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Nosocomial infections are the single most common adverse event experienced by hospitalized children and adults. A recent multicenter survey found that 6% of patients develop nosocomial infections during admission to an acute care hospital.1 A point prevalence study performed in 30 pediatric facilities in Canada found an 8.7% prevalence of healthcare-associated infections and the prevalence was greatest for patients in intensive care units and oncology wards.2

Healthcare-associated infections increase morbidity, extend hospital stays, and raise hospital charges, and they are also associated with substantial increases of in-hospital mortality. An analysis of discharge data from more than 5 million pediatric hospitalizations revealed that postoperative sepsis and infection as a result of medical care were common events among hospitalized children and had a remarkable impact on length of stay and hospital costs.3 These findings persisted even after adjustment for patient and hospital characteristics (Table 5-1). Additionally, patients with a healthcare-associated infection were more likely to require the use of isolation precautions and antimicrobial therapy.2

TABLE 5-1Impact of Nosocomial Infections in Hospitalized Children

Thus the risk of healthcare-associated infections is significant, and the consequences are great. It is critical that all members of a healthcare team remain vigilant in order to prevent their patients from acquiring nosocomial infections during hospitalization.


To prevent nosocomial infections, healthcare providers must understand how organisms are transmitted, both between individuals and from the environment or an inanimate object to a patient, how and when colonizing organisms (often referred to as commensal organisms) can become pathogenic, and how host and environmental factors modify the risk of nosocomial infection.


Three basic mechanisms explain how most microorganisms are transmitted from one person to another: contact, either direct or indirect; droplet transmission; and airborne spread.

Contact is the most common route by which the vast majority of bacteria and viruses are spread among patients and healthcare workers. Viruses, such as respiratory syncytial virus (RSV), and bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), are typically spread directly from one person to another, particularly when infected or colonized children play together in hospital playrooms. Hands, particularly those of healthcare workers, are another critical method by which potentially pathogenic organisms spread between patients. Indirect contact or fomite transmission is yet another common way that organisms, especially ...

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