Research in context
Evidence before this study
We searched PubMed with the search terms “cross infection” [MeSH], “healthcare-associated infection$”, “nosocomial infection$”, and “hospital-acquired infection$”) in combination with “prevalence”, with age restriction (0–18 years) but without language or time restriction (up to June 30, 2016). Of 928 titles and abstracts, 15 reports were multicentre national or multinational prevalence surveys in high-income countries. One report was the pilot testing of the European Centre for Disease Prevention and Control (ECDC) point-prevalence survey in 2010. Two national surveys (Scotland and Poland) were part of the ECDC point-prevalence survey 2011–12 reported in this study. Most surveys were done in acute care adult or mixed adult and paediatric health-care settings. Only one multinational point-prevalence survey reported paediatric data. Between 1983 and 1987, WHO conducted a multinational prevalence survey in 47 hospitals of 14 high-income and upper-middle-income countries. Nine surveys were conducted in a general population in which children were included, two addressed neonatal intensive care only, and one was done in general paediatric wards. Finally, one study in the UK and Ireland focused exclusively on respiratory tract infections in children.
Added value of this study
This analysis of paediatric data from the ECDC point-prevalence survey 2011–12 represents the largest multinational study on prevalence of health-care-associated infections in children. The adjusted prevalence of health-care-associated infections was 4·2% (95% CI 3·7–4·8). The survey confirms that the burden of infections is highest in infants younger than 12 months and in neonatal and paediatric intensive care units. Bloodstream infection was the most common type of health-care-associated infection, not only in neonates and infants in their first 11 months of life but throughout most of childhood. With older age, infections such as lower respiratory tract infections or surgical-site infections were more common. The variation of prevalence among countries could not be explained by the distribution of paediatric settings, nor did it follow a geographical or socioeconomic pattern.
Implications of all the available evidence
Infection prevention and control should focus on the prevention of bloodstream infections in the youngest age groups, particularly in neonatal and paediatric intensive care units.