Healthcare-associated infection prevention in pediatric intensive care units: a review

  • N. Joram
  • L. de Saint Blanquat
  • D. Stamm
  • E. Launay
  • C. Gras-Le Guen


The objective of this review was to summarize the current knowledge base on the prevention of nosocomial infections in pediatric intensive care units (PICUs). Healthcare-associated infections (HAIs) are a crucial problem in PICUs because of their impact on patient outcome, length of hospital stay, and costs. Studies published between 1998 and 2011 were identified using the MEDLINE and Cochrane databases. Randomized, cohort, case–control studies, and meta-analyses concerning global strategies of prevention, general organization of the wards, general recommendations on antibiotic management, and measures for the prevention of ventilator-associated pneumonia (VAP), bloodstream infections (BSIs), urinary tract infections (UTIs), and surgical site infections (SSIs) were incorporated. Limits of age from 1 month to 18 years were used. When recommendations could not be supported by the pediatric literature, adult studies were also reviewed. This review excludes the neonate population. Specific pediatric data are often lacking so as to establish specific evidence-based pediatric recommendations. This review underlines the absolute necessity of pediatric studies and to harmonize the definitions of HAIs.


  1. 1.
    Abou Elella R, Najm HK, Balkhy H, Bullard L, Kabbani MS (2010) Impact of bloodstream infection on the outcome of children undergoing cardiac surgery. Pediatr Cardiol 31(4):483–489, Epub 2010 Jan 10PubMedCrossRefGoogle Scholar
  2. 2.
    Foglia EE, Fraser VJ, Elward AM (2007) Effect of nosocomial infections due to antibiotic-resistant organisms on length of stay and mortality in the pediatric intensive care unit. Infect Control Hosp Epidemiol 28(3):299–306, Epub 2007 Feb 20PubMedCrossRefGoogle Scholar
  3. 3.
    Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics 103(4):e39PubMedCrossRefGoogle Scholar
  4. 4.
    Olaechea PM, Ulibarrena MA, Alvarez-Lerma F, Insausti J, Palomar M, De la Cal MA; ENVIN-UCI Study Group (2003) Factors related to hospital stay among patients with nosocomial infection acquired in the intensive care unit. Infect Control Hosp Epidemiol 24(3):207–213PubMedCrossRefGoogle Scholar
  5. 5.
    Hugonnet S, Uçkay I, Pittet D (2007) Staffing level: a determinant of late-onset ventilator-associated pneumonia. Crit Care 11(4):R80PubMedCrossRefGoogle Scholar
  6. 6.
    Taylor RW, O’Brien J, Trottier SJ, Manganaro L, Cytron M, Lesko MF, Arnzen K, Cappadoro C, Fu M, Plisco MS, Sadaka FG, Veremakis C (2006) Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 34(9):2302–2308, quiz 2309PubMedCrossRefGoogle Scholar
  7. 7.
    Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36(5):309–332PubMedCrossRefGoogle Scholar
  8. 8.
    Dubos F, Vanderborght M, Puybasset-Joncquez AL, Grandbastien B, Leclerc F (2007) Can we apply the European surveillance program of nosocomial infections (HELICS) to pediatric intensive care units? Intensive Care Med 33(11):1972–1977, Epub 2007 Aug 1PubMedCrossRefGoogle Scholar
  9. 9.
    Raymond J, Aujard Y (2000) Nosocomial infections in pediatric patients: a European, multicenter prospective study. European Study Group. Infect Control Hosp Epidemiol 21(4):260–263PubMedCrossRefGoogle Scholar
  10. 10.
    Grohskopf LA, Sinkowitz-Cochran RL, Garrett DO, Sohn AH, Levine GL, Siegel JD, Stover BH, Jarvis WR; Pediatric Prevention Network (2002) A national point-prevalence survey of pediatric intensive care unit-acquired infections in the United States. J Pediatr 140(4):432–438PubMedCrossRefGoogle Scholar
  11. 11.
    Raymond J, Nordmann P, Doit C, Vu Thien H, Guibert M, Ferroni A, Aujard Y (2007) Multidrug-resistant bacteria in hospitalized children: a 5-year multicenter study. Pediatrics 119(4):e798–e803PubMedCrossRefGoogle Scholar
  12. 12.
    Bhutta A, Gilliam C, Honeycutt M, Schexnayder S, Green J, Moss M, Anand KJ (2007) Reduction of bloodstream infections associated with catheters in paediatric intensive care unit: stepwise approach. BMJ 334(7589):362–365PubMedCrossRefGoogle Scholar
  13. 13.
    Costello JM, Morrow DF, Graham DA, Potter-Bynoe G, Sandora TJ, Laussen PC (2008) Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 121(5):915–923PubMedCrossRefGoogle Scholar
  14. 14.
    Babcock HM, Zack JE, Garrison T, Trovillion E, Jones M, Fraser VJ, Kollef MH (2004) An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 125(6):2224–2231PubMedCrossRefGoogle Scholar
  15. 15.
    Dettenkofer M, Seegers S, Antes G, Motschall E, Schumacher M, Daschner FD (2004) Does the architecture of hospital facilities influence nosocomial infection rates? A systematic review. Infect Control Hosp Epidemiol 25(1):21–25, reviewPubMedCrossRefGoogle Scholar
  16. 16.
    Mulin B, Rouget C, Clément C, Bailly P, Julliot MC, Viel JF, Thouverez M, Vieille I, Barale F, Talon D (1997) Association of private isolation rooms with ventilator-associated Acinetobacter baumanii pneumonia in a surgical intensive-care unit. Infect Control Hosp Epidemiol 18(7):499–503PubMedCrossRefGoogle Scholar
  17. 17.
    Smith G, Smylie HG, McLauchlan J, Logie JR (1980) Ward design and wound infection due to Staphylococcus pyogenes. J R Coll Surg Edinb 25(2):76–79PubMedGoogle Scholar
  18. 18.
    Huebner J, Frank U, Kappstein I, Just HM, Noeldge G, Geiger K, Daschner FD (1989) Influence of architectural design on nosocomial infections in intensive care units—a prospective 2-year analysis. Intensive Care Med 15(3):179–183, reviewPubMedCrossRefGoogle Scholar
  19. 19.
    Preston GA, Larson EL, Stamm WE (1981) The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 70(3):641–645PubMedCrossRefGoogle Scholar
  20. 20.
    Société Française d’Hygiène Hospitalière (2000) Prévention du risque aspergillaire chez les patients immunodéprimés (hématologie, transplantation). Conférence de consensus, Paris 2000. Hygiènes 8(6):305–308Google Scholar
  21. 21.
    American Institute of Architects (AIA) Academy of Architecture for Health (AAH) (2001) Guidelines for design and construction of hospital and health care facilities. American Institute of Architects Press, Washington, DC.
  22. 22.
    Leone M, Garcin F, Bouvenot J, Boyadjev I, Visintini P, Albanèse J, Martin C (2007) Ventilator-associated pneumonia: breaking the vicious circle of antibiotic overuse. Crit Care Med 35(2):379–385, quizz 386PubMedCrossRefGoogle Scholar
  23. 23.
    de Man P, Verhoeven BA, Verbrugh HA, Vos MC, van den Anker JN (2000) An antibiotic policy to prevent emergence of resistant bacilli. Lancet 355(9208):973–978PubMedCrossRefGoogle Scholar
  24. 24.
    Patel JC, Mollitt DL, Pieper P, Tepas JJ 3rd (2000) Nosocomial pneumonia in the pediatric trauma patient: a single center’s experience. Crit Care Med 28(10):3530–3533PubMedCrossRefGoogle Scholar
  25. 25.
    National Nosocomial Infections Surveillance System (2004) National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32(8):470–485CrossRefGoogle Scholar
  26. 26.
    Urrea M, Pons M, Serra M, Latorre C, Palomeque A (2003) Prospective incidence study of nosocomial infections in a pediatric intensive care unit. Pediatr Infect Dis J 22(6):490–494PubMedGoogle Scholar
  27. 27.
    Elward AM, Warren DK, Fraser VJ (2002) Ventilator-associated pneumonia in pediatric intensive care unit patients: risk factors and outcomes. Pediatrics 109(5):758–764PubMedCrossRefGoogle Scholar
  28. 28.
    Wright ML, Romano MJ (2006) Ventilator-associated pneumonia in children. Semin Pediatr Infect Dis 17(2):58–64PubMedCrossRefGoogle Scholar
  29. 29.
    Principi N, Esposito S (2007) Ventilator-associated pneumonia (VAP) in pediatric intensive care units. Pediatr Infect Dis J 26(9):841–843, discussion 843–844PubMedCrossRefGoogle Scholar
  30. 30.
    Miyazawa R, Tomomasa T, Kaneko H, Tachibana A, Ogawa T, Morikawa A (2002) Prevalence of gastro-esophageal reflux-related symptoms in Japanese infants. Pediatr Int 44(5):513–516PubMedCrossRefGoogle Scholar
  31. 31.
    Amantéa SL, Piva JP, Sanches PR, Palombini BC (2004) Oropharyngeal aspiration in pediatric patients with endotracheal intubation. Pediatr Crit Care Med 5(2):152–156PubMedCrossRefGoogle Scholar
  32. 32.
    Gopalareddy V, He Z, Soundar S, Bolling L, Shah M, Penfil S, McCloskey JJ, Mehta DI (2008) Assessment of the prevalence of microaspiration by gastric pepsin in the airway of ventilated children. Acta Paediatr 97(1):55–60, Epub 2007 Dec 10PubMedCrossRefGoogle Scholar
  33. 33.
    Jongerden IP, Rovers MM, Grypdonck MH, Bonten MJ (2007) Open and closed endotracheal suction systems in mechanically ventilated intensive care patients: a meta-analysis. Crit Care Med 35(1):260–270PubMedCrossRefGoogle Scholar
  34. 34.
    Subirana M, Solà I, Benito S (2007) Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients. Cochrane Database Syst Rev 4:CD004581PubMedGoogle Scholar
  35. 35.
    Vonberg RP, Eckmanns T, Welte T, Gastmeier P (2006) Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: meta-analysis of randomized controlled trials. Intensive Care Med 32(9):1329–1335, Epub 2006 Jun 21PubMedCrossRefGoogle Scholar
  36. 36.
    Hess DR, Kallstrom TJ, Mottram CD, Myers TR, Sorenson HM, Vines DL; American Association for Respiratory Care (2003) Care of the ventilator circuit and its relation to ventilator-associated pneumonia. Respir Care 48(9):869–879PubMedGoogle Scholar
  37. 37.
    Kola A, Eckmanns T, Gastmeier P (2005) Efficacy of heat and moisture exchangers in preventing ventilator-associated pneumonia: meta-analysis of randomized controlled trials. Intensive Care Med 31(1):5–11, Epub 2004 Sep 11PubMedCrossRefGoogle Scholar
  38. 38.
    Boots RJ, George N, Faoagali JL, Druery J, Dean K, Heller RF (2006) Double-heater-wire circuits and heat-and-moisture exchangers and the risk of ventilator-associated pneumonia. Crit Care Med 34(3):687–693PubMedCrossRefGoogle Scholar
  39. 39.
    Lacherade JC, Auburtin M, Cerf C, Van de Louw A, Soufir L, Rebufat Y, Rezaiguia S, Ricard JD, Lellouche F, Brun-Buisson C, Brochard L (2005) Impact of humidification systems on ventilator-associated pneumonia: a randomized multicenter trial. Am J Respir Crit Care Med 172(10):1276–1282, Epub 2005 Aug 26PubMedCrossRefGoogle Scholar
  40. 40.
    Dreyfuss D, Djedaini K, Weber P, Brun P, Lanore JJ, Rahmani J, Boussougant Y, Coste F (1991) Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Respir Dis 143(4 Pt 1):738–743PubMedGoogle Scholar
  41. 41.
    Lorente L, Lecuona M, Galván R, Ramos MJ, Mora ML, Sierra A (2004) Periodically changing ventilator circuits is not necessary to prevent ventilator-associated pneumonia when a heat and moisture exchanger is used. Infect Control Hosp Epidemiol 25(12):1077–1082PubMedCrossRefGoogle Scholar
  42. 42.
    Fontela PS, Piva JP, Garcia PC, Bered PL, Zilles K (2005) Risk factors for extubation failure in mechanically ventilated pediatric patients. Pediatr Crit Care Med 6(2):166–170PubMedCrossRefGoogle Scholar
  43. 43.
    Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G (1998) The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 114(2):541–548PubMedCrossRefGoogle Scholar
  44. 44.
    Sadowski R, Dechert RE, Bandy KP, Juno J, Bhatt-Mehta V, Custer JR, Moler FW, Bratton SL (2004) Continuous quality improvement: reducing unplanned extubations in a pediatric intensive care unit. Pediatrics 114(3):628–632PubMedCrossRefGoogle Scholar
  45. 45.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342(20):1471–1477PubMedCrossRefGoogle Scholar
  46. 46.
    Quenot JP, Ladoire S, Devoucoux F, Doise JM, Cailliod R, Cunin N, Aubé H, Blettery B, Charles PE (2007) Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med 35(9):2031–2036PubMedCrossRefGoogle Scholar
  47. 47.
    Popernack ML, Thomas NJ, Lucking SE (2004) Decreasing unplanned extubations: utilization of the Penn State Children’s Hospital Sedation Algorithm. Pediatr Crit Care Med 5(1):58–62PubMedCrossRefGoogle Scholar
  48. 48.
    Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354(9193):1851–1858PubMedCrossRefGoogle Scholar
  49. 49.
    van Nieuwenhoven CA, Vandenbroucke-Grauls C, van Tiel FH, Joore HC, van Schijndel RJ, van der Tweel I, Ramsay G, Bonten MJ (2006) Feasibility and effects of the semirecumbent position to prevent ventilator-associated pneumonia: a randomized study. Crit Care Med 34(2):396–402PubMedCrossRefGoogle Scholar
  50. 50.
    Craig WR, Hanlon-Dearman A, Sinclair C, Taback S, Moffatt M (2004) Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev 4:CD003502, reviewPubMedGoogle Scholar
  51. 51.
    Fineman LD, LaBrecque MA, Shih MC, Curley MA (2006) Prone positioning can be safely performed in critically ill infants and children. Pediatr Crit Care Med 7(5):413–422PubMedCrossRefGoogle Scholar
  52. 52.
    Gauvin F, Dugas MA, Chaïbou M, Morneau S, Lebel D, Lacroix J (2001) The impact of clinically significant upper gastrointestinal bleeding acquired in a pediatric intensive care unit. Pediatr Crit Care Med 2(4):294–298PubMedCrossRefGoogle Scholar
  53. 53.
    Yildizdas D, Yapicioglu H, Yilmaz HL (2002) Occurrence of ventilator-associated pneumonia in mechanically ventilated pediatric intensive care patients during stress ulcer prophylaxis with sucralfate, ranitidine, and omeprazole. J Crit Care 17(4):240–245PubMedCrossRefGoogle Scholar
  54. 54.
    Lopriore E, Markhorst DG, Gemke RJ (2002) Ventilator-associated pneumonia and upper airway colonisation with Gram negative bacilli: the role of stress ulcer prophylaxis in children. Intensive Care Med 28(6):763–767, Epub 2002 Apr 20PubMedCrossRefGoogle Scholar
  55. 55.
    Reveiz L, Guerrero-Lozano R, Camacho A, Yara L, Mosquera PA (2010) Stress ulcer, gastritis, and gastrointestinal bleeding prophylaxis in critically ill pediatric patients: a systematic review. Pediatr Crit Care Med 11(1):124–132, reviewPubMedCrossRefGoogle Scholar
  56. 56.
    Krueger WA, Lenhart FP, Neeser G, Ruckdeschel G, Schreckhase H, Eissner HJ, Forst H, Eckart J, Peter K, Unertl KE (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 166(8):1029–1037PubMedCrossRefGoogle Scholar
  57. 57.
    de Jonge E, Schultz MJ, Spanjaard L, Bossuyt PM, Vroom MB, Dankert J, Kesecioglu J (2003) Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 362(9389):1011–1016PubMedCrossRefGoogle Scholar
  58. 58.
    Liberati A, D’Amico R, Pifferi S, Torri V, Brazzi L, Parmelli E (2009) Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care. Cochrane Database Syst Rev 4:CD000022PubMedGoogle Scholar
  59. 59.
    Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R; CDC; Healthcare Infection Control Practices Advisory Committee (2004) Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 53(RR-3):1–36PubMedGoogle Scholar
  60. 60.
    Barret JP, Jeschke MG, Herndon DN (2001) Selective decontamination of the digestive tract in severely burned pediatric patients. Burns 27(5):439–445PubMedCrossRefGoogle Scholar
  61. 61.
    Ruza F, Alvarado F, Herruzo R, Delgado MA, García S, Dorao P, Goded F (1998) Prevention of nosocomial infection in a pediatric intensive care unit (PICU) through the use of selective digestive decontamination. Eur J Epidemiol 14(7):719–727PubMedCrossRefGoogle Scholar
  62. 62.
    Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S; PneumA Trial Group (2003) Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 290(19):2588–2598PubMedCrossRefGoogle Scholar
  63. 63.
    Ibrahim EH, Ward S, Sherman G, Schaiff R, Fraser VJ, Kollef MH (2001) Experience with a clinical guideline for the treatment of ventilator-associated pneumonia. Crit Care Med 29(6):1109–1115PubMedCrossRefGoogle Scholar
  64. 64.
    Micek ST, Ward S, Fraser VJ, Kollef MH (2004) A randomized controlled trial of an antibiotic discontinuation policy for clinically suspected ventilator-associated pneumonia. Chest 125(5):1791–1799PubMedCrossRefGoogle Scholar
  65. 65.
    Stocker M, Fontana M, El Helou S, Wegscheider K, Berger TM (2010) Use of procalcitonin-guided decision-making to shorten antibiotic therapy in suspected neonatal early-onset sepsis: prospective randomized intervention trial. Neonatology 97(2):165–174, Epub 2009 Sep 24PubMedCrossRefGoogle Scholar
  66. 66.
    Kopterides P, Siempos II, Tsangaris I, Tsantes A, Armaganidis A (2010) Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: a systematic review and meta-analysis of randomized controlled trials. Crit Care Med 38(11):2229–2241, reviewPubMedCrossRefGoogle Scholar
  67. 67.
    Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, Schortgen F, Lasocki S, Veber B, Dehoux M, Bernard M, Pasquet B, Régnier B, Brun-Buisson C, Chastre J, Wolff M; PRORATA trial group (2010) Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 375(9713):463–474, Epub 2010 Jan 25PubMedCrossRefGoogle Scholar
  68. 68.
    Elward AM, Hollenbeak CS, Warren DK, Fraser VJ (2005) Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 115(4):868–872PubMedCrossRefGoogle Scholar
  69. 69.
    O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S. Pediatrics 110(5):e51PubMedCrossRefGoogle Scholar
  70. 70.
    de Jonge RC, Polderman KH, Gemke RJ (2005) Central venous catheter use in the pediatric patient: mechanical and infectious complications. Pediatr Crit Care Med 6(3):329–339, reviewPubMedCrossRefGoogle Scholar
  71. 71.
    Yogaraj JS, Elward AM, Fraser VJ (2002) Rate, risk factors, and outcomes of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics 110(3):481–485PubMedCrossRefGoogle Scholar
  72. 72.
    García-Teresa MA, Casado-Flores J, Delgado Domínguez MA, Roqueta-Mas J, Cambra-Lasaosa F, Concha-Torre A, Fernández-Pérez C; Spanish Central Venous Catheter Pediatric Study Group (2007) Infectious complications of percutaneous central venous catheterization in pediatric patients: a Spanish multicenter study. Intensive Care Med 33(3):466–476, Epub 2007 Jan 19PubMedCrossRefGoogle Scholar
  73. 73.
    Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A (2004) Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance. Infect Control Hosp Epidemiol 25(9):753–758PubMedCrossRefGoogle Scholar
  74. 74.
    Nahum E, Levy I, Katz J, Samra Z, Ashkenazi S, Ben-Ari J, Schonfeld T, Dagan O (2002) Efficacy of subcutaneous tunneling for prevention of bacterial colonization of femoral central venous catheters in critically ill children. Pediatr Infect Dis J 21(11):1000–1004PubMedCrossRefGoogle Scholar
  75. 75.
    Levy I, Katz J, Solter E, Samra Z, Vidne B, Birk E, Ashkenazi S, Dagan O (2005) Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J 24(8):676–679PubMedCrossRefGoogle Scholar
  76. 76.
    Ho KM, Litton E (2006) Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother 58(2):281–287, Epub 2006 Jun 6, review. Erratum in: J Antimicrob Chemother. 2010 Apr;65(4):815PubMedCrossRefGoogle Scholar
  77. 77.
    Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste-Orgeas M, Pease S, Herault MC, Haouache H, Calvino-Gunther S, Gestin B, Armand-Lefevre L, Leflon V, Chaplain C, Benali A, Francais A, Adrie C, Zahar JR, Thuong M, Arrault X, Croize J, Lucet JC; Dressing Study Group (2009) Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 301(12):1231–1241PubMedCrossRefGoogle Scholar
  78. 78.
    Gillies D, O’Riordan L, Wallen M, Morrison A, Rankin K, Nagy S (2005) Optimal timing for intravenous administration set replacement. Cochrane Database Syst Rev 4:CD003588, reviewPubMedGoogle Scholar
  79. 79.
    Shah PS, Shah VS (2008) Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database Syst Rev 2:CD002772, reviewPubMedGoogle Scholar
  80. 80.
    Schroeder AR, Axelrod DM, Silverman NH, Rubesova E, Merkel E, Roth SJ (2010) A continuous heparin infusion does not prevent catheter-related thrombosis in infants after cardiac surgery. Pediatr Crit Care Med 11(4):489–495PubMedGoogle Scholar
  81. 81.
    Pierce CM, Wade A, Mok Q (2000) Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med 26(7):967–972PubMedCrossRefGoogle Scholar
  82. 82.
    Anton N, Cox PN, Massicotte MP, Chait P, Yasui Y, Dinyari PM, Marzinotto V, Mitchell LG (2009) Heparin-bonded central venous catheters do not reduce thrombosis in infants with congenital heart disease: a blinded randomized, controlled trial. Pediatrics 123(3):e453–e458, Epub 2009 Feb 23PubMedCrossRefGoogle Scholar
  83. 83.
    Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, Klein JP (2000) Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: a randomized, multicenter, double-blind trial. J Clin Oncol 18(6):1269–1278PubMedGoogle Scholar
  84. 84.
    Safdar N, Maki DG (2006) Use of vancomycin-containing lock or flush solutions for prevention of bloodstream infection associated with central venous access devices: a meta-analysis of prospective, randomized trials. Clin Infect Dis 43(4):474–484, Epub 2006 Jul 11, reviewPubMedCrossRefGoogle Scholar
  85. 85.
    Chelliah A, Heydon KH, Zaoutis TE, Rettig SL, Dominguez TE, Lin R, Patil S, Feudtner C, St John KH, Bell LM, Coffin SE (2007) Observational trial of antibiotic-coated central venous catheters in critically ill pediatric patients. Pediatr Infect Dis J 26(9):816–820PubMedCrossRefGoogle Scholar
  86. 86.
    Stover BH, Shulman ST, Bratcher DF, Brady MT, Levine GL, Jarvis WR; Pediatric Prevention Network (2001) Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units. Am J Infect Control 29(3):152–157PubMedCrossRefGoogle Scholar
  87. 87.
    Matlow AG, Wray RD, Cox PN (2003) Nosocomial urinary tract infections in children in a pediatric intensive care unit: a follow-up after 10 years. Pediatr Crit Care Med 4(1):74–77PubMedCrossRefGoogle Scholar
  88. 88.
    Davies HD, Jones EL, Sheng RY, Leslie B, Matlow AG, Gold R (1992) Nosocomial urinary tract infections at a pediatric hospital. Pediatr Infect Dis J 11(5):349–354PubMedCrossRefGoogle Scholar
  89. 89.
    Pratt RJ, O’Malley B (2007) Supporting evidence-based infection prevention and control practice in the National Health Service in England. The NHS/TVU/Intuition Approach. J Hosp Infect 65(Suppl 2):142–147PubMedCrossRefGoogle Scholar
  90. 90.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 27:97–132, quiz 133–134, discussion 96PubMedCrossRefGoogle Scholar
  91. 91.
    Horwitz JR, Chwals WJ, Doski JJ, Suescun EA, Cheu HW, Lally KP (1998) Pediatric wound infections: a prospective multicenter study. Ann Surg 227:553–558PubMedCrossRefGoogle Scholar
  92. 92.
    Mehta PA, Cunningham CK, Colella CB, Alferis G, Weiner LB (2000) Risk factors for sternal wound and other infections in pediatric cardiac surgery patients. Pediatr Infect Dis J 19(10):1000–1004PubMedCrossRefGoogle Scholar
  93. 93.
    Pollock EM, Ford-Jones EL, Rebeyka I, Mindorff CM, Bohn DJ, Edmonds JF, Lightfoot NE, Coles J, Williams WG, Trusler GA, Barker GA (1990) Early nosocomial infections in pediatric cardiovascular surgery patients. Crit Care Med 18(4):378–384PubMedCrossRefGoogle Scholar
  94. 94.
    Segers P, Speekenbrink RG, Ubbink DT, van Ogtrop ML, de Mol BA (2006) Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate: a randomized controlled trial. JAMA 296(20):2460–2466PubMedCrossRefGoogle Scholar
  95. 95.
    Bode LG, Kluytmans JA, Wertheim HF, Bogaers D, Vandenbroucke-Grauls CM, Roosendaal R, Troelstra A, Box AT, Voss A, van der Tweel I, van Belkum A, Verbrugh HA, Vos MC (2010) Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 362(1):9–17PubMedCrossRefGoogle Scholar
  96. 96.
    De Chiara S, Chiumello D, Nicolini R, Vigorelli M, Cesana B, Bottino N, Giurati G, Caspani ML, Gattinoni L (2010) Prolongation of antibiotic prophylaxis after clean and clean-contaminated surgery and surgical site infection. Minerva Anestesiol 76(6):413–419PubMedGoogle Scholar
  97. 97.
    Harbarth S, Samore MH, Lichtenberg D, Carmeli Y (2000) Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 101(25):2916–2921PubMedCrossRefGoogle Scholar
  98. 98.
    Kato Y, Shime N, Hashimoto S, Nomura M, Okayama Y, Yamagishi M, Fujita N (2007) Effects of controlled perioperative antimicrobial prophylaxis on infectious outcomes in pediatric cardiac surgery. Crit Care Med 35(7):1763–1768. Erratum in: Crit Care Med. 2007 Sep;35(9):2240PubMedCrossRefGoogle Scholar
  99. 99.
    Tamayo E, Gualis J, Flórez S, Castrodeza J, Eiros Bouza JM, Alvarez FJ (2008) Comparative study of single-dose and 24-hour multiple-dose antibiotic prophylaxis for cardiac surgery. J Thorac Cardiovasc Surg 136(6):1522–1527PubMedCrossRefGoogle Scholar
  100. 100.
    Maher KO, VanDerElzen K, Bove EL, Mosca RS, Chenoweth CE, Kulik TJ (2002) A retrospective review of three antibiotic prophylaxis regimens for pediatric cardiac surgical patients. Ann Thorac Surg 74(4):1195–1200PubMedCrossRefGoogle Scholar
  101. 101.
    Greif R, Akça O, Horn EP, Kurz A, Sessler DI; Outcomes Research Group (2000) Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 342(3):161–167PubMedCrossRefGoogle Scholar
  102. 102.
    Belda FJ, Aguilera L, García de la Asunción J, Alberti J, Vicente R, Ferrándiz L, Rodríguez R, Company R, Sessler DI, Aguilar G, Botello SG, Ortí R; Spanish Reduccion de la Tasa de Infeccion Quirurgica Group (2005) Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 294(16):2035–2042. Erratum in: JAMA. 2005 Dec 21;294(23):2973PubMedCrossRefGoogle Scholar
  103. 103.
    Wong PF, Kumar S, Bohra A, Whetter D, Leaper DJ (2007) Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery. Br J Surg 94(4):421–426PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • N. Joram
    • 1
    • 2
  • L. de Saint Blanquat
    • 3
  • D. Stamm
    • 4
  • E. Launay
    • 2
  • C. Gras-Le Guen
    • 1
    • 2
  1. 1.Service de Réanimation PédiatriqueCHU NantesNantesFrance
  2. 2.CIC PédiatriqueCHU NantesNantesFrance
  3. 3.Département d’Anesthésie-RéanimationCHU Cochin—Saint Vincent de Paul, Assistance Publique Hôpitaux de Paris (APHP)ParisFrance
  4. 4.Service de Réanimation PédiatriqueCHU LyonLyonFrance

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