To assess the appropriateness of using the indices developed by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) project to determine risk factors for surgical site infection (SSI) in children and, if not appropriate, to explore the factors related to SSI in children so these factors could be used in a risk index for pediatric patients.

Cohort study during more than 4 years.

La Paz University Hospital, a national reference center that serves Health Area 5 of Madrid, Spain, which has approximately 500,000 inhabitants.

Convenience sample consisting of the 3,646 children admitted for surgery who had a postsurgical stay of more than 2 days.

A model with 8 predictive factors (degree of surgical contamination; duration of surgery; type of surgery; use of a peripheral venous catheter, central venous catheter, or urinary catheter; number of diagnoses; and SSI exposition time) was created. Its relation to the SSI rate was better than that of the SENIC or NNIS indices. Its sensitivity, specificity, and area under the receiver–operating characteristic curve were higher than that of the SENIC index.

The model that we created seems to be more adequate for predicting SSI and evaluating pediatric patients' intrinsic risk than the SENIC and NNIS indices.

To evaluate the effectiveness of different disinfection treatments in a spa water system contaminated by Legionella pneumophila and associated with a case of Legionella pneumonia.

During an 18-month period, the spa water was analyzed by taking samples from the well, the recirculation line, and the final distribution devices (nebulizers and nasal irrigators). Various attempts were made to eradicate Legionella organisms by chemical and thermal shock. The final protocol consisted of heat shock treatment at 70°C-75°C for 3 hours, 2 nights per week, followed by a lowering of the water temperature to 30°C ± 1°C for use in the plant. In addition, 3 times a week superheated steam (at a pressure of 1 atmosphere) was introduced for 1 hour into the nebulization machines.

A spa at which sulfurous water was used for hydrotherapy by means of aerosol and nasal irrigation.

A 74-year-old woman with legionnaires disease.

After the case of infection occurred, L. pneumophila was isolated from the recirculation line at a concentration of 400,000 cfu/L and from the nebulizers and nasal irrigators at levels ranging from 3,300 to 1,800,000 cfu/L. The colonizing organisms consisted of a mixture of L. pneumophila serogroup 1 (12%) and serogroup 5 (88%). The shock treatment with chlorine dioxide and peracetic acid resulted in the eradication of Legionella organisms from the recirculation line but not from the water generated from the final distribution devices. After the restructuring of the plant and the application of thermal shock protocol, an evaluation after 12 months revealed no evidence of Legionella contamination.

To prevent Legionella colonization, disinfection treatment is effective if associated with carefully selected materials, good circuit design, and good maintenance practices.