“…5 b; Supplementary material 2, Table 4). The pooled estimate for blood culture-proven cases, a subgroup of HA neonatal sepsis cases, was 45.7 (95% CI 26.0–79.2, range 20.5–75.6) cases per 1000 NICU-treated neonates (five studies [ 59 , 65 , 66 , 69 , 70 ]) and accounted for 25.0% (95% CI 15.9–37.0%, range 16.5–50.7%)) of all HAIs. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Among the included studies, 28 were conducted in ICUs (including adult or paediatric ICU patients) [12,, 13 in NICUs [59][60][61][62][63][64][65][66][67][68][69][70][71] and 10 were conducted hospital-wide (including patients from all hospital wards) [6,[23][24][25][26][27][28][29][30][31] (Supplementary material 2, Table 1). Most hospital-wide and ICU-based studies were conducted in high-income countries (n = 26/38) and nations from the European and American WHO regions (n = 29/38) ( Fig.…”
Purpose: Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospitalacquired (HA) and ICU-acquired (ICU-A) sepsis. Methods: We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed. Results: Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low-and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.
“…5 b; Supplementary material 2, Table 4). The pooled estimate for blood culture-proven cases, a subgroup of HA neonatal sepsis cases, was 45.7 (95% CI 26.0–79.2, range 20.5–75.6) cases per 1000 NICU-treated neonates (five studies [ 59 , 65 , 66 , 69 , 70 ]) and accounted for 25.0% (95% CI 15.9–37.0%, range 16.5–50.7%)) of all HAIs. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Among the included studies, 28 were conducted in ICUs (including adult or paediatric ICU patients) [12,, 13 in NICUs [59][60][61][62][63][64][65][66][67][68][69][70][71] and 10 were conducted hospital-wide (including patients from all hospital wards) [6,[23][24][25][26][27][28][29][30][31] (Supplementary material 2, Table 1). Most hospital-wide and ICU-based studies were conducted in high-income countries (n = 26/38) and nations from the European and American WHO regions (n = 29/38) ( Fig.…”
Purpose: Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospitalacquired (HA) and ICU-acquired (ICU-A) sepsis. Methods: We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed. Results: Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low-and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.
“…Up to 5–10% of hospitalised patients in industrialised nations are affected1 with even higher rates in the neonatal intensive care unit (NICU). For example, in Europe an incidence of 25.6% was noted in NICUs over a 6-year period 2. In the USA, using a point prevalence survey design, 116 HAIs were documented from 827 admissions across 29 NICUs (14/100 admissions) 3.…”
ObjectivesTo evaluate the impact of implementing a simple, user-friendly eLearning module on hand hygiene (HH) compliance and infection rates.DesignPreintervention and postintervention observational study.ParticipantsAll neonates admitted to the neonatal intensive care unit (NICU) over the study period were eligible for participation and were included in the analyses. A total of 3422 patients were admitted over a 36-month span (July 2009 to June 2012).InterventionsIn the preintervention and postintervention periods (phases I and II), all healthcare providers were trained on HH practices using an eLearning module. The principles of the ‘4 moments of HH’ and definition of ‘baby space’ were incorporated using interactive tools. The intervention then extended into a long-term sustainability programme (phase III), including the requirement of an annual recertification of the module and introduction of posters and screensavers throughout the NICU.Primary and secondary outcome measuresThe primary outcome was HH compliance rates among healthcare providers in the three phases. The secondary outcome was healthcare-associated infection rates in the NICU.ResultsHH compliance rates declined initially in phase II then improved in phase III with the addition of a long-term sustainability programme (76%, 67% and 76% in phases I, II and III, respectively (p<0.01). Infection rates showed an opposing, but concomitant trend in the overall population as well as in infants <1500 g and were 4%, 6% and 4% (p=0.02), and 11%, 21% and 16% (p<0.01), respectively, during the three phases.ConclusionsInterventions to improve HH compliance are challenging to implement and sustain with the need for ongoing reinforcement and education.
Nosocomial infections in neonatal intensive care units are a preoccupying issue. Bacillus sp. can be pathogenic in immuno-compromised hosts, including premature infants. Central catheters and mechanical ventilation are potential sources of infection. We report for the first time a case of Bacillus licheniformis bacteremia in a premature infant. Recovery necessitated treatment with vancomycin and cefotaxime in combination with removal of the central catheter.
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