scholarly journals Infection Prevention Practices in Neonatal Intensive Care Units Reporting to the National Healthcare Safety Network

2014 ◽  
Vol 35 (9) ◽  
pp. 1126-1132 ◽  
Author(s):  
Susan N. Hocevar ◽  
Fernanda C. Lessa ◽  
Lauren Gallagher ◽  
Craig Conover ◽  
Rachel Gorwitz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Optimal Strategies ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Line Insertion ◽  
National Healthcare ◽  
Line Insertion ◽  
National Healthcare Safety Network ◽  
Healthcare Associated

Background.Patients in the neonatal intensive care unit (NICU) are at high risk for healthcare-associated infections. Variability in reported infection rates among NICUs exists, possibly related to differences in prevention strategies. A better understanding of current prevention practices may help identify prevention gaps and areas for further research.MethodsWe surveyed infection control staff in NICUs reporting to the National Healthcare Safety Network (NHSN) to assess strategies used to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and central line–associated bloodstream infections in NICUs.ResultsStaff from 162 of 342 NICUs responded (response rate, 47.3%). Most (92.3%) NICUs use central line insertion and maintenance bundles, but maintenance practices varied, including agents used for antisepsis and frequency of dressing changes. Forty-two percent reported routine screening for MRSA colonization upon admission for all patients. Chlorhexidine gluconate (CHG) use for central line care for at least 1 indication (central line insertion, dressing changes, or port/cap antisepsis) was reported in 82 NICUs (51.3%). Among sixty-five NICUs responding to questions on CHG use restrictions, 46.2% reported no restrictions.ConclusionsOur survey illustrated heterogeneity of CLABSI and MRSA prevention practices and underscores the need for further research to define optimal strategies and evidence-based prevention recommendations for neonates.Infect Control Hosp Epidemiol 2014;35(9):1126-1132

Device-Associated Infections among Neonatal Intensive Care Unit Patients: Incidence and Associated Pathogens Reported to the National Healthcare Safety Network, 2006–2008

2012 ◽  
Vol 33 (12) ◽  
pp. 1200-1206 ◽  
Author(s):  
Susan N. Hocevar ◽  
Jonathan R. Edwards ◽  
Teresa C. Horan ◽  
Gloria C. Morrell ◽  
Martha Iwamoto ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Incidence Rates ◽  
General Hospitals ◽  
Weight Category ◽  
National Healthcare ◽  
National Healthcare Safety Network

Objective.To describe rates and pathogen distribution of device-associated infections (DAIs) in neonatal intensive care unit (NICU) patients and compare differences in infection rates by hospital type (children's vs general hospitals).Patients and Setting.Neonates in NICUs participating in the National Healthcare Safety Network from 2006 through 2008.Methods.We analyzed central line–associated bloodstream infections (CLABSIs), umbilical catheter–associated bloodstream infections (UCABs), and ventilator-associated pneumonia (VAP) among 304 NICUs. Differences in pooled mean incidence rates were examined using Poisson regression; nonparametric tests for comparing medians and rate distributions were used.Results.Pooled mean incidence rates by birth weight category (750 g or less, 751–1,000 g, 1,001–1,500 g, 1,501–2,500 g, and more than 2,500 g, respectively) were 3.94, 3.09, 2.25, 1.90, and 1.60 for CLABSI; 4.52, 2.77, 1.70, 0.91, and 0.92 for UCAB; and 2.36, 2.08, 1.28, 0.86, and 0.72 for VAP. When rates of infection between hospital types were compared, only pooled mean VAP rates were significantly lower in children's hospitals than in general hospitals among neonates weighing 1,000 g or less; no significant differences in medians or rate distributions were noted. Pathogen frequencies were coagulase-negative staphylococci (28%), Staphylococcus aureus (19%), and Candida species (13%) for bloodstream infections and Pseudomonas species (16%), S. aureus (15%), and Klebsiella species (14%) for VAP. Of 673 S. aureus isolates with susceptibility results, 33% were methicillin resistant.Conclusions.Neonates weighing 750 g or less had the highest DAI incidence. With the exception of VAP, pooled mean NICU incidence rates did not differ between children's and general hospitals. Pathogens associated with these infections can pose treatment challenges; continued efforts at prevention need to be applied to all NICU settings.

scholarly journals 584. Use of Multi-Disciplinary Prevention Rounds to Reduce Central Line-Associated Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S276
Author(s):  
Matthew Linam ◽  
Jessica Wright ◽  
Kum Kim ◽  
Cara Van Treek ◽  
Patrick Spafford
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Central Venous Line ◽  
Patient Specific ◽  
Successful Implementation ◽  
Evidence Based ◽  
Clabsi Rate

Abstract Background Despite successful implementation of evidence-based prevention bundles, central line-associated bloodstream infections (CLABSIs) continue to occur in neonatal intensive care units (NICUs). We hypothesized that multi-disciplinary prevention rounds may be able to further reduce CLABSIs. Methods We implemented bedside rounds in a 39-bed tertiary NICU in November 2018 with the focus of reducing CLABSIs. Standardized rounds for all patients with a central venous line (CVL) occurred 2–3 times/week on weekdays during either the day or evening shifts. Rounds included NICU nursing leadership, the Hospital Epidemiologist and the patient’s nurse. Questions focused on the CVL maintenance bundle, reducing line access, and patient-specific CLABSI risk factors. Best practices were reinforced and solutions for identified risk factors were developed. Recommendations were communicated to the physician, as appropriate. Prevention rounds data were collected. Nurses and providers in the NICU were surveyed about their perceptions of the rounds. CLABSIs were identified by Infection Prevention using standard definitions. Results The average daily NICU census was 35.6, with an average of 14 patients with CVLs/day. The average duration of rounds was 45 minutes. Recommendations to physicians, such as changing medications from intravenous to oral or line removal, were accepted 85% of the time. 74.5% of nurses and 87.5% of providers thought that prevention rounds had at least some impact on CLABSI prevention. Nurse and provider responses to the perceived impact of CLABSI prevention rounds are in Tables 1 and 2, respectively. In the 12 months prior to starting prevention rounds, the CLABSI rate was 1.53 /1000 line days and the CLABSI rate for the 6 months after starting rounds was 0.99/1,000 line days, a 65% decrease. Conclusion CLABSI prevention rounds helped reinforce evidence-based prevention practices, identified patient-specific risk factors and improved physician-nurse communication. CLABSIs in NICU were reduced. Disclosures All authors: No reported disclosures.

scholarly journals 582. Impact of Central Line Bundle for Prevention of Umbilical Vein Catheter-Related Bloodstream Infections in a Neonatal Intensive Care Unit

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S275-S275
Author(s):  
İlker devrim ◽  
Ferit Kulalı ◽  
İlknur Çağlar ◽  
Yeliz Oruc ◽  
Nevbahar Demiray ◽  
...  
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Umbilical Vein ◽  
Bloodstream Infections ◽  
Central Line ◽  
Neonatal Intensive Care Units ◽  
Vein Catheter ◽  
Single Use ◽  
Umbilical Vein Catheter ◽  
Central Line Bundle

Abstract Background Umbilical vein catheters (UVC) are one of the most common types of vascular access device in the neonatal intensive care units. Central line-associated bloodstream infections were reported to be in the first place of healthcare-associated infections in preterm infants. In this study, we aimed to evaluate the effectiveness of the bundle applications in the prevention of umbilical vein catheter-associated bloodstream infections in neonates including premature infants. Methods This 40 months cross-sectional study included two periods, including pre-bundle period (from August 1, 2015 to March 31, 2017) and bundle period (April 1, 2017 to November 30, 2018). The umbilical vein catheter-related bloodstream infections, catheter line days, number of the patients were recorded and compared between the prebundle and bundle periods. Bundle steps were defined as education-training-assignment, evaluation of daily catheter indications, hand hygiene and aseptic technique while insertion, maximal sterile barrier precautions, closure of the catheter area with transparent semi-permeable membrane, using needless connectors in stead of 3-way stop-cocks, and single-use prefilled saline syringes for flushing. Results During the whole study period total umbilical vein catheter days were 2,228 days. During the prebundle period there was 10 and in the bundle period there was 2 umbilical vein catheter-related bloodstream infections (Table 1). While umbilical vein-associated bloodstream infection rate was 8.9 per 1,000 catheter days in the pre-bundle period, and significantly decreased to 1.79 in the bundle period (P < 0.05). After the introduction of bundle applications, it was observed that the rate of infection decreased by 68% (P < 0.05) Conclusion Our study showed that implementation of central line bundle including needless connectors and single-use prefilled syringes for umbilical vein-related bloodstream infections was effective for the prevention of catheter-related bloodstream infections in neonatal intensive care units. Disclosures All authors: No reported disclosures.

scholarly journals 585. Shifting Focus Toward Healthcare-Associated Bloodstream Infections: Need for More NICU-Specific NHSN Definitions

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S276-S277
Author(s):  
Sonali D Advani ◽  
Thomas Murray ◽  
Matthew Bizzarro
Keyword(s):  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Mucosal Barrier ◽  
Source Attribution ◽  
Chi Square ◽  
Mortality And Morbidity ◽  
Source Of Infection ◽  
Chi Square Test ◽  
Healthcare Associated

Abstract Background Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population. Methods We performed a retrospective review of all neonates admitted to the 54-bed level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013 and December 31, 2018. HABSI was defined as a positive blood culture at >72 hours of life growing an organism not considered a contaminant. Clinical definitions per treating NICU team and NHSN site-specific definitions were compared for source attribution using McNemar’s Chi-square test. Results We identified 88 HABSIs with an incidence rate of 0.81 per 1,000 patient-days. Only 13% of these were central line-associated bloodstream infections (CLABSIs). Infants with a HABSI had median birth weight and gestational age of 830 grams and 26 weeks, respectively, with a high percentage requiring mechanical ventilation parenteral nutrition and vascular access (Table 1). Sepsis-related mortality was 24%. The majority of HABSIs were caused by gram-positive and gram-negative bacteria (Figure 1). Most were secondary to necrotizing enterocolitis, pneumonia or a source that was not identified (Table 2). NHSN definitions were less likely to identify a source compared with clinical definitions per NICU treating team (P < 0.001, Table 2). Fifty percent of patients without an identified source of infection by NHSN criteria were identified with a Mucosal Barrier Injury (MBI) organism, likely causing bacteremia from gut translocation. Conclusion HABSIs occur in premature babies with comorbidities, and are more prevalent than CLABSIs. Gut translocation with MBI organisms may be an important unidentified source of HABSIs in neonates. With the increasing focus on HABSI prevention, there is a need for better NHSN definitions for source attribution of bloodstream infections in neonates. Disclosures All authors: No reported disclosures.

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