1. Paediatric Infection Control
Jodie Burr
Infection Control Coordinator
Women’s and Children’s Hospital

2. Primary Role of Infection Control
Prevent nosocomial infections
Reduce mortality, morbidity, and cost
Educate and advise
staff
patients
their families
the community
Surveillance of nosocomial infections
Policy development, implementation and assessment

3. IC Issues specific to Paediatrics
Communicable diseases affect a higher % of paediatric patients than adults
Developmental immunity (increased susceptibility) - acquire – spread

4. IC Issues specific to Paediatrics
Paediatric personnel are at a greater risk for exposure to communicable diseases - immune status
Type and amount of physical contact (eg feeding, diapering)

5. IC Issues specific to Paediatrics
May lack the mental / physical ability to adhere to IC principles
lack of hygiene
unable to understand / comply with IC principles

6. IC Issues specific to Paediatrics
More likely to have contact with contaminated environmental surfaces and objects

7. IC Issues specific to Paediatrics
Parents and siblings
may have the same infectious agent
involved in patient care – education about transmission and IC principles

8. IC Issues specific to Paediatrics
Types of pathogens and sites of nosocomial infection differ from adults.
Most common nosocomial infections (paediatrics):
Viral infections of the upper respiratory tract
Viral infections of the gastrointestinal tract
Most common nosocomial infections (adults):
UTI

9. IC Issues specific to Paediatrics
Neonatal and ICU
Bacteraemias are the most common source of nosocomial infection
Adult ICU
The lower respiratory tract is the
most common source of nosocomial
infection
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):

10. Incidence of Nosocomial Infection
Incidence varies by age and hospital unit:
Range: 0.2% %
Paediatric ICU %
Haematology Unit 8.2%
Neonatal Unit 7.0%
General Paediatric Unit 1.0%
Highest in children aged 23 months or younger
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):

11. Additional Length of Stay
Duration of hospitalisation is longer for children with nosocomial infections
Paediatric ICU
26.1 days vs 10.6 days
General Paediatric Units
9.2 days vs 3.5 days
Attributable cost of infection $13,000
Alexis, M. Steps to Reduce Nosocomial Infections in Children, Infectious Medicine, 2002, 19 (9):

12. Spread of Infection Sources of infections
The host’s own (endogenous) flora
The hand’s of health care workers
Inanimate objects (fomites)
After being exposed to an infectious agent:
Some people already have immunity and therefore don’t develop an infection
Some people become asymptomatic carriers
Other people develop clinical disease (ie infection)

13. Spread of Infection The Susceptible Host Varies with age
Underlying medical conditions
Nutritional status
Drug therapy
Trauma
Surgical procedures
Invasive or indwelling devices
Therapeutic and diagnostic procedures

14. Spread of Infection 3 main routes of transmission Contact
Direct / Indirect
Most frequent means of transmission
Droplet
Generated during coughing, sneezing, talking and during certain procedures such as suctioning
Airborne
Generated by coughing, sneezing, OR by mechanical respiratory aerosolisers, OR by air currents

15. Standard Precautions Apply to:
Blood
Non-intact skin
Mucus membranes
All body fluids (including sweat)
Regardless of whether there is visible blood or body fluids

16. Hand Hygiene
The single most effective method in the prevention of disease transmission
Healthcare workers think they wash their hands more than what they do
80 % hospital acquired infections are thought to be transmitted by hands

17. Hand Hygiene Soap and Water
mechanical removal of most transient flora and soil
minimal microbial kill
no sustained activity
15 seconds

18. Hand Hygiene Antimicrobial Soaps
removes soil, removes transient and reduces resident flora
may have sustained activity
15 seconds (antiseptic handwash)
60 seconds (clinical handwash)
2 minutes (surgical scrub)

19. Hand Hygiene Alcohol Handrubs / Gels very rapid kill
destroys transient and reduces resident flora
no residual activity (except with antiseptic)
will not remove or denature soiling
15 seconds

20. Personal Protective Equipment
Eye and/or facial protection (glasses, goggles, face shields)
Gloves
Gowns
Masks
Assess the likely hood of contamination and prepare accordingly

21. Assessment of Risk Factors
Your knowledge or experience with the situation or procedure
The likely hood of exposure to blood or body fluids at the time
The patients ability to cooperate through out the procedure

22. Additional Precautions
May include:
Single room accommodation (ensuite for some)
Special ventilation (negative, positive pressure)
Special room cleaning
Dedicated patient equipment
Rostering of immune staff
Extended sterilization (or use of disposable equipment)
Cohorting may be considered

25. Multi-resistant organisms (MRO)
MRSA: Methicillin resistant Staphylococcus aureus
VISA: Vancomycin intermediate Staphylococcus aureus
VRSA: Vancomycin resistant Staphylococcus aureus
VRE: vancomycin resistant enterococci
ESBL: Extended spectrum beta-lactamase
MRGN: Multi-resistant gram negative
MRPA: Multi-resistant Pseudomonas aeruginosa
MRAB: Multi-resistant Acinetobacter baumanii

26. Multi-resistant organisms
(MRO)
Difficult to treat and control
Have the ability to cause infections, particularly in susceptible people
Have the ability to cause wound infections, bacteraemias and IV line sepsis
Can cause significant morbidity and mortality
Increased community awareness and expectations

27. Factors that contribute to the acquisition of MROs
Staff - inadequate handwashing
Environmental - inadequate cleaning
Prolonged or inappropriate antibiotic treatment
Close proximity to a MRO patient
Extended hospital stay
Co-morbidities
ICU / Burns Unit

28. Respiratory Syncitial Virus
Highly contagious and nosocomial infection common
Causes upper and lower respiratory infection
Usually occurs during winter
No vaccine at present
Can be re-infected during the same season
Transmitted by contact or droplet
Can survive for several hours in the environment

29. Respiratory Syncitial Virus

30. Rotavirus Highly contagious and nosocomial infection is common
Usually a winter disease but pattern changing
Onset is sudden and lasts for days
Mainly infants and children up to 3 years affected
Transmitted usually through contact
Can survive in environment for several hours

31. Rotavirus

32. Pertussis Bacterial infection caused by Bordetella pertussis
Most dangerous to under 3 year olds
Contagious for 3 weeks or for 5 days after commencing erythromycin
Transmitted by contact and droplet
Symptoms - runny nose, cough, which may develop into a whooping cough
High particulate mask when in contact with patient

33. Pertussis

34. Meningococcal Disease
Bacterial infection caused by Neisseria meningitidis
Transmitted by contact or droplet
Non infectious after 24 hours of appropriate antibiotic therapy
Significant contacts traced and may be given prophylaxis

35. Meningococcal Disease

36. Measles
Complications more common and severe in chronically ill and very young children
Transmitted by droplet and contact with respiratory secretions
Infectious for 4 days before and after rash
Vaccination available
Notifiable disease

37. Measles

38. Rubella In early pregnancy risk of teratogenic damage to fetus
Infectious for 7 days before and days after onset of rash
Infants with congenital rubella may shed virus for several months or years
Transmitted by droplet route
Vaccination available
Notifiable disease

39. Rubella

40. Varicella Zoster Virus Chicken Pox
Highly contagious
Most cases in children, over 90% of adult population is immune
Transmitted by droplet and contact
Infectious 2 days prior and days after rash
Now a notifiable disease
Vaccination now available

41. Varicella or Chicken-pox

42. Congenital varicella
Caused by maternal varicella in early pregnancy (ie <20 weeks)
Risk of acquiring congenital varicella syndrome is 1 - 2%
Range and severity of symptoms vary greatly depending on when maternal varicella infection occurred
intrauterine growth retardation, skin abnormalities, incomplete development of fingers/toes. Brain degeneration, nervous system damage, eye abnormalities

43. Congenital varicella

44. Parvovirus B19 Usually a mild rash disease
Also called Fifth Disease or “Slapped - Cheek”
Infectious prior to the rash
Transmitted by droplet route

45. Parvovirus B19