Sustained Reduction in Bloodstream Infections in Infants at a Large Tertiary Care Neonatal Intensive Care Unit

Abstract

Purpose Reduction of bloodstream infections (BSI) has emerged as an important patient safety goal. Implementation of central line insertion bundles, standardized line care protocols, and health care provider education programs have reduced BSI in neonatal intensive care units (NICUs) around the country. The ability of large tertiary care centers to decrease nosocomial infections, including BSI, has been demonstrated. However, long-term BSI reductions in infants are not well documented. We sought to demonstrate that a low incidence of BSI can be maintained over time in a tertiary care NICU. Subjects 6,790 infants admitted to a large, tertiary care NICU between 2005 and 2013. Design Retrospective intervention study. Methods A staged, multifaceted infection prevention plan was implemented beginning in October 2007 under nursing leadership. The incidence of BSI was determined annually for 2005-2013. Results Baseline BSI incidence for infants admitted to the NICU was 5.15 and 6.08 episodes per 1,000 infant-days in 2005 and 2006, respectively. After protocol implementation, the incidence of BSI decreased to 2.14/1,000 infant-days and 2.44/1,000 infant-days in 2008 and 2009, respectively. Yearly incidence remained low over the next 4 years and decreased even further to 0.20-0.45 infections/1,000 infant days. This represents a 92% decrease in BSI over a period of >5 years. Conclusions Implementation of a nursing-led comprehensive infection control initiative can effectively produce and maintain a reduction in the incidence of BSI in infants at a large tertiary care NICU. What this study adds Long term reductions in neonatal BSI are possible with implementation of a multidisciplinary team approach and strong nursing leadership.

Can we optimize antibiotic use in Norwegian neonates? A prospective comparison between a university hospital and a district hospital

“…The number of extremely premature infants with a positive blood culture (37% of all extremely premature infants in the units, EOS and LOS), is in line with international reports (45,46). It confirms the need for new strategies to prevent infections in these vulnerable neonates.…”

Improved survival and neurodevelopmental outcomes among extremely premature infants born near the limit of viability

“…In 2001, we introduced an educational campaign to prevent lung injury and established written guidelines to promote a consistent approach to caring for extremely premature infants. In 2007, we initiated an infection control program that resulted in a significant reduction in bloodstream infections [25]. In 2008, we began using donor breast milk in place of preterm formula when mother’s milk was unavailable.…”

Bundle para manuseio do cateter central de inserção periférica em neonatos

“…It was identified a lack of studies about this theme related to this specific population, being this, one of the limiting factors of the study. (9,(24)(25)(26)(27) Adherence to the use of bundle has shown significant results in reducing CLABSI in NICU, linked to permanent education practices. (9,26) A meta-analysis aimed at evaluating the efficacy of bundles of CLABSI prevention in neonatal, pediatric and adult Intensive Care Unit, identified that this strategy implementation in different countries presents positive results in costs reduction.…”

“…(9,24) Regarding the exchange of the stopcocks and connectors, item 4 of the Bundle, it was followed the guidelines of The Brazilian Health Regulatory Agency (ANVISA -Agência Nacional de Vigilância Sanitária), with the recommendation to perform it immediately when there are clots present or after collection of blood or administration of blood products, and with interval less than 96 hours if they remain unchanged; confirming the recommendations of other studies. (16,25,27) Item 5 includes the performance of the permeability test of the access before and after the use, to minimize the return of blood to the lumen of the Perform hand hygiene for 40 to 60 seconds, before and after handling the PICC with antiseptic solution of chlorhexidine gluconate and/or 70% alcohol gel; use procedure gloves and take off adornments.…”