Reduction in Central Line–Associated Bloodstream Infection Rates After Implementations of Infection Control Measures at a Level 3 Neonatal Intensive Care Unit

AbstractAn outbreak of nosocomial ringworm involved five infants in a neonatal intensive care unit. The index case was a nurse infected with Microsporum canis by her cat. After standard infection control measures were initiated, the outbreak was resolved successfully by an interdisciplinary professional collaboration of physician and veterinary dermatologists and infection control personnel.

Download Full-text

Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures

Infectious Disease Reports ◽

10.3390/idr13020039 ◽

2021 ◽

Vol 13 (2) ◽

pp. 411-417

Author(s):

Teresa L. Almeida ◽

Tânia Mendo ◽

Raquel Costa ◽

Cristina Novais ◽

Mónica Marçal ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Infection Control ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Control Measures ◽

Infection Prevention And Control ◽

Infection Control Measures ◽

Gut Colonization

Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student’s t-test or Mann–Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.

Download Full-text

Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit

The Journal of Vascular Access ◽

10.1177/1129729820928182 ◽

2020 ◽

pp. 112972982092818

Author(s):

Mohammad A A Bayoumi ◽

Matheus F P Van Rens ◽

Prem Chandra ◽

Airene L V Francia ◽

Sunitha D’Souza ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Intervention Study ◽

Central Line ◽

Success Rates ◽

Infection Rates ◽

Umbilical Catheters ◽

Dedicated Team

Background: Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced. Methods: In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018. Results: The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team’s establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line–associated bacterial stream infection rates. Conclusion: A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line–associated bacterial stream infection rates.

Download Full-text

An Outbreak of Carbapenem-Resistant Acinetobacter baumannii Infection in a Neonatal Intensive Care Unit: Investigation and Control

Infection Control and Hospital Epidemiology ◽

10.1086/657669 ◽

2011 ◽

Vol 32 (1) ◽

pp. 34-41 ◽

Cited By ~ 33

Author(s):

Eric J. McGrath ◽

Teena Chopra ◽

Nahed Abdel-Haq ◽

Katherine Preney ◽

Winston Koo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Infection Control ◽

Neonatal Intensive Care Unit ◽

Acinetobacter Baumannii ◽

Neonatal Intensive Care ◽

Multidrug Resistant ◽

Control Measures ◽

Carbapenem Resistant ◽

Surveillance Cultures

Objective.To investigate the mode of transmission of and assess control measures for an outbreak of carbapenem-resistant (multidrug-resistant) Acinetobacter baumannii infection involving 6 premature infants.Design.An outbreak investigation based on medical record review was performed for each neonate during the outbreak (from November 2008 through January 2009) in conjunction with an infection control investigation.Setting.A 36-bed, level 3 neonatal intensive care unit in a university-affiliated teaching hospital in Detroit, Michigan.Interventions.Specimens were obtained for surveillance cultures from all infants in the unit. In addition, geographic cohorting of affected infants and their nursing staff, contact isolation, re-emphasis of adherence to infection control practices, environmental cleaning, and use of educational modules were implemented to control the outbreak.Results.Six infants (age, 10-197 days) with multidrug-resistant A. baumannii infection were identified. All 6 infants were premature (gestational age, 23-30 weeks) and had extremely low birth weights (birth weight, 1000 g or less). Conditions included conjunctivitis (2 infants), pneumonia (4 infants), and bacteremia (1 infant). One infant died of causes not attributed to infection with the organism; the remaining 5 infants were discharged home. All surveillance cultures of unaffected infants yielded negative results.Conclusions.The spread of multidrug-resistant A. baumannii infection was suspected to be due to staff members who spread the pathogen through close contact with infants. Clinical staff recognition of the importance of multidrug-resistant A. baumannii recovery from neonatal intensive care unit patients, geographic cohorting of infected patients, enhanced infection control practices, and staff education resulted in control of the spread of the organism.

Download Full-text

Targeting Risk Factors for the Control of Central Line-Associated Bloodstream Infection in the Neonatal Intensive Care Unit: A Single Tertiary Center Experience

Neonatal Medicine ◽

10.5385/nm.2021.28.3.116 ◽

2021 ◽

Vol 28 (3) ◽

pp. 116-123

Author(s):

Jiyoon Jeong ◽

Yoojin Kwun ◽

Min-ju Kim ◽

Sang-Ho Choi ◽

Euiseok Jung ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

High Risk ◽

Infection Control ◽

Neonatal Intensive Care Unit ◽

Bloodstream Infection ◽

Neonatal Intensive Care ◽

Central Line ◽

High Risk Infants

Purpose: The aim of this study was to estimate the effect of targeting risk factors for the control of central line-associated bloodstream infection (CLABSI) among high-risk infants in a tertiary neonatal intensive care unit (NICU).Methods: Infants admitted to the NICU and diagnosed with CLABSI from January to December 2013 were eligible for inclusion to the study. The CLABSI group (n=47) was matched in a 1:2 ratio to the control group (n=94) based on gestational age, birth weight, and Score for Neonatal Acute Physiology-II. Risk factors for CLABSI were identified using the Cox proportional hazard model, and analysis of the effect of these risk factors targeting infection control was performed.Results: The risk factors associated with CLABSI were prolonged central line dwell days (adjusted hazard ratio [HR], 1.028; 95% confidence interval [CI], 1.011 to 1.045; P=0.001), use of a silicone catheter (adjusted HR, 5.895; 95% CI, 1.893 to 18.355; P=0.002), surgical treatment (adjusted HR, 3.793; 95% CI, 1.467 to 9.805; P=0.006), and less probiotic supplementation (adjusted HR, 0.254; 95% CI, 0.068 to 0.949; P=0.042). By targeting these risk factors with a quality improvement initiative, the mean CLABSI incidence rate per 1,000 catheter-days decreased from 6.6 to 3.1 (P=0.004).Conclusion: Targeting risk factors for infection control significantly reduced the rate of CLABSI among high-risk infants in the NICU.

Download Full-text

Improving central line infection rates in the neonatal intensive care unit: Effect of hospital location, site of insertion, and implementation of catheter-associated bloodstream infection protocols

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2015.02.001 ◽

2015 ◽

Vol 50 (5) ◽

pp. 860-863 ◽

Cited By ~ 11

Author(s):

Jennifer J. Freeman ◽

Samir K. Gadepalli ◽

Sabina M. Siddiqui ◽

Marcus D. Jarboe ◽

Ronald B. Hirschl

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Bloodstream Infection ◽

Neonatal Intensive Care ◽

Central Line ◽

Infection Rates ◽

Central Line Infection ◽

Line Infection

Download Full-text

Methicillin-Resistant Staphylococcus Aureus Transmission and Hospital-Acquired Bacteremia in a Neonatal Intensive Care Unit in Greece

10.21203/rs.3.rs-231274/v1 ◽

2021 ◽

Author(s):

ANASTASSIOS GEORGE DOUDOULAKAKIS ◽

Iris Spiliopoulou ◽

Nikolaos Giormezis ◽

Garyfallia Syridou ◽

Angeliki Nika ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Positive Culture ◽

Maternity Hospital ◽

Control Measures ◽

Methicillin Resistant ◽

Infection Control Measures ◽

Hospital Acquired

Abstract The epidemiology of methicillin-resistant S. aureus (MRSA) colonization and infections in a 30-bed, level III university-affiliated neonatal intensive care unit was retrospectively investigated (2014-2018). Virulence, resistance genes and clonality of 46 isolates were determined by PCRs and MLST. Of 1538 neonates, 77 (5%) had a positive culture for MRSA; four bacteremias occured. One major clone was identified, ST225 (23/40, 58%), imported from the same maternity hospital. Another clone, ST217, was predominant (4/6) among colonized health care workers. Four isolates classified as ST80 were PVL-positive, four tst-positive, and two etb-positive. Strengthening of infection control measures with emphasis on hand hygiene was applied.

Download Full-text