Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

Abstract

INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7%) CA-BSIs were observed. There were 46 (32%) episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]). Neonates in the group after implementation of the intervention had 21 (19.6%) episodes of CA-BSI (14.9 per 1,000 CVC days). The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04). In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

A correlação entre procedimentos assistenciais invasivos e a ocorrência de sepse neonatal

“…The implementation of a "care bundle at the NICU" have revealed to be an effective strategy, through an evidence-based intervention group and recommendations from manuals, adopting a multifaceted approach to reduce the incidence of healthcare-associated sepsis. (21) In addition, the intensive and continuing education of the entire health team effectively reduces the HAI (22) , contributing to improve the neonatal health indicators.…”

Método bundle na redução de infecção de corrente sanguínea relacionada a cateteres centrais: revisão integrativa

“…We observed that nine studies (60%) had adult population as their target audience (9,(17)(18)(22)(23)25) , two of them (13,3%) were carried out with children (5,24) , three of them (20%) with newborns (15)(16)20) , and one of them (6,7%) with both populations, in pediatric and neonatology units (14) . Eight of them (53,3%) were developed in the USA (6,9,(15)(16)18,(22)(23)25) and only three (20%) were developed in Latin America, two of them in Brazil (20)(21) and one in Colombia (14) .…”

“…Eight of them (53,3%) were developed in the USA (6,9,(15)(16)18,(22)(23)25) and only three (20%) were developed in Latin America, two of them in Brazil (20)(21) and one in Colombia (14) .…”

“…Articles analysis regarding the type of bundle methodology described showed that they were composed of at least three and at most six interventions and the majority of the prospective studies presented statistically significant results regarding CRBSI and CLABSI reduction, being CLABSI the object of study in most of the articles (9,(15)(16)(19)(20)(21)(22)25) . Table 1 presents the summary of the interventions described as bundle elements and the number of times that each strategy was listed in the fifteen analyzed articles.…”

“…Bundle can include constant surveillance, health staff education, training of catheterinserting / handling staff and prevention strategies against bloodstream infection (9,14,(16)(17)(18)(19)(20)(21)(22)(23)(24) .…”