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

2011 ◽  
Vol 44 (6) ◽  
pp. 731-734 ◽  
Author(s):  
Daiane Silva Resende ◽  
Jacqueline Moreira do Ó ◽  
Denise von Dolinger de Brito ◽  
Vânia Olivetti Steffen Abdallah ◽  
Paulo Pinto Gontijo Filho
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Multiple Logistic Regression Analysis ◽  
Bloodstream Infections ◽  
University Hospital ◽  
Neonatal Intensive Care Units ◽  
Care Bundle ◽  
Evidence Based ◽  
And Control

INTRODUCTION: 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. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: 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. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

scholarly journals Candidemia in the Neonatal Intensive Care Unit: A Retrospective, Observational Survey and Analysis of Literature Data

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Giuseppina Caggiano ◽  
Grazia Lovero ◽  
Osvalda De Giglio ◽  
Giovanna Barbuti ◽  
Osvaldo Montagna ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Epidemiological Data ◽  
Common Species ◽  
Sensu Stricto ◽  
University Hospital ◽  
Microbiological Laboratory

We evaluated the epidemiology ofCandidabloodstream infections in the neonatal intensive care unit (NICU) of an Italian university hospital during a 9-year period as a means of quantifying the burden of infection and identifying emerging trends. Clinical data were searched for in the microbiological laboratory database. For comparative purposes, we performed a review of NICU candidemia. Forty-one candidemia cases were reviewed (overall incidence, 3.0 per 100 admissions).Candida parapsilosis sensu stricto(58.5%) andC. albicans(34.1%) were the most common species recovered. A variable drift through years was observed; in 2015, 75% of the cases were caused by non-albicansspecies. The duration of NICU hospitalization of patients with non-albicanswas significantly longer than in those withC. albicans(median days, 10 versus 12). Patients with non-albicansspecies were more likely to have parenteral nutrition than those withC. albicans(96.3% versus 71.4%).Candida albicanswas the dominant species in Europe and America (median, 55% and 60%; resp.); non-albicansspecies predominate in Asia (75%). Significant geographic variation is evident among cases of candidemia in different parts of the world, recognizing the importance of epidemiological data to facilitate the treatment.

scholarly journals Quality Improvement Measures to Reduce Central-Line–Associated Bloodstream Infections (CLABSIs) in a Neonatal Intensive Care Unit (NICU)

2020 ◽  
Vol 41 (S1) ◽  
pp. s362-s363
Author(s):  
Tamika Anderson ◽  
Michelle Flood ◽  
Susan Kelley ◽  
Lea Ann Pugh ◽  
Renato Casabar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Multidisciplinary Team ◽  
Neonatal Intensive Care ◽  
Infection Prevention ◽  
Bloodstream Infections ◽  
Neonatal Infection ◽  
Central Line ◽  
Evidence Based

Background: Central-line–associated bloodstream infections (CLABSIs) are a significant contributor to morbidity and mortality for neonates; they also increased healthcare costs and duration of hospitalization. This population is susceptible to infections because of their undeveloped immune systems, and they require intravenous access until they can tolerate enteral feedings, which for extremely premature infants can take several weeks (if not months) to achieve. Our hospital is a regional-referral teaching hospital with 772 licensed beds. The neonatal intensive care unit (NICU) is a level 3, 35-bed unit where the most critically ill neonates receive care. After a sustained 3-year period of zero CLABSIs, we identified 10 infections between September 2016 through April 2018. Methods: A multidisciplinary team known as the neonatal infection prevention team (NIPT) was reinstated. This team included members from nursing and infection prevention (IP) and from NICU Shared Governance, as well as a neonatal nurse practitioner (NNP) and a neonatologist to review these CLABSIs. Evidence-based practices, policies, and procedures were implemented to help reduce CLABSIs. Nurse educators provided education and training. The infection prevention team reinstated and modified the central-line maintenance and insertion tools to document compliance and to identify any gaps in care. Nurses were expected to document line maintenance once per shift (a.m. and p.m.). All CLABSIs were entered into the CDC NHSN and the hospital’s safety event reporting system, which required follow-up by a clinical manager. The infection prevention team monitored NHSN standardized infection ratios (SIRs) monthly. The SIR is the number of observed events divided by the number predicted (calculated based on national aggregate data). Results: The highest reported quarterly SIR was 1.423, which occurred in the third quarter of 2018 (Fig. 1). Overall compliance with line maintenance protocols was 86% on the morning shift and 89% on the afternoon shift. With implementation of an evidence-based bundle, the NICU had a rolling 12-month SIR of 0.00 as of October 2019. Conclusions: Multidisciplinary team development, implementation of evidence-based bundle elements, and education on catheter care contributed to the long-term success in decreasing CLABSI rates in our NICU. Although this implementation achieved a zero CLABSI rate, we experienced some barriers, including compliance issues with staff not completing the audit tools, staff turnover, and high patient census.Funding: NoneDisclosures: None

scholarly journals Aspirin for Evidence-Based Preeclampsia Prevention trial: effect of aspirin on length of stay in the neonatal intensive care unit

2018 ◽  
Vol 218 (6) ◽  
pp. 612.e1-612.e6 ◽  
Author(s):  
David Wright ◽  
Daniel L. Rolnik ◽  
Argyro Syngelaki ◽  
Catalina de Paco Matallana ◽  
Mirian Machuca ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Prevention Trial ◽  
Evidence Based ◽  
Trial Effect

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 Food safety and quality of distribution of raw human milk from a University Hospital

2018 ◽  
Vol 31 (6) ◽  
pp. 547-556
Author(s):  
Marina Aparecida da Silva MORENO ◽  
Lucíola Sant’Anna de CASTRO ◽  
Ana Cristina Freitas de Vilhena ABRÃO ◽  
Kelly Pereira COCA
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Human Milk ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Energy Content ◽  
University Hospital ◽  
Milk Analysis

ABSTRACT Objective To evaluate the quality of raw human milk distributed in the Neonatal Intensive Care Unit of a University Hospital of the city of São Paulo. Methods A cross-sectional study with raw human milk samples from mothers who attended the Human Milk Collection Station of a University Hospital, analyzed between May 2016 and January 2017, excluding mothers of twins. The quality of the raw human milk was assessed by verifying the presence of dirt, the coloration of the milk, the titratable acidity using the Dornic method, and through its energy content. Kruskal-Wallis and Mann-Whitney tests were used for the analysis of the energy profile and the degree of Dornic acidity, according to the stage of the raw human milk and the gestational age of the child. Results The study was composed of 40 samples of 40 different women, with a mean age of 27 years, an average of 11.8 years of education, most of them were multiparous and with a partner. Regarding milk analysis, 55.0% was classified as colostrum, 27.5% as mature milk and 17.5% as transitional milk. All samples presented negative results for dirt and normal coloration. The mean milk acidity was 3.24º Dornic and most of the samples were classified as hypercaloric energy content. There was no association between the lactation stage and gestational age with the acidity value and energy content. Conclusion The quality of raw human milk distributed in the Neonatal Intensive Care Unit of the institution evaluated was considered adequate and the samples analyzed had a high energy content and excellent Dornic acidity.

A descriptive report of end-of-life care practices occurring in two neonatal intensive care units

2016 ◽  
Vol 30 (10) ◽  
pp. 971-978 ◽  
Author(s):  
Vanessa Lam ◽  
Nicole Kain ◽  
Chloe Joynt ◽  
Michael A van Manen
Keyword(s):  
Congenital Anomaly ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Life Care ◽  
Life Sustaining Treatment ◽  
Care Practices

Background: In Canada and other developed countries, the majority of neonatal deaths occur in tertiary neonatal intensive care units. Most deaths occur following the withdrawal of life-sustaining treatments. Aim: To explore neonatal death events and end-of-life care practices in two tertiary neonatal intensive care settings. Design: A structured, retrospective, cohort study. Setting/participants: All infants who died under tertiary neonatal intensive care from January 2009 to December 2013 in a regional Canadian neonatal program. Deaths occurring outside the neonatal intensive care unit in delivery rooms, hospital wards, or family homes were not included. Overall, 227 infant deaths were identified. Results: The most common reasons for admission included prematurity (53.7%), prematurity with congenital anomaly/syndrome (20.3%), term congenital anomaly (11.5%), and hypoxic ischemic encephalopathy (12.3%). The median age at death was 7 days. Death tended to follow a decision to withdraw life-sustaining treatment with anticipated poor developmental outcome or perceived quality of life, or in the context of a moribund dying infant. Time to death after withdrawal of life-sustaining treatment was uncommonly a protracted event but did vary widely. Most dying infants were held by family members in the neonatal intensive care unit or in a parent room off cardiorespiratory monitors. Analgesic and sedative medications were variably given and not associated with a hastening of death. Conclusion: Variability exists in end-of-life care practices such as provision of analgesic and sedative medications. Other practices such as discontinuation of cardiorespiratory monitors and use of parent rooms are more uniform. More research is needed to understand variation in neonatal end-of-life care.

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.

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