IPS 2011 offered an insight into infection control in paediatrics – highlighting a variety of key issues, including the need to tailor prevention strategies to target children and neonates.
Dr Andrew Riordan, consultant in paediatric diseases, Alder Hey Children’s NHS Foundation Trust, raised some important issues concerning the relevance of mandatory surveillance and infection prevention guidance in relation to children.
He pointed out that MRSA and C.difficile rates are not good markers of infection prevention and control for children’s hospitals. In fact, national targets focusing on MRSA bacteraemia and C.difficile miss the majority of hospital acquired infections in children and may take attention away from preventing the more important paediatric healthcare associated infections.
For example, Rotavirus is the most common cause of hospital associated diarrhoea, in children, and causes around half a million deaths per year, around the world, due to dehydration: “For every two or three children you admit with Rotavirus, you will get another one who will obtain the virus as a hospital acquired infection,” he warned.
Dr Riordan added that while C.difficile is the infection most often associated with diarrhoea in adult patients, it is difficult to gain an accurate picture of rates in children: “C.difficile is part of the natural bowel flora in babies. It is normal to find C.difficile in young children’s stools, but what does this mean?” he questioned.
He also drew attention to another major cause of hospital acquired infection on paediatric units – Respiratory Syncytical Virus (RSV), which causes around half a million deaths each year. This infection is a major cause of being in hospital with bronchiolitis, with around 70% of cases due to RSV, said Dr Riordan.
Although prevalence rates are not as high as for Rotavirus, a study in the US found that hospital acquired RSV resulted in hospital stays that were twice as long. Dr Riordan pointed out that if a child enters hospital with community acquired RSV their length of stay will be around five days compared to 10 for hospital acquired RSV. More importantly, on a paediatric intensive care unit, the mortality rate for RSV is very high at around 12% to 15%.
“There is significant potential for morbidity and mortality with this type of infection, but how many times does EPIC 2 mention RSV? The answer is that it doesn’t. Is it preventable? Yes it is,” exclaimed Dr Riordan.
“We have to do things differently with children when it comes to infection prevention and control,” he continued. “The first rule of infection prevention, when it comes to paediatrics, is that you cannot treat children like adults.”
“If healthcare organisations are to achieve the same progress in reducing infections in infants, as has been already been achieved in adults, adapting guidelines to ensure they are paediatric focused will be crucial,” he concluded.
