HEALTHCARE -ASSOCIATED INFECTIONS IN A NICU: EVALUATION OF THE EFFECTIVENESS OF IMPLEMENTED PREVENTION STRATEGIES
Keywords:Central venous catheter, healthcare-associated infections, neonatal intensive care unit, prevention, sepsis
Introduction: Neonates admitted to Neonatal Intensive Care Units (NICU) have a substantial risk for healthcare-associated infections (HAI). A high incidence of HAI was found in Maternidade Júlio Dinis (MJD) NICU and led to changes in daily clinical practice.
Objectives: To evaluate the effectiveness of new strategies for prevention of infection implemented in the NICU of MJD.
Methods: We conducted a prospective study that included all infants admitted to the NICU of MJD during the 16 months before (group 1) and 16 months after (group 2) the protocol change, comparing the rates of infection in these two time periods.
Results: 528 infants were included in group 1 and 593 in group 2, with no statistical evidence of different characteristics between them (weight, gestational age, CVC utilization rate, duration of parenteral nutrition and invasive ventilation). Overall mean infection indices decreased between the two periods: incidence -density of infection – sepsis, pneumonia, necrotizing enterocolitis and meningitis – (10,0 vs. 6,3; p=0,0007), incidence- -density of clinical plus laboratory -confirmed sepsis (9,6 vs. 5,9; p=0,0007), incidence -density of laboratory -confirmed sepsis (6,8 vs. 4,6; p=0,015), incidence rate of central vascular catheter (CVC) -associated sepsis (30,3 vs. 22,4; p=0,021) and coagulase- -negative Staphylococcus isolation rate (85,7% vs. 71,1%; p=0,041). Although incidence rate of laboratory -confirmed CVC- -associated sepsis decreased (22 vs. 19), the difference was not significant. Similar tendencies were observed considering very low birth weight neonates.
Conclusions: This study demonstrated that an evidence- -based intervention was effective, resulting in a decrease of 37% of the HAI in the NICU of MJD.
Polin RA, Denson S, Brady MT and the the Committee on
Fetus and Newborn and Committee on Infectious Diseases.
Epidemiology and diagnosis of health care -associated infectious
in the NICU. Pediatrics 2012;e1104 -e1108.
Polin RA, Denson S, Brady MT and the Committee on Fetus
and Newborn and Committee on Infectious Diseases. Strategies
for prevention of health care -associated infectious in the
NICU. Pediatrics 2012; 129:e1085 -e1091.
Borghesi A, Stronati M. Strategies for the prevention of
hospital -acquired infections in the neonatal intensive care
unit. J Hosp Infect 2008; 68:293 -300.
Geffers C, Baerwolff S, Schwab F, Gastmeier P. Incidence
of healthcare -associated infections in high -risk neonates:
results from the German surveillance system for very -low-
-birthweight infants. J Hosp Infect 2008; 68:214 -21.
Aly H, Herson V, Duncan A, Herr J, Bender J, Patel K, et al. Is
bloodstream infection preventable among premature infants?
A tale of two cities. Pediatrics 2005; 115:1513 -7.
Phillips P, Cortina -Borja M, Millar M, Gilbert R. Risk -adjusted
surveillance of hospital -acquired infections in neonatal intensive
care units: a systematic review. J Hosp Infect 2008;
Kilbride HW, Wirtschafter DD, Powers RJ, Sheehan MB. Implementation
of evidence -based potentially better practices to
decrease nosocomial infections. Pediatrics 2003; 111: e519-
Kilbride HW, Powers R, Wirtschafter DD, Sheehan MB, Charsha
DS, LaCorte M, et al. Evaluation and Development of
Potentially Better Practices to Prevent Neonatal Nosocomial
Bacteremia. Pediatrics 2003; 111:e504 -e512.
NEO -KISS (Nosocomial infection surveillance system for
preterm infants on neonatology departments and ICUS).
Disponível em: http://www.nrz -hygiene.de/en/surveillance/
hospital -infection -surveillance -system/neo -kiss/
Payne NR, Barry J, Berg W, Brasel DE, Hagen EA, Matthews
D, et al. Sustained Reduction in Neonatal Nosocomial Infections
Through Quality Improvement Efforts. Pediatrics 2012;
Schwab F, Gastmeier P, Piening B, Geffers C. The step from
a voluntary to a mandatory national nosocomial infection surveillance
system: the influence on infection rates and surveillance
effect. Antimicrob Resist Infect Control 2012; 1:24.
Couto RC, Carvalho EAA, Pedrosa TMG, Pedroso ER, Neto
MC, Biscione FM. A 10 -year prospective surveillance of nosocomial
infections in neonatal intensive care units. Am J Infect
Control 2007; 35:183 -9.
Gill AW. Analysis of neonatal nosocomial infection rates
across the Australian and New Zealand Neonatal Network. J
Hosp Infect 2009; 72:155 -62.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz
RA, et al. Late -onset sepsis in very low birth weight
neonates: the experience of the NICHD Neonatal Research
Network. Pediatrics 2002; 110:285 -91.
How to Cite
Copyright and access
This journal offers immediate free access to its content, following the principle that providing free scientific knowledge to the public provides greater global democratization of knowledge.
The works are licensed under a Creative Commons Attribution Non-commercial 4.0 International license.
Nascer e Crescer – Birth and Growth Medical Journal do not charge any submission or processing fee to the articles submitted.