Evaluation of national health-care related infection
               criteria for epidemiological surveillance in neonatology

Ferreira, Janita; Bouzada, Maria C.F.; Jesus, Lenize A. de; Cortes, Maria da Conceição Werneck; Armond, Guilherme A.; Clemente, Wanessa T.; Anchieta, Lêni M.; Romanelli, Roberta M.C.

doi:10.1016/j.jped.2013.11.002

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Original Articles • J. Pediatr. (Rio J.) 90 (4) • Jul-Aug 2014 • https://doi.org/10.1016/j.jped.2013.11.002 copy

Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology ^☆ ☆ Please cite this article as: Ferreira J, Bouzada MC, de Jesus LA, Cortes MdC, Armond GA, Clemente WT, et al. Evaluation of national health-care related infection criteria for epidemiological surveillance in neonatology. J Pediatr (Rio J). 2014;90:389-95.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

to assess the use of the Brazilian criteria for reporting of hospital-acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN).

METHODS:

this was a cross-sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa.

RESULTS:

a total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient-days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%.

CONCLUSION:

there was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV.

Epidemiological surveillance; Infection; Neonatology; Newborn

Weight	No. of Patients at risk	No. of HAIs	Patients with HAIs (%)	IR of HAIs (/1,000 patient-days)	p-value	Risk (95% CI)
Up to 750 g	20	35	85.00	44.76	< 0.001	1.94 (1.32–2.84)
751 g to 1,000 g	65	88	73.85	28.23	0.16	1.22 (0.92–1.62)
1,001 g to 1,500 g	146	95	42.47	23.04	0.99	1.00 (0.76–1.32)
1,501 g to 2,500 g	348	198	34.77	30.37	0.02	1.32 (1.04–1.67)
> 2,500 g	303	106	26.73	23.06	-	1
TOTAL	882	522	37.30	27.28

Topography	Both	ANVISA	NHSN	Total	%
Sepsis
Sepsis with laboratory confirmation – late onset	102	0	0	102	19.5
Clinical sepsis – early	94	0	22	116	22.2
Clinical sepsis – late-onset	78	0	03	81	15.5
Sepsis with laboratory confirmation – early	6	0	0	6	1.1
Subtotal – sepsis	280	0	25	305	58.3

Skin infection – candidiasis	79	0	0	79	15.1
Conjunctivitis	32	2	0	34	6.5
Pneumonia with clinical diagnosis	32	0	0	32	6.1
Meningitis or ventriculitis	21	0	0	21	4.0
Necrotizing enterocolitis	11	6	0	17	3.3
Symptomatic urinary tract infection	10	0	0	10	1.9
Oral cavity infection – candidiasis	5	0	0	5	1.0
Skin infection – except candidiasis	3	0	0	3	0.6
Pneumonia with laboratory confirmation	3	0	0	3	0.6
Intra-abdominal infection	3	0	0	3	0.6
Skin infection (undefined)	3	0	0	3	0.6
Tracheal and bronchial infection	2	0	0	2	0.4
Artery or vein infection	2	0	0	2	0.4
Endocarditis	1	0	0	1	0.2
Asymptomatic bacteriuria	1	0	0	1	0.2
Other urinary tract infection	1	0	0	1	0.2
TOTAL	489	8	25	522	100.0

Test	Index	95% CI
Sensitivity	95.1%	92.8 - 96.8
Specificity	98.6%	97.1 - 99.3
PPV	98.4%	96.7 - 99.2
NPV	95.7%	93.6 - 97.1
Kappa	96.9%	92.6 - 97.4

Test for sepsis	Index	95% CI
Sensitivity	91.8%	88.0–94.5
Specificity	100.0%	99.3–100.0
PPV	100.0%	98.3–100.0
NPV	96.3%	94.5–97.6
Kappa	97.3%	96.1–98.6

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail: ferreira.jnt@gmail.com janitaferreira@bol.com.br (J. Ferreira).