Effectiveness of simple strategies in reducing multidrug resistant bloodstream infections in the NICU of a tertiary care hospital in Karachi, Pakistan

Abstract

Background: Nosocomial infections in the neonatal intensive care unit (NICU) are a cause of increased mortality, length of stay and cost of management. There is limited data on strategies for reducing these infections from developing countries. Therefore we evaluated the effectiveness of implementation of six strategies in reducing the rate of nosocomial bloodstream infections (BSI) due to multidrug resistant organisms (MDRO) in the NICU.Methods: Using a pre and post design, the study was carried out (from June 2010-August 2011) at the NICU of the Aga Khan University, a tertiary care hospital with a 12-bed, level III NICU. The intervention comprised of hand washing certification for all NICU staff, use of chlorhexidine instead of povidone iodine for skin preparation, use of non-sterile gloves for diaper change, implementation of barrier nursing for clinically suspected and culture proven infections, provision of separate intubation & central line trolley for each room and limiting the use of umbilical catheters to7 days. Within unit transmission of multidrug resistant acinetobacter, pseudomonas, vancomycin resistant enterococcus (VRE), extended spectrum ␤ lactamase producer (ESBL) and methicillin resistant staphylococcus aureus (MRSA), were used as markers for nosocomial BSI. Average rates of BSI due to within unit transmission of MDRO are reported (3months pre-intervention period, 3 months implementation phase and 3months post intervention). Average number of admissions within the unit was used as denominator.Results: The average pre intervention rates of BSI due to ESBL, Acinetobacter, Pseudomonas and MRSA were 4.7, 3.3, 1.2 and zero respectively. In the implementation phase the BSI rates for all organisms dropped except for ESBL. A significant reduction in rates was observed in the post implementation period (ESBL 1.3, Acinetobacter 1.0, no case due to Pseudomonas and MRSA). No case of BSI due to VRE was reported during the entire study period. The average number of admissions during the 3 phases was almost similar (64, 49 and 51 respectively). There was sustained reduction in rates for all organisms, six months after the post intervention period.Conclusion: Nosocomial transmission of MDRO within the NICU can be effectively reduced by adoption of simple strategies.

Epidemiology and healthcare factors associated with neonatal enterococcal infections

“…Few studies address the role of nappies in the aetiology of neonatal infection. Disposable compared with cloth nappies reduce the risk of sepsis,31 and gloves for nappy changes may decrease the risk of spread of infections when used in conjunction with other infection control strategies such as handwashing certification 32. While gloves may also reduce spread of vancomycin-resistant Enterococcus spp onto healthcare worker hands, they are not fool-proof, rendering handwashing after glove removal essential 33…”

Knowledge, Attitudes, and Practices of NICU Doctors and Nurses Toward Prevention and Control of Nosocomial Infection With Multidrug Resistant Organism

“…The current study also found that training can enhance the self-reported behavioral compliance of medical staff, which was similar to the results of several other studies ( 12 , 21 , 24 ). In addition, one study ( 29 ) whose interventions included hand hygiene training and certification for medical staff effectively reduced MDRO infection. Training can not only improve the medical staff's grasp of infection prevention and control knowledge, deepen their understanding of MDRO infection prevention and control, and make them realize the importance of prevention and control but also regulate the behavior of doctors and nurses, which is an important means of improving the KAP of medical staff toward MDRO infection prevention and control.…”

Controle de infecções relacionadas à assistência à saúde por bactérias Gram-negativas resistentes à carbapenêmicos em unidade de tratamento intensivo neonatal do Rio de Janeiro.

“…Effective infection control programs are able to considerably reduce rates of HAI in neonates, including those caused by multi-resistant microorganisms. [1][2][3][4] Carbapenem-resistant Gram-negative bacteria (CR-GNB) are considered by the World Health Organization (WHO) to be critical in relation to the need to control the spread and research of new effective antimicrobials. The main measures described for prevention and control of these bacteria include: hand hygiene, contact precaution, patient isolation, environmental cleanliness, crop surveillance and monitoring, auditing and feedback of infection prevention and control interventions.…”