Preventing Nosocomial Infection

Preventing Nosocomial Infection

IS INFECTION IN THE N.I.C.U. PREVENTABLE? Aly, Hany, et al. PEDIATRICS Vol. 115 No. 6 June 2005, pages 1513-1517

Background: Blood stream infection is a significant cause of morbidity and death encountered in the NICU. The rates vary significantly in NICU’s across the nation.

Objective: Review policies and practices associated with lower infection rates nationally and to test their reproducibility in our unit at George Washington University.

Methods: Data on bloodstream infection rates in 16 NICU’s were reviewed. Connecticut Children’s Medical Center was the lowest amongst those reviewed. A team from GW went on a site visit to examine their practices. Differences in the aseptic precautions used for intravenous line management were noted. The infection rates from 1998 to 2000 (group I) amongst <2500 grams infants were compared to the new technique (applying a close medication system) begun in 2001 to 2003 (group 2).

Results: A total of 536 inborn LBW infants were included in this retrospective study (N=169 in group 1; group 2, N=367). The incidence of sepsis decreased significantly from group1 to group 2 (25% to 2%, respectively). The reduction of sepsis observed in association with the new practice was statistically significant after controlling for birth weight, central line days and ventilator days. Central line related bloodstream infection rate decreased from 15.17 infections per 1000 line days to 2.1 infections per 1000 line days.

Conclusion: Applying the closed medication system was associated with reduced bloodstream infection in their unit. The protocol was easily reproducible in their environment and showed immediate results. Serious attempts to share data can potentially optimize outcomes and standardize policies and practices among NICU’s.

Comments: This articles shows how we can improve our patients care by sharing Potentially Better Practices from other institutions. This is the motto of The Vermont-Oxford organization. Which should be endorsed throughout the land. EV.

Additional Comments:

Date: 25 Aug 2005
Time: 21:18:50

What are the details of this protocol? With such low IV rates and instability of TPN/lipids (have to be changed every day), we are going to stop using the buretrol (so fluid from the newly spiked bag gets to the patient faster) and then only change the tubing q72h. What do you do with intermittent med. ports and tubing -- leave connected or disconnect, flush and reuse for how long?

UserName: Kristin Mack
Institution: Medical Center of Plano, Texas
telephone: 214-802-0189

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