DETECTING PEDIATRIC NOSOCOMIAL INFECTIONS - HOW DO INFECTION-CONTROL AND QUALITY ASSURANCE PERSONNEL COMPARE

Objective: To compare how well infection control (IC) and quality assu rance (PA) personnel in a specialty setting identify the presence, typ e (nosocomial or community-acquired), and (if nosocomial) site of infe ction. Methods: In 1994, we mailed a survey that included 21 pediatric case histories to IC and QA personnel in pediatric settings in the Un ited States (children's hospitals and medical school-affiliated hospit als with pediatric wards of >30 beds). From the case histories present ed, the respondents were asked to determine whether an infection was p resent and, if so, whether it was nosocomial or community-acquired. If the infection was nosocomial, the respondent was asked to determine t he site of the infection (e.g., urinary tract, bloodstream). Results: From the 289 hospitals to which surveys were mailed, 131 respondents ( 45.3%) completed 212 surveys. Of the 212 returned surveys, 120 (56.6%) were completed by IC personnel and 92 (43.4%) were completed by QA pe rsonnel. Among the 183 respondents from acute care pediatric settings, 92.3% of IC personnel (96/104) and 54.4% of QA personnel (43/79) corr ectly identified at least 75% of the nosocomial infections (n = 14; p < 0.0001). IC and QA personnel were similar in ability to identify com munity-acquired infection (88/104 vs 70/79, respectively; p = 0.436). IC personnel were significantly more likely than QA personnel to accur ately identify the following sites of infection: respiratory tract inf ection without secondary bloodstream infection, necrotizing enterocoli tis, urinary tract infection with and without secondary bloodstream in fection, primary bloodstream infection, surgical site infection, gastr oenteritis, esophagitis, and clinical sepsis. Conclusions: Overall, IC personnel were more accurate than QA personnel in determining whether a nosocomial infection was present and in correctly determining most sites of infection. Both IC and QA personnel had difficulty identifyin g venous infection and respiratory tract infection with secondary bloo dstream infection. Both IC and QA personnel could thus benefit from mo re concise definitions or further training in detection of these sites of nosocomial infections. In addition, QA personnel did not perform o verall as well as IC personnel in identifying nosocomial infections an d their sites; this finding suggests the need for QA personnel to be p rovided specific training on detection of nosocomial infections and va lidation of their ability to do so. Nosocomial infection surveillance should be the responsibility of those trained and proved capable of de tecting these infections.