DC Child Accident & Safety Blog

Hospital infections have been a hot topic for a few years now, and most hospitals have made strides toward cleaning up their microbial act. A recent story in Consumer Reports, however, presents a bad news-goods news scenario about hospital-acquired infections in pediatric intensive care units.

Pediatric ICUs, the consumer group found, often have higher infection rates than ICUs for adults. The most threatening infections are delivered by catheters, tubes that provide nutrition, fluids and medication. If not inserted and managed under completely sterile conditions, they can spread infection throughout the body. In 2009, 1 in 4 of such infections were fatal.

Children are more susceptible to infection because their immune systems are less developed. And the very ill kids in ICUs are particularly vulnerable.

Part of the difficult of infection control, Consumer Reports said, concerns lack of information: “Of the 423 pediatric intensive-care units in the U.S., information on bloodstream infection rates is publicly available for less than half.” You cannot solve a problem of which you’re unaware.

By analyzing information from 92 pediatric ICUs in 31 states and Washington, D.C., Consumer Reports concluded that they carried an infection rate 20 percent higher than national rates for adult ICUs.

That’s the bad news. The good news is that parents can do something to minimize the chances of their child contracting an infection courtesy of the ICU.

If your child requires ICU care, and if your proximity, doctor’s admitting privileges and insurance coverage permit you to choose among hospitals, examine their respective infection rates as charted on the Consumer Reports website.

In choosing a pediatrician, find out where he or she has admitting privileges, and how those hospitals have performed.

If you don’t have the luxury of choice—and even if you do—here’s the Consumer Reports prescription for keeping infections at bay.

Ask the staff how you can help. A nurse has several patients to care for; parents have one. Watch that the central line stays clean, and that everyone in contact with it scrubs it clean and uses sterile equipment to access it.

Make sure the hospital follows best practices for inserting and maintaining central lines. This means disinfecting the site and changing the dressings regularly and standardizing procedures for changing the catheter caps and tubes. Following a regular routine with the proper tools is more protective than re-inventing the wheel each time. It’s not your job to know each of the steps; simply asking about them can remind staff to be extra vigilant about adhering to the safety measures.

Ask if the central line is still needed. Smaller veins can make it more difficult to insert catheters into a child, so sometimes doctors prefer to leave it in until they’re sure it’s no longer necessary. And once a child has a central line, often it’s used for blood samples, reducing a child’s exposure to traumatic needle sticks. Those practices can be good medicine, but they’re not without risk.

Keep hands clean. Make sure you, visitors and the hospital staff wash their hands with soap or an alcohol-based solution before touching your child or the catheter.

Watch the catheter. The line can come into contact with a diaper; a fidgeting child might put the lines in his or her mouth.

Take notes. Keep track of how often hospital staff change the catheter or dressing and how long the catheter has been in.

Raise an alarm. If something seems amiss, trust your instincts. Voice them and make sure someone responds.

Share your story. If you or someone you care for has been harmed by a hospital-acquired infection, contact Consumer Union’s Safe Patient Project, which raises awareness about hospital safety. That site offers a wealth of information about how patients can influence their care and that of their loved ones in positive ways.

Another resource for hospital patients, and potential patients, is Consumer Reports hospital survival guide.

Also, see our Web page on hospital monitoring.

For many children with autistic spectrum disorders who are learning to deal with autistic mannerisms, riding on a swing is a daily therapeutic activity whose effectiveness in improving sensory integration has been documented in scientific studies (see a ScienceDaily story published in April, 2008). However, a recent paper reports a potential hazard in these therapeutic swings that may cause eye injuries, according to the New York Times’ Roni Rabin.

Rabin cites a study appearing in the December 2009 issue of the Journal of the American Association for Pediatric Ophthalmology that describes two eye injury cases linked to the patients’ use of swings. In both cases, young autistic children presented to the hospital multiple times with small foreign objects in the eye that were found to be metallic fragments. Noticing that the multiple occurrences pointed to a common cause, the paper’s author, Dr. Dean Bonsall of the University of Cincinnati, took extensive history of the boys’ daily activities and discovered their frequent use of a swing.

Dr. Bonsall hypothesized that wear and tear of the swings caused small metal fragments to become dislodged and fall into children’s eyes. He recommended protective eyewear for one of the patients, which prevented further recurrence of the injury.

The study explains that the metallic foreign bodies in the eyes “leave a white scar and may become secondarily infected and lead to vision loss,” therefore requiring timely medical attention. However, autistic children, especially those who are non-verbal, often have difficulty communicating discomfort of foreign objects in their eyes and therefore can fall victim to delayed diagnosis.

Dr. Bonsall encourages parents of autistic children who use swings to give them protective eyewear or wrap the swing mechanism in a cloth.

Small children frequently get fevers and infections, and survive them just fine. But occasionally something more dangerous comes along. Here is a checklist of warning signs, put together by Consumers Report and the British Medical Journal. Go to the emergency room if your child has any of these:

• A blue or purplish tinge to the child’s skin, often around the fingernails or the mouth
• Rapid breathing
• Poor blood flow to the hands and feet. Your child’s hands or feet might feel much colder than usual, or their fingernails might take longer than a couple of seconds to turn pink again after being squeezed
• A rash caused by broken blood vessels under the skin. This kind of rash can be a symptom of meningitis. Some rashes will go away if you press them, but this kind won't.
• You can check by rolling a glass over the rash
• Drowsiness or loss of consciousness
• A seizure
• A fever measuring over 104 degrees Fahrenheit.

Also, trust your instincts. If you have a bad feeling that something might be seriously wrong, go ahead and take your child to the hospital. Those instincts are often correct, and if they're wrong, no harm is done by being cautious.

Here is the full report from Consumer Reports.