Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

Daiane Silva Resende,Denise Von Dolinger De Brito,Jacqueline Moreira Do Ó,Paulo Pinto Gontijo Filho,Vânia Olivetti Steffen Abdallah

doi:10.1590/s0037-86822011000600015

Abstract

Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. A total of sixty-seven (26.7%) CA-BSIs were observed. There were 46 (32%) episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]). Neonates in the group after implementation of the intervention had 21 (19.6%) episodes of CA-BSI (14.9 per 1,000 CVC days). The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04). In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

Highlights

Catheter-associated bloodstream infection (CA-Bloodstream infections (BSIs)) is the most common nosocomial infection in neonatal intensive care units
One hundred forty-four neonates were admitted before the intervention (Group 1), and 107 neonates were admitted after the implementation of the five evidence-based procedures in the neonatal intensive care units (NICUs) (Group 2)
We affirm the effectiveness of evidence-based prevention bundles in reducing the rate of Catheter-associated bloodstream infection (CA-BSI) in our NICU patients

Summary

Introduction

Catheter-associated bloodstream infection (CA-BSI) is the most common nosocomial infection in neonatal intensive care units. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. Risk factors associated to BSI include prematurity, low birth weight, poor skin integrity, low gestational age, use of parenteral nutrition (PN), central venous catheter (CVC), prolonged duration of NICU stay, and exposure to broad-spectrum antibiotics[3,8]. To reduce these infections, guidelines and, recently, bundles of practices have been shown effective in preventing a large proportion of catheterassociated BSI (CA-BSI) . Guidelines and, recently, bundles of practices have been shown effective in preventing a large proportion of catheterassociated BSI (CA-BSI) . 2,9-10 These bundles include ongoing surveillance, healthcare workers’ education, a trained team of caregivers for catheter insertion and care, and strategies designed to prevent intraluminally and extraluminally acquired BSIs11-12

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