Healthcare-associated Infections In Neonates Research Articles

Development and evaluation of prevention bundle for neonatal healthcare-associated infections: an interventional study

Background Neonatal healthcare-associated infection (HAI) globally is the leading preventable cause of neonatal mortality. Neonatal mortality in India is also very high. Considering that HAIs can be prevented globally, there are disparities in resources; the current study aimed at developing locally feasible and effective prevention bundles for neonatal HAIs. Methods A mixed-method study was conducted at one tertiary care teaching hospital's level IV Neonatal Intensive Care Unit. The study explores the causes of neonatal HAIs, current processes, benchmark practices, gaps in current practices with HAIs, root-cause analysis and system process mapping, and failure mode effect analysis. Observations, interviews, brainstorming activities, and a survey were conducted. Written and audio-video recorded prevention bundle was developed and implemented using a quasi-experimental study design. Results Process standardisation, healthcare worker training, hand hygiene practices, nursing care process and vascular access process were identified as key improvement areas to prevent neonatal HAIs. Out of eighteen identified processes, three processes were standardised. All the healthcare providers were trained at three-time intervals of three months each. After implementing the prevention bundle, there was a significant decline in the rate of HAIs, reducing it from 9.6 to 7.0 per 100 admissions >48 hours. The bacteraemia rate fell from 5.2 per 1000 patient days to 2.6 per 1000 patient days and was statistically significant on a two-tailed student t-test with 95% CI with p-value=0.00073. Conclusions Our developed prevention bundle for neonatal HAIs was significantly effective and reproducible for healthcare workers' training and development. Considering variations in global infection control practices and resources constraint, it is effective to develop a local prevention bundle for neonatal HAIs.

The Risk of Neonatal Healthcare-Associated Infections at Three Teaching Hospitals in Rwanda

BackgroundHealthcare-acquired infections (HCAIs) are a substantial source of neonatal morbidity and mortality that also carry a financial burden on families and healthcare systems worldwide. However, little is known about common and factors related to HCAIs among neonates hospitalized in Rwanda. The study's objective was to assess the risk of neonatal HCAIs in three selected teaching hospitals in Rwanda.MethodsA retrospective cross-sectional study was conducted and stratified simple random sampling was used. Files of 273 neonates were recruited from 15th July to 30th October 2021. The data abstraction sheet was used in data collection. The data was analysed using logistic regression analysis, and the results were presented in tables.ResultsThe most common neonatal HCAI agent was Klebsiella pneumoniae affecting 142/273(52%). Neonates weighting ≥3.6kg (OR=0.09; 95% CI= 0.02—0.54), 2.6–3.5kg (OR=0.07, 95% CI = 0.01–0.42); 1.5–2.5kg (OR= 0.03 (95% CI= 0.01–0.22) were significantly less likely to have an HCAIs than neonates weighting <1.5kg. Maternal blood groups, especially AB and O, had significantly higher odds for HCAI, OR=2.37 (95% CI=1.1–5.1) and OR=3.1 (95%CI=1.32–7.26) respectively. ConclusionLow birth weight and maternal blood type were associated with HCAIs at the three study sites and the most common HCAI was Klebsiella pneumoniae. Rwanda J Med Health Sci 2023;6(3):367-378

Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case–control study

Background and objectivesEarly diagnosis of neonatal infection is essential to prevent serious complications and to avoid unnecessary use of antibiotics. The prevalence of healthcare-associated infections (HAIs) among very low birthweight...

Infant isolation and cohorting for preventing or reducing transmission of healthcare-associated infections in neonatal units.

Neonatal healthcare-associated infections (HAIs) result in increased morbidity and mortality, as well as increased healthcare costs. Patient isolation measures, i.e. single-room isolation or the cohorting of patients with similar infections, remain a recommended and commonly used practice for preventing horizontal spread of infections in the neonatal intensive care unit (NICU). OBJECTIVES: Our primary objective was to assess the effect of single-room isolation or cohorting, or both for preventing transmission of HAIs or colonization with HAI-causing pathogens in newborn infants less than six months of age admitted to the neonatal intensive care unit (NICU). Our secondary objective was to assess the effect of single-room isolation or cohorting, or both on neonatal mortality and perceived or documented adverse effects in newborn infants admitted to the NICU. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. There were no restrictions to date, language or publication type. We also checked the reference lists of studies identified for full-text review. SELECTION CRITERIA: Types of studies: cluster-randomized or quasi-randomized trials at the level of the cluster (where clusters may be defined by NICU, hospital, ward, or other subunits of the hospital). We also included cross-over trials with a washout period of more than four months (arbitrarily defined). newborn infants less than six months of age in neonatal units that implemented patient isolation or cohorting as infection control measures to prevent HAIs. Types of interventions: patient isolation measures (single-room isolation or cohorting, or both of infants with similar colonization or infections) compared to routine isolation measures. the primary outcome was the rate of transmission of HAIs as estimated by the infection and colonization rates in the NICU. Secondary outcomes included all-cause mortality during hospital stay at 28 days of age, length of hospital stay, as well as potential adverse effects of isolation or cohorting measures, or both. The standard methods of Cochrane Neonatal were used to identify studies and assess the methodological quality of eligible cluster-randomized trials. The certainty of the evidence was to be assessed by the GRADE method as evidence of high, moderate, low, or very low certainty. Infection and colonization rates were to be expressed as rate ratios for each trial and if appropriate for meta-analysis, the generic inverse variance method in RevMan was to be used. We did not identify any published or ongoing trials to include in the review. The review found no evidence from randomized trials to either support or refute the use of patient isolation measures (single-room isolation or cohorting) in neonates with HAIs. Risks secondary to infection control measures need to be balanced against the benefits of decreasing horizontal transmission in the neonatal unit for optimal neonatal outcomes. There is an urgent need to research the effectiveness of patient isolation measures for preventing the transmission of HAIs in neonatal units. Well-designed trials randomizing clusters of units or hospitals to a type of patient isolation method intervention are warranted.

Development and evaluation of prevention bundle for neonatal healthcare-associated infections: an interventional study

Background: Neonatal healthcare-associated infection (HAI) globally is the leading preventable cause of neonatal mortality. Neonatal mortality in India is also very high. Considering that HAIs can be prevented globally, there are disparities in resources; the current study aimed at developing locally feasible and effective prevention bundles for neonatal HAIs. Methods: A mixed-method study was conducted at one tertiary care teaching hospital's level IV Neonatal Intensive Care Unit. The study explores the causes of neonatal HAIs, current processes, benchmark practices, gaps in current practices with HAIs, root-cause analysis and system process mapping, and failure mode effect analysis. Observations, interviews, brainstorming activities, and a survey were conducted. Written and audio-video recorded prevention bundle was developed and implemented using a quasi-experimental study design. Results: Process standardisation, healthcare worker training, hand hygiene practices, nursing care process and vascular access process were identified as key improvement areas to prevent neonatal HAIs. Out of eighteen identified processes, three processes were standardised. All the healthcare providers were trained at three-time intervals of three months each. After implementing the prevention bundle, there was a significant decline in the rate of HAIs, reducing it from 9.6 to 7.0 per 100 admissions >48 hours. The bacteraemia rate fell from 5.2 per 1000 patient days to 2.6 per 1000 patient days and was statistically significant on a two-tailed student t-test with 95% CI with p-value=0.00073. Conclusions: Our developed prevention bundle for neonatal HAIs was significantly effective and reproducible for healthcare workers' training and development. Considering variations in global infection control practices and resources constraint, it is effective to develop a local prevention bundle for neonatal HAIs.

Covid-period-associated changes in organism profile of neonatal sepsis in a tertiary center from East India.

Neonatal sepsis is a major cause of morbidity and mortality with a higher burden from the low- and middle-income countries. The coronavirus disease 2019 (Covid 19) pandemic has impacted healthcare in various ways including healthcare-associated infections (HAI). The objective of the present study was to determine changes in organism profile and incidence rates of HAI in neonates admitted to the index hospital during the pandemic and compared it with the data from the pre-pandemic period. The study design was a retrospective, observational analysis of data from neonates with culture-positive sepsis, in a tertiary care children's hospital, between January 2018 and December 2021. Pre-Covid (January 2018 to December 2019) and Covid period data (January 2020 to December 2021) were analyzed for the significance of change. The prevalence of culture-positive sepsis, in pre-Covid and Covid periods, was 19.55% [95% confidence interval (95% CI) 17.13-21.52)] and 18.36% (CI 16.05-20.74), respectively. HAI rates/1000 patient days increased slightly during the Covid pandemic [7.2% (95% CI 6.98-10.08) to 9.8% (95% CI 9.78-13.67)] mainly due to an increase in fungal HAI (26% pre- vs. 41.5% Covid period). However, the proportion of Gram-negative (GN) infections fell significantly (70.5% vs. 48.6%) during the same period. In the pre-Covid period, Klebsiella followed by Burkholderia cepacia, Acinetobacter spp and Pseudomonas, were the major HAI isolates. During the Covid period, there was a decline in these isolates and Burkholderia spp was not detected. All fungal isolates were Candida species. The case fatality ratio (CFR) from HAI decreased significantly from 38% to 15.45%, mainly due to a decrease in GN HAI. During Covid pandemic, there was a significant decline in GN HAI and CFR from HAI, due to improved compliance with infection control measures in the neonatal intensive care unit (NICU). At the same time, there was a rise in the fungal HAI, possibly because of a higher proportion of premature, and sick neonates with longer hospital stay and more invasive procedures. Consolidations of gains in infection control and restriction of invasive procedures could help to minimize HAI in NICUs.

Preventable contributors to the neonatal healthcare-associated infections: a uni-center analytical study from South India.

Background: Globally, neonatal healthcare-associated infections (HAIs) are known to cause high mortality. HAIs is a preventable condition related to the healthcare environment. The current study explored the contributors to neonatal HAIs in one of the largest tertiary care referral hospitals in South India. Methods: Neonates from December 2016 to June 2018 were observed for the occurrence of healthcare-associated infections and compared with the matched control group. Various observations on neonatal demography, maternal contributors, and medical procedures were made and recorded to explore and analyse the contributors to neonatal HAIs. Univariate and multivariate analysis was carried out to find the contributors. The Odds ratio with 95% CI was also computed and reported. Results: Bloodstream infection (83%) was prevalent among neonates; the maternal contributor was only preterm labor (Odds ratio of 11.93; 95% CI; 6.47-21.98; p<.05) to acquire HAIs. On univariate analysis, mechanical ventilation for > 3days duration, NIV for > five days, and PICC line insertion procedure were significant (p<0.05) contributors to neonatal HAIs. IV cannulation for more than three times in four consecutive days was found in 100(85%) neonates considered being associated with neonatal HAIs. On multivariate analysis, NIV, PICC line, preterm labor, and low birth weight were significant (p<0.05) contributors to neonatal HAIs. Conclusion: The increased duration of invasive and non-invasive therapeutic devices and catheters contributes to neonatal HAIs. Neonates are acquiring bloodstream infections; low birth weight (LBW) neonates are more susceptible to acquiring HAIs.

Preventable contributors to the neonatal healthcare-associated infections: a uni-center analytical study from South India.

Globally, neonatal healthcare-associated infections (HAIs) are known to cause high mortality. HAIs is a preventable condition related to the healthcare environment. The current study explored the contributors to neonatal HAIs in one of the largest tertiary care referral hospitals in South India. Neonates from December 2016 to June 2018 were observed for the occurrence of healthcare-associated infections and compared with the matched control group. Various observations on neonatal demography, maternal contributors, and medical procedures were made and recorded to explore and analyse the contributors to neonatal HAIs. Univariate and multivariate analysis was carried out to find the contributors. The Odds ratio with 95% CI was also computed and reported. Bloodstream infection (83%) was prevalent among neonates; the maternal contributor was only preterm labor (Odds ratio of 11.93; 95% CI; 6.47-21.98; p<.05) to acquire HAIs. On univariate analysis, mechanical ventilation for > 3days duration, NIV for > five days, and PICC line insertion procedure were significant (p<0.05) contributors to neonatal HAIs. IV cannulation for more than three times in four consecutive days was found in 100(85%) neonates considered being associated with neonatal HAIs. On multivariate analysis, NIV, PICC line, preterm labor, and low birth weight were significant (p<0.05) contributors to neonatal HAIs. The increased duration of invasive and non-invasive therapeutic devices and catheters contributes to neonatal HAIs. Neonates are acquiring bloodstream infections; low birth weight (LBW) neonates are more susceptible to acquiring HAIs.

The Impact of Interventions to Prevent Neonatal Healthcare-associated Infections in Low- and Middle-income Countries: A Systematic Review.

Background:Clinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control interventions for neonates in low- and middle-income countries (LMIC) are unknown.Aim:To identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units.Methods:Medline, PUBMED, the Cochrane Database of Systematic Reviews, EMBASE and PsychInfo (January 2003 to October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units.Results:Our initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and Integrated Quality Criteria for the Review of Multiple Study Designs assessment criteria and were summarized in the final analysis. No studies were carried out in low-income countries, only 1 in Sub-Saharan Africa and just 2 in multiple countries. Of the 18 single-intervention studies, most targeted skin (n = 4) and gastrointestinal mucosal integrity (n = 5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-center studies. Of the 9 studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections.Conclusions:There is a limited evidence base for the effectiveness of infection prevention and control interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multisite studies with robust study designs are needed to inform infection prevention and control intervention strategies in low-resource neonatal units.

Effect of chlorhexidine cleansing on healthcare-associated infections in neonates: a systematic review and meta-analysis

BackgroundHealthcare-associated infections (HAIs) have a significant impact on neonatal morbidity, mortality and long-term prognosis, which have a high incidence in neonates. Many studies have shown that chlorhexidine cleansing is effective...

Identifying the priority infection prevention and control gaps contributing to neonatal healthcare-associated infections in low-and middle-income countries: results from a modified Delphi process.

In low- and middle-income countries (LMIC), neonatal healthcare-associated infections (HAI) are associated with increased morbidity, mortality, hospital stay, and costs. When resources are limited, addressing HAI through infection prevention and control (IPC) requires prioritizing interventions to maximize impact. However, little is known about the gaps in LMIC that contribute most to HAI. A literature review was conducted to identify the leading IPC gaps contributing to neonatal HAIs in intensive care units and specialty care wards in LMIC. Additionally, a panel of 21 global experts in neonatology and IPC participated in an in-person modified Delphi process to achieve consensus on the relative importance of these gaps as contributors to HAI. Thirteen IPC gaps were identified and summarized into four main categories: facility policies such as prioritizing a patient safety culture and maintaining facility capacity, general healthcare worker behaviors such as hand hygiene and proper device insertion and maintenance, specialty healthcare worker behaviors such as cleaning and reprocessing of medical equipment, and infrastructural considerations such as adequate medical equipment and hand hygiene supplies. Through a modified Delphi process, we identified the leading IPC gaps contributing to neonatal HAIs; this information can assist policymakers, public health officials, researchers, and clinicians to prioritize areas for further study or intervention.

Multidrug-Resistant Healthcare-Associated Infections in Neonates with Severe Respiratory Failure and the Impacts of Inappropriate Initial Antibiotic Therap.

Background: Multidrug-resistant (MDR) pathogens have emerged as an important issue in neonatal intensive care units (NICUs), especially in critically ill neonates with severe respiratory failure. We aimed to investigate neonatal healthcare-associated infections (HAIs) caused by MDR pathogens and the impacts of inappropriate initial antibiotic therapy on the outcomes. Methods: We retrospectively analyzed all cases of HAIs in neonates with severe respiratory failure in a tertiary-level NICU in Taiwan between January 2014 and May 2020. All clinical features, microbiology, therapeutic interventions, and outcomes were compared between the MDR-HAI and non-MDR HAI groups. Multivariate regression analyses were used to investigate independent risk factors for sepsis-attributable mortality. Results: A total of 275 critically ill neonates with severe respiratory failure who had HAIs were enrolled. Ninety-five cases (34.5%) were caused by MDR pathogens, and 141 (51.3%) cases had positive bacterial cultures from multiple sterile sites. In this cohort, the MDR-HAI group was more likely to receive inappropriate initial antibiotic therapy (51.0% versus 4.7%, respectively; p < 0.001) and exhibit delayed control of the infectious focus (52.6% versus 37.8%, respectively; p = 0.021) compared with the non-MDR HAI group. The sepsis-attributable and final in-hospital rates were 21.8% and 37.1%, respectively, and they were comparable between the MDR-HAI and non-MDR HAI groups. Empirically broad-spectrum antibiotics were prescribed in 76.7% of cases, and inappropriate initial antibiotic treatment was not significantly associated with worse outcomes. Independent risk factors for sepsis-attributable mortality in neonates with severe respiratory failure included the presence of septic shock (OR: 3.61; 95% CI: 1.54–8.46; p = 0.003), higher illness severity (OR: 1.33; 95% CI: 1.04–1.72; p = 0.026), and neonates with bronchopulmonary dysplasia (OR: 2.99; 95% CI: 1.47–6.09; p = 0.003). Conclusions: MDR pathogens accounted for 34.5% of all neonatal HAIs in the NICU, but neither MDR pathogens nor inappropriate initial antibiotics were associated with final adverse outcomes. Because the overuse of broad-spectrum antibiotics has emerged as an important issue in critically ill neonates, the implementation of antimicrobial stewardship to promote the appropriate use of antimicrobials is urgently needed.

Development of an algorithm to prevent neonatal healthcare-associated infections (HAIs): A multimodal approach

Background: The current study is carried out with an aim to explore the spectrum of microorganism causing HAIs and to develop prevention bundle (algorithm) for neonatal healthcare-associated infections (HAIs) using the multimodal approach to overcome adaptation and training limitations. Methods and materials: A cross-sectional study was carried out for 19 months among 1233 neonate admitted for >48 hours at level III Neonatal Intensive Care Unit (NICU) identifying cases of HAIs (Using CDC & WHO criteria). The International expert proposal for interim definitions for acquired resistance was used for identifying Multi-drug resistance (MDR), extreme-drug resistance (XDR) and pan-drug resistance (PDR) strains. Root cause analysis using open-ended questionnaire, multiple observations, and failure mode effect analysis was done. Multiple in-depth interviews of the experts from neonatology and microbiology were carried out. System process mapping for various process & critical task involved in NICU against evidence was recorded to prevent HAIs, that brought the development of three major processes out of eighteen processes. The training videos were developed to prevent HAIs. Results: Among 1233 patients 118 neonates (9.6/100 admissions) acquired HAIs. The BacT/Alert culture showed 34% positivity for 474 blood/ fluid samples of these patients sent for investigation. Common pathogens isolated include Klebsiella pneumoniae (35%), coagulase-negative Staphylococcus aureus (CONS) (32%), Acinetobacter baumanii (12%), Enterobacter cloacae (8%), E. coli (8%) and others (5%). MDR, XDR, PDR microorganism identified were Klebsiella pneumoniae (66%, 19%, 4%), Acinetobacter baumanii (0%, 39%, 28%), E. coli (22%, 11%, 33%) and Enterobacter cloacae (46%, 18%, 9%). Common antibiotics used therapeutically for neonates acquiring HAIs were Amikacin, Piperacillin-Tazobactam, and Ampicillin among 95%, 78%, and 64% respectively. The frequent cause of HAIs were improper hand-washing, multiple procedures, improper device disinfection. Three process algorithm [(1) Nursing care process; (2) vascular access process; (3) cardiopulmonary resuscitation management process] identifying critical step preventing HAIs were developed. Conclusion: Presence of MDR, XDR and PDR demands the institution of antimicrobial stewardship. High vigilance on infection control measures, system process mapping of the individual healthcare setting and strict adherence to the algorithms is the need of an hour to prevent neonatal HAIs.

Factors Associated with Neonatal Healthcare-Associated Infections (HAIs) in India: A Protocol for Systematic Review and Meta-analysis

Factors Associated with Neonatal Healthcare-Associated Infections (HAIs) in India: A Protocol for Systematic Review and Meta-analysis

Prevention of Neonatal healthcare-associated infections: Current update

Looking at the neonatal mortality due to infectious diseases like sepsis and healthcare-associated infections (HAIs) in India. It is necessary to collate the evidence that is feasible to practice in the Indian healthcare system to prevent further morbidity or related mortality. This review focuses on the levels of evidences and the practices followed in neonatal settings to prevent HAIs. The articles published in a peer-reviewed journal published in the last 20 years were included. Articles were focusing more on central line-associated bloodstream infections, catheter-associated infections, and non-specific HAIs. There is dearth of studies related to VAP prevention and its effect among neonates. Many articles focused on hand washing practices, surveillance, continuous educational program and adherence to it is the prime focus to prevent HAIs. Monitoring using checklist is one of the tool practiced at many settings but with lot of challenges. We conclude that multimodal integrated approach by active and passive surveillance, hand washing practices and commitment of healthcare workers following the set policy can bring a change in the current status of neonatal mortality due to HAIs.

The Necessity to Change the Approaches to the Registration of Healthcare-Associated Infections Newborns and Intrauterine Infections

Objective: To estimate the registration quality of neonatal healthcare-associated infections (HAI) and intrauterine infections in separate maternity hospitals in Moscow. Material and methods : We carried out a retrospective epidemiological analysis neonates HAIs and intrauterine infections. In this study was conducted patients from Moscow during 2008–2017 and three maternity hospitals in Moscow during 2009–2017. These case study maternity hospitals would be known as MH № X01, № X02 and № X03. Also in this study we assessed postpartum woman’s HAIs morbidity in MH during 2009–2017. From these patients we selected cases where not only newborn suffered the disease but mother got sick neither. Then we analyzed on which day after day birth the child got the diagnosis HAIs or intrauterine infections. In addition, the quality of registration was established on the basis on Rospotrebnadzor order № 29 dated on 16.03.2018 «About an order of case registration of infectious and parasitic diseases in the city of Moscow». The data selection was from Statistical Reporting Form № 2 in Moscow. Also, were used data from infectious and parasitic diseases accounting and registration department of The Hygiene and Epidemiology Center in Moscow. The morbidity rate of HAIs and intrauterine infections of newborns was counted on 1,000 births newborns. The morbidity rate of HAIs of postpartum women was counted on 1000 births. For this purpose «Microsoft Office Excel 2010» software packages were used. The calculation of the increase/decrease rate was made by the method of least squares. Results: On basis of conducted analysis it was determined that morbidity HAIs newborn has tended to be on the decline, especially compared with a sharp and considerable increase in the intrauterine infections morbidity. This trend can be observed both in Moscow and in the three described MH. The incidence of HAIs of postpartum woman is represented by a single registration. It had been identified a minimal number of cases, when the disease was being recorded in both the mother and the baby. Analyzing the timing of intrauterine infections and HAIs diagnosis from the moment of birth, it was found that about a quarter of all cases of intrauterine infections should have been registered as nosocomial infections. According to the Order № 29 on the basis on the nosology list (diseases which can only be registered as HAIs) it was established that about 10% of cases of intrauterine infections was misdiagnosed. Thus, the analysis indicators once again do not refute, but only proves the poor-quality registration of moving the newborn HAIs and cases of intrauterine infections from one category to another. The identified problem is extremely relevant and requires action to solve it. Conclusion : Multi-criteria analysis, revealing the quality of newborns HAIs and intrauterine infections registration, such as an incidence rate, the ratio intrauterine infections and HAIs newborns, the number of the disease in mother and baby’s cases registration, compliance with normative documents, showed that official statistics are unreliable. The register system for the described infections is in needed of be reformed. First of all, it is necessary to standardize the diagnostic process, that mean the development of a standard case definition for each nosology among the HAIs and intrauterine infections.

Reducing Healthcare-associated Infections in Neonates by Standardizing and Improving Compliance to Aseptic Non-touch Techniques: A Quality Improvement Approach

To standardize and improve compliance to Aseptic non-touch techniques (ANTT) for commonly performed procedures in Neonatal intensive care unit (NICU) through application of Model for improvement, and study its impact on Healthcare-associated infection (HCAI) rates. Quality improvement project utilizing multiple Plan-Do-Study-Act (PDSA) cycles. Tertiary-care neonatal unit. All resident doctors and nurses working in neonatal unit were subjects for assessment of compliance to ANTT. All admitted neonates staying in hospital for more than 48 hours were subjects for HCAI data collection. Most frequently performed procedures in NICU were identified and pictorial Standard Operating Procedures (SOP) were developed. Implementation and uptake was reinforced by means of PDSA cycles. Compliance to ANTT was assessed as proportion of components to which adherence was documented. Trend of HCAI rates in unit were analyzed using process control charts. Change in compliance to ANTT for most frequently performed procedures. Significant improvement in compliance to ANTT practices was observed, specifically in use of procedure tray/trolley (16% to 49%, P=0.001), iv hub scrubbing (0% to 60%, P=0.001), local skin cleaning (33% to 67%, P=0.004), personal protective equipment use (55% to 80%, P=0.02) and disposal (27% to 51%, P=0.03), use of non-touch technique (50% to 70%, P=0.001) and reduction in key part contamination (45% to 31%, P=0.03). A modest decrease in HCAI rates was seen in the short period of observation after implementation. Substantial improvements in compliance to aseptic non-touch techniques can be ensured by adopting a combination of initial intensive teaching and sustaining through multiple PDSA cycles, targeting specific areas revealed by audits.

Establishing nationally representative central line-associated bloodstream infection surveillance data for paediatric patients in Greece

Healthcare-associated infections (HCAIs) are associated with increased morbidity and mortality and with excess costs. Central line-associated bloodstream infections (CLABSIs) are the most common HCAIs in neonates and children. To establish national benchmark data for rates of CLABSI in neonatal and paediatric intensive care units (NICUs and PICUs) and paediatric oncology units (ONCs). Active surveillance for CLABSI was conducted from June 2016 to February 2017. A collaborative of 14 NICUs, four PICUs, and six ONCs participated in the programme. Surveillance definitions of central line (CL), central line utilization (CLU) ratio, CLABSI event, and CLABSI rate were based on the Centers for Disease Control and Prevention's 2014 National Healthcare Safety Network criteria. Medical records were assessed daily for calculating CL-days, patient-days, and susceptibility of isolated organisms. A total of 111 CLABSI episodes were recorded. The overall mean CLABSI rate was 4.41 infections per 1000 CL-days, and the CLU ratio was 0.31. CLABSI rates were 6.02 in NICUs, 6.09 in PICUs, and 2.78 per 1000 CL-days in ONCs. A total of 123 pathogens were isolated. The most common pathogens were Enterobacteriaceae (36%), followed by Gram-positive cocci (29%), non-fermenting Gram-negative bacteria (16%), and fungi (16%). Overall, 37% of Gram-negative pathogens were resistant to third-generation cephalosporins and 37% to carbapenems. Nationally representative CLABSI rates were determined for paediatric patients. These data could be used to benchmark and serve as baseline data for the design and evaluation of infection control and antimicrobial stewardship interventions.

Lack of evidence for the efficacy of enhanced surveillance compared to other specific interventions to control neonatal healthcare-associated infection outbreaks.

BackgroundDespite current prevention efforts, outbreaks of healthcare-associated infections in neonatal units remain high globally, with a considerable burden of mortality and morbidity.MethodsWe searched Medline, Cochrane Library and Outbreak database to identify studies of neonatal healthcare-associated outbreaks between 2005 and 2015 that described interventions to control outbreaks. All studies were evaluated using the ORION guidance.ResultsThirty studies were identified including 17 102 infants of whom 664 (3.9%) became infected. No single intervention was identified that reduced duration or mortality. Studies that introduced multiple interventions had significantly reduced case fatality ratio and outbreak duration compared to those that used basic surveillance only. Low and low-middle income countries reported the fewest interventions to control outbreaks and these studies were also associated with higher mortality than that found in middle and high income countries.ConclusionsSystematic reporting and formal evaluation of interventions used to reduce healthcare-associated neonatal infection outbreaks is key to identifying containment strategies worldwide.

Health care–associated infection surveillance in a tertiary neonatal intensive care unit: A prospective clinical study after moving to a new building

There are very few prospective clinical studies on neonatal health care-associated infection (HAI) surveillance. HAI surveillance helps reduce not only mortality, but also morbidity, length of hospital stay, and health care costs. This prospective clinical study covered a period of 12 months in a tertiary neonatal intensive care unit (NICU). HAI rates were calculated using different denominators: number of patients hospitalized in the NICU, number of patient-days, and number of specific device-days. The HAI rate was 18%, and the incidence density was 17/1,000 patient-days. The most common HAI was bloodstream infection (n = 34; 50%). The most common pathogen was coagulase-negative staphylococci (CoNS; 54.9%) in gram-positive bacteria and in general. Methicillin resistance was 96.4% for CoNS. Klebsiella spp (13.7%) was the most common gram-negative bacteria. Extended-spectrum β-lactamase positivity was 14.3% for Klebsiella spp and 25% for Escherichia coli. HAI-related mortality was 0.3%. NICUs should perform their own HAI surveillance with prospective clinical design. Attention paid to handwashing, disinfection and sanitizing, complying with the terms of asepsis, extending in-service training, increasing the number of medical staff, preventing frequent changes in health care staff positions, and improving physical environmental conditions in NICUs might eventually decrease HAI rates.