Prevalence and Risk Factors of Healthcare-Associated Infections among Hospitalized Pediatric Patients: Point Prevalence Survey in Thailand 2021

Abstract

Background: Healthcare-associated infections (HAIs) pose a grave threat to patient safety, morbidity, and mortality, contributing to antimicrobial resistance. Thus, we estimated the point prevalence, risk factors, types, and pathogens of HAIs in hospitalized pediatric patients.

Methods: A point prevalence survey (PPS) of HAIs in hospitalized pediatric patients < 18 years old was conducted from March to May 2021. Outcomes, risk factors, and types of HAIs associated with HAIs in 41 hospitals across Thailand were collected.

Results: The prevalence of HAIs was 3.9% (95% CI 2.9-5.0%) (56/1443). By ages < 1 month, 1 month-2 years, 2-12 years, and 12-18 years, the prevalence of HAIs was 4.2%, 3.3%, 4.1%, and 3.0%, respectively (p = 0.80). Significant independent risk factors were extended hospital length of stay (LOS) and central venous catheter (CVC) use. Compared to an LOS of <4 days, LOSs of 4-7 days, 8-14 days, and >14 days had adjusted odds ratios (aORs) of 2.65 (95% CI 1.05, 6.68), 5.19 (95% CI 2.00, 13.4), and 9.03 (95% CI 3.97, 20.5), respectively. The use of a CVC had an aOR of 2.45 (95% CI 1.06-5.66). Lower respiratory tract infection (LRTI) was the most common HAI type (46.4%: 26/56). The highest prevalence of HAIs was predominantly observed in LRTI diagnoses, with the highest among these in the <1 month age category at 2.3% (17/738).

Conclusion: The prevalence of HAIs in hospitalized pediatric patients was 3.9%. Extended LOS and use of CVC were HAI risk factors. A strategy for reducing LOS and reviewing insertion indications or the early planned removal of a CVC was implemented. The surveillance of HAIs stands as a cornerstone and fundamental component of IPC, offering invaluable insights that enhance hospital IPC interventions aimed at preventing HAIs.

Keywords: and hospitalized pediatric patients; healthcare-associated infections; point prevalence survey; risk factor.

Figure 1

Prevalence of HAIs, proportion of hospitalized pediatric patients in 1443 hospitalized pediatric patients categorized by the proportion of hospital types (%) and age stages; age groups were defined as <1 month, 1 month to 2 years, 2 to 12 years, and 12 to 18 years. Notes: By hospital ownership type, 99.3% (1433/1443) of patients were in government-owned hospitals, 0.3% (4/1443) were in a Thai Army-owned hospital, and 0.4% (6/1443) were in a for-profit privately owned hospital. 95% CIs for the prevalence of HAIs by the following age categories are as follows: total cohort 95% CI = 2.9 to 5.0%; <1 mo age group 95% CI = 3.0 to 6.1%; 1 mo to 2 years age group 95% CI = 1.3 to 6.6%; 2–12 years age group 95% CI = 1.9 to 6.6%; and 12 to 18 years age group 95% CI = 1.1 to 6.5%. 95% CIs by hospital level were primary-level facilities 95% CI 0.1 to 4.3%; secondary-level facilities 95% CI 2.1 to 5.1%; and tertiary-level facilities 95% CI 3.5 to 7.1%. Abbreviations: NS, not significant.

Figure 2

Proportions of HAI types within each age group.