Objective To identify risk factors for the first healthcare-associated infection (HCAI) in a paediatric intensive care unit (PICU).
Methods Prospective cohort study in a clinical–surgical PICU in a hospital that treats patients from the public health system.
Results From January 2005 to June 2006, daily accompaniment was carried out during the length of stay in the PICU through to 48 h after discharge of 870 children (5773 patient-days) between 0 and 18 years of age. In 256 admissions, there were 363 episodes of HCAI, with a cumulative incidence of 41.7% and a density of 62.9/1000 patient-days. Intrinsic and extrinsic factors were investigated and measured until occurrence of the first HCAI, diagnosed according to National Institute of Statistical Sciences criteria, or until discharge or death. In multivariate logistic regression analysis, risk factors for the first HCAI in the PICU, controlled for length of stay, were the following: age under 2 years (odds ratio (OR) 1.80; 95% CI 1.30 to 2.49); longer time on respirator (OR 1.16; 95% CI 1.08 to 1.25); use of blood products (OR 1.49; 95% CI 1.08 to 2.06), corticoids (OR 1.45; 95% CI 1.04 to 2.02) and gastric acid H2 blockers (OR 1.47; 95% CI 1.05 to 2.06).
Conclusions Efforts towards reduction of exposure to extrinsic risk factors should be made, as each of these factors accounts for an approximately 30% risk of HCAI. Interventions directed at processes related to the use of a respirator and limitations on its duration of use should be a priority as a HCAI control strategy, as each day of respirator use increased the risk of HCAI by 16%.