı.Gereç ve Yöntem: İstanbul Üniversitesi İstanbul Tıp Fakültesi Hastanesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı servislerinde 1 Ocak 2010 - 30 Haziran 2010 tarihleri arasında yatan hastalar değerlendirmeye alındı. Dosya kayıtları, hemşire gözlemleri, radyoloji, mikrobiyoloji ve diğer tanı yöntemlerine ait raporlar incelenerek elde edilen veriler prospektif olarak toplandı.Bulgular: Çalışma süresi olan altı aylık dönemde 1900 hasta değerlendirilmiş olup, 176 hastada SBİE saptanmıştır. SBİE sıklığı tüm servislerde %9.3 %0.9-%28.1 , insidans yoğunluğu 10.86 0.82-24.86 / 1000 hasta günü saptandı. SBİE en sık sırasıyla yenidoğan yoğun bakım ünitesi, çocuk yoğun bakım ünitesi, hematoloji-onkoloji servisi & kemik iliği transplant ünitesi ve nöroloji servisinde görüldü. En sık görülen SBİE sırasıyla kan dolaşımı enfeksiyonu, pnömoni ve gastrointestinal sistem enfeksiyonlarıydı. Hastane enfeksiyonu yaşla ters ilişkili bulundu. Diğer risk faktörleri hastanede yatış süresi, girişimsel işlemler, ko-morbid hastalıklar, transfüzyon, antiasit kullanımı olarak belirlendi. Etken mikroorganizma 2 saptanan hastane enfeksiyonu olgularının %53’ünden gram-negatif bakteriler, %28’inden gram-pozitif bakteriler sorumluydu.Sonuç: SBİE sürveyansı; sorunların tanınması ve analiz edilmesi, enfeksiyon kontrol önlemlerinin hedefe yöneltilmesi ve geri bildirim yapılmasını sağlayan, SBİE azaltılmasında önemli bir basamaktır

Anahtar Kelimeler:

Hastane enfeksiyonu, çocuk, sürveyans, risk faktörleri

Surveillance of Pediatric Health Care Associatedm Infection in a University Hospital: Six-Years of Prospective Follow-up

Objective: Health care-associated infections HAIs increase patient morbidity, mortality and cost, and are the most common complications in hospitalised patients. The aim of this study was to determine the epidemiology, causative microorganisms, and resistance patterns of HAIs.Material and Method: Patients hospitalised between January 1, 2010 and June 30, 2010 in Istanbul University Faculty of Medicine Department of Children’s Health and Diseases were included in the study. Data in patient files, nursery observation charts, reports of radiology, microbiology and other diagnostic methods were investigated, and the data obtained were prospectively collected.Results: In the study period of six months, 1900 patients were evaluated and HAIs were detected in 176 patients. The frequency of HAIs in all services combined was 9.3% 0.9%-28.1% and incidence density was 10.86/1000 0,82-24.86/1000 patient days. HAIs were most frequently seen in neonatal intensive care unit, paediatric intensive care unit, haematology-oncology ward & bone marrow transplantation unit and neurology wardin order of decreasing frequency. The most frequently seen HAIs were blood stream infections, pneumonia and gastrointestinal system infections, respectively. The incidence of HAIs was found to be reversely related with age. Other risk factors were length of hospital stay, invasive interventions, co-morbid diseases, transfusion, antacid use. Gram-negative bacteria were responsible for 53% and gram-positive bacteria for 28% of nosocomial infections where the causative microorganisms were detected. Conclusion: HAIs surveillance is an important step for decreasing the hospital infection rates by recognising and analysing the problems, giving feed-back, directing the infection control measures toward the target

Keywords:

Hospital infection, child, surveillance, risk factors,

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