When considering the work involved in repairing the hearts of children, it’s natural to first think of the surgery or operation itself. Images of operating rooms, surgeons in scrubs and masks, ventilators, anesthesia, etc., come to mind. There’s no doubt about it – the heart operation is a central part of the repair and healing process.
At West China Hospital in Chengdu, China, a poster reinforces the importance of hand washing for ICU staff.
However, as critical as it is, a successful heart operation is only one of the many steps on a child’s road to recovery. In the Intensive Care Unit (ICU), attending physicians, nurses, respiratory therapists and other medical professionals must work together to help children recover from the trauma of an operation and the stress of being on the heart-lung bypass machine. During the operation, the surgeon and operating room team hold the life of the child in their hands. After the operation, the ICU team must also work closely together to ensure a child’s successful recovery.
Over the years, Children’s HeartLink has seen the overall level of pediatric cardiac surgical skills improve in the countries in which we work. However, ICU, or critical care, skills often need extra attention. One particular issue that Children’s HeartLink sees repeatedly, is the need to reduce post-operative infections, many of which can start soon after an operation while the child is still in the ICU. Increasingly, infection control is a key area of focus during Children’s HeartLink training visits.
Medical volunteers from The Hospital for Sick Children (SickKids) in Toronto have been partnering with West China Hospital in Chengdu, China since 2006. Cardiologist and intensivist Steve Schwartz, M.D., a member of the SickKids team, emphasizes the importance of reducing post-op infections. “Infection control is a crucial aspect of improving outcomes in developing countries. There are often customs and practices that are based on outdated notions of the cause of major infections and how to prevent them. By working with partner institutions on simple things they can do to reduce infections, we can have a major impact with very little cost.
“Effective hand washing, initiatives to prevent ventilator associated pneumonia and central line infections, and teaching rational use of antibiotics are all part of what we do. At our partner site in Chengdu, China, they report as much as a 90 percent decrease in infections since adopting some of these strategies,” said Schwartz.
While hospital infections are still a concern for developed countries, recent research indicates developing countries face a greater struggle. In a study published in The Lancet in January 2011, researchers found much higher infection rates in developing countries (15.5 per 100 patients) than in the U.S. (4.5) or Europe (7.1). The difference in intensive care infections was even greater, with developing countries reporting infection rates of 47.9 per 1,000 patient-days, compared to 13.6 in the US.
As research and experience indicate, higher infection rates lead to deaths, longer hospital stays and additional costs, yet simple, low cost measures can make a big difference. Children’s HeartLink is helping all our partner hospitals learn how to better prevent and control in-hospital infections – and saving lives in the process.
 Benedetta Allegranzi M.D., Sepideh Bagheri Nejad M.D., et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis,” The Lancet, Volume 377, Issue 9761, Pages 228 – 241, 15 January 2011.