Decreasing infection in neonatal intensive care units through quality improvement

Bowen, Jennifer R.; Callander, Ian; Richards, R; Lindrea, Kwee Bee

doi:10.1136/archdischild-2015-310165

Cited by 32 publications

(41 citation statements)

References 26 publications

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“…Çünkü bu bebeklerde immün sistem yeterince gelişmemiştir. Ayrıca invaziv girişimlerin sık uygulanmasıda sağlık bakım ilişkili enfeksiyon (SBİE)'ların sıklığını yükseltir (3,4). SBİE'ler bu bebekler için önemli bir morbidite ve mortalite nedeni olup hastanede kalış süresini ve maliyetleri arttırır (3,5,6).…”

Section: Introductionunclassified

Yenidoğan Yoğun Bakım Ünitesinde Gelişen Sağlık Bakım İlişkili Enfeksiyonlar: Son 6 Yılın Değerlendirilmesi

Karabay¹,

Kaya²,

Güçlü³

et al. 2020

Turkish Journal of Pediatric Disease

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Sağlık bakım ilişkili enfeksiyon (SBİE)'ların yenidoğan yoğun bakım ünite (YYBÜ)'lerinde önemli morbidite ve mortalite nedenidir. Bu çalışmada altı yıllık zaman diliminde YYBÜ'deki SBİE'ler ve ilişkili faktörlerin değerlendirilmesi amaçlandı. Gereç ve Yöntemler: Çalışma YYBÜ'de 1 Ocak 2013-31 Aralık 2018 tarihleri arasında yapıldı. YYBÜ'de gelişen SBİE'ler retrospektif olarak değerlendirildi. YYBÜ günlük aktif sürveyansla takip edildi. SBİE tanısı Center for Disease Control and Prevention (CDC) kriterlerine göre konuldu. YYBÜ'de yatan hasta sayısı, hasta günü, tespit edilen SBİE, invaziv araç kullanım oranı ve tespit edilen patojenler değerlendirildi. Bulgular: Bu araştırmada 2196 hasta, 33652 hasta günü, 4157 ventilatör günü, 3343 umbilikal kateter günü, 5210 santral venöz kateter günü ve 92 üriner kateter günü değerlendirildi. SBİE hızı %4.78 (105/2196) ve insidans dansitesi ‰3.12 (105/33652)'di. SBİE dağılımları değerlendirildiğinde; SBİE'nin 101 (%96.1)'i kan dolaşımı enfeksiyonu (KDE), ikisi (%1.90) pnömoni, biri (%0.95) merkezi sinir sistemi enfeksiyonu ve biri (%0.95) yumuşak doku enfeksiyonuydu. SBİE sıklığı 2500 gr dan büyük bebeklerde daha az (%1.02) iken, 751-1000 gr arası bebeklerde daha fazla (%23.95)'di (p<0.001). Etken dağılımına göre; %59.0 (62/105)'u gram negatif bakteri (GNB), %41.0 (43/105)'i gram pozitif bakteri (GPB) kaynaklıydı. En sık izole edilen GNB'ler; Klebsiella spp. (%34.2), Enterobacter spp. (%12.3) ve en sık izole edilen GPB'ler; Stafilokoklardı (%37.0). İnvaziv araç ilişkili enfeksiyon hızları değerlendirildiğinde; santral venöz kateter ilişkili KDE hızı ‰ 0.95, umbilikal kateter ilişkili KDE hızı ‰2.09'du. Sonuç: SBİE'ler içinde en sık görüleni KDE'di. İnvaziv girişimler ve düşük doğum ağırlığı enfeksiyon riskini artıran faktörler olarak saptandı. SBİE gelişme sıklığı bebek doğum ağırlığı ile ters orantılıydı. Düşük doğum ağırlıklı bebeklerde daha hassas enfeksiyon kontrol önlemlerinin gerektiği düşünüldü.

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Section: Introductionunclassified

Yenidoğan Yoğun Bakım Ünitesinde Gelişen Sağlık Bakım İlişkili Enfeksiyonlar: Son 6 Yılın Değerlendirilmesi

Karabay¹,

Kaya²,

Güçlü³

et al. 2020

Turkish Journal of Pediatric Disease

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“…The risk of CLABSI is significantly increased in patients with lower gestational age and birth weight, as they exhibit poor skin integrity, an immature immune system, and require the prolonged use of central lines [ 6 ]. As a result, CLABSI are the most common cause of late onset sepsis (LOS) in neonates and thus constitute one of the leading causes of both morbidity and mortality in this age group [ 7 ]. The Australian and New Zealand Neonatal Network (ANZNN) reports the incidence of late onset sepsis as 4.5%, with CLABSI constituting 69% of these infections [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Investigation of CLABSI at The Canberra Hospital (TCH) in 2012-2013 showed one of the highest rates among each of the NICUs in New South Wales and the Australian Capital Territory [ 7 ]. In response, current practices were audited and a new central line bundle policy was introduced in 2014 in attempt to lower this statistic.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Cohort Analysis of Central Line Associated Blood Stream Infection following Introduction of a Central Line Bundle in a Neonatal Intensive Care Unit

Bannatyne

Smith

Panda

et al. 2018

International Journal of Pediatrics

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Background Central Line Associated Bloodstream Infections (CLABSI) constitute a leading cause of morbidity and mortality in neonatal populations. There has been an overwhelming increase in the use of evidence-based care practices, also known as bundles, in the reduction of these infections. In this report, rates of CLABSI and central line utilisation were examined following the introduction of a central line bundle in our Neonatal Intensive Care Unit (NICU) at the Canberra Hospital. Methods The research undertaken was a retrospective cohort study in which newborn infants admitted to the Canberra Hospital NICU between January 2011 and December 2016 and had a central line inserted were included in the study. Data regarding central line days, bed days, infection rates, and patient demographics were collected before and after the introduction of an intervention bundle. CLABSI rates were calculated per 1,000 central line days for before (2011-2013) and after (2014-2016) the introduction of the bundle. The postintervention period was retrospectively analysed for compliance, with data regarding the completion of maintenance forms and insertion forms collected. Results Overall, the results showed a significant decrease in CLABSI rates from 8.8 per 1,000 central line days to 4.9 per 1,000 central line days in the intervention period (p<0.001). Central line utilisation ratio (CLUR: ratio of central line days to bed days) was also reduced between pre- and postintervention periods, from 0.177 (4414/25013) to 0.13 (3633/27384; p<0.001). Compliance to insertion forms and maintenance forms was observed to increase within the intervention period. Conclusion The implementation of a central line bundle was effective in reducing both CLABSI rates and dwell time (CLUR) for central venous catheters.

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“…The proven quality improvement initiatives to improve the neonatal care outcomes include maintaining hand hygiene, maintenance and optimization of the central line, improving mother-infant interaction, reducing the risk of bronchopulmonary dysplasia and hypothermia, reducing the exposure of infants to various stressors, and implementing the family-centered care approach. Pain assessment and management Pain assessment and documentation using a neonatal pain tool, N-PASS Considerable improvement in pain reduction strategies -2 Ting et al 9 CLABSI prevention 10 step regimen Considerable reduction in rate of CLABSI Bowen et al 11 Koeppel et al 12 Zhou et al 14 Byrd et al 15 3…”

Section: Discussionmentioning

confidence: 99%

“…Bowden et al 11 in 2011 demonstrate a >50% reduction in BSI in extremely premature neonates from D3 to 35 following a collaborative quality improvement project to reduce neonatal infection across a NICU network consisting of eight neonatal intensive care units (NICUs) in New South Wales, Australia. Koeppel et al, 12 on a 10year review of CLABSI prevention efforts in NICUs, demonstrated that the implementation of QI processes that include strict compliance to best practices and decreasing central line entry by use of a closedmedication system were associated with a significant and sustainable reduction in CLABSI rates.…”

Section: Prevention Of Sepsismentioning

confidence: 99%

"Quality improvement initiatives in neonatal intensive care unit (NICU) for improved care outcomes- a review of evidence"

El-Atawi¹,

Elhalik²,

Dash³

2019

JPNC

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This review mainly focuses on the identification of preventable causes of negative neonatal outcomes in the NICUs, and reviews the currently available evidence on the interventions implemented to prevent these causes. Methods An extensive literature search was conducted for the English language articles in the EMBASE and MEDLINE databases. A total of 300 articles were retrieved with the keyword search. Further attempts were made to search the reference lists of retrieved articles to identify the relevant studies. An internet database search was made to include all articles. The keywords used to retrieve this data were 'quality improvement', 'quality initiatives', 'neonatal outcomes', 'health outcomes', 'care outcomes', 'neonatal intensive care unit', 'NICU', 'preterm infants', 'preterm neonates', 'low birth weight infants', 'low birth weight neonates', 'quality team', 'quality intervention', 'premature infants', 'premature neonates'.

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Decreasing infection in neonatal intensive care units through quality improvement

Abstract: This study demonstrates a >50% reduction in BSI in extremely premature neonates from D3 to 35 following a collaborative quality improvement project to reduce neonatal infection across an NICU network, supported by timely provision of data.

Cited by 32 publications

References 26 publications

Yenidoğan Yoğun Bakım Ünitesinde Gelişen Sağlık Bakım İlişkili Enfeksiyonlar: Son 6 Yılın Değerlendirilmesi

Yenidoğan Yoğun Bakım Ünitesinde Gelişen Sağlık Bakım İlişkili Enfeksiyonlar: Son 6 Yılın Değerlendirilmesi

Retrospective Cohort Analysis of Central Line Associated Blood Stream Infection following Introduction of a Central Line Bundle in a Neonatal Intensive Care Unit

"Quality improvement initiatives in neonatal intensive care unit (NICU) for improved care outcomes- a review of evidence"

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