Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection

Control

Safe Injection Global Network Meeting in Cambodia, 2002

Background: Request for Assistance to Prevent Sepsis among NICU Patients at a University Hospital in Egypt

• High rates of sepsis among infants in neonatal ICU- mortality rates > 50%- poor response to antibiotic therapy

• Early onset sepsis- immediately after admission

MethodsInvestigation of Sepsis among NICU Patients in Egypt

• Observation of infection control practices • Epidemiology - laboratory-based surveillance for BSI (blood culture) - culture of IV fluids (opened and unopened) - culture of medications - monitor mortality

Results: Investigation of Sepsis in NICU

• Clinical practice – All infants placed on IV fluids and antibiotics

• Assessment of Infection control practices– Poor understanding of infection control– Unsafe practices in the preparation of IV fluids– Opened IV fluids: Contaminated (klebsiella

predominant)– Unopened IV fluids: no growth– NICU environmental surfaces: Klebsiella predominant

• Prospective surveillance– 70% of infants with sepsis (most is early onset)– 55% mortality

Investigation of Sepsis in Newborn Nursery

Poor infection control practices

Contamination of IV fluids

Sepsis and death

Rapid Assessment of Sepsis in NICUs

• Sample - NICUs throughout the country (n= 36)

• Assessment - sepsis and mortality rates - culture of IVF - BSI among patients with clinical sepsis - infection control practices with emphasis on management of IV fluids

• Team - laboratory, epidemiologist, neonatologist

Results of IV Fluid and Blood Cultures Survey of Rapid Assessment of Sepsis in NICU’s ,Egypt ‘02

Type of facility

 

No. pts.

Blood No. %cultures pos

IV fluidsNo. % cultures pos

MedicationsNo. %Cultures pos

MOE(n=12)

176 63 75% 70 64% 31 23%

MOHP(n=24)

180 86 69% 100 64% 25 20%

TOTAL 356 149 71% 170 64% 56 21%

Results: Assessment of Infection Control Practices Rapid assessment of Sepsis in NICUs

• General - poor understanding of infection control

• Preparation of IV fluids - mixing of fluids on ward - poor adherence to aseptic techniques - prolonged usage of individual bags - no assigned nurse or special area for IV preparation - reuse of syringes to prepare IV fluids

• Infection control supplies - gloves, syringes, appropriately sized IV fluids

Intervention to Prevent Sepsis in NICUs

• Task analysis on preparation of IV fluids - SOPs for preparation of IV fluids

• Training - 3 days onsite, applied and didactic - follow-up with monthly site visits

• Supplies and reagents - distribution of critical infection control materials

• Supervision and monitoring - key indicators

Key Indicators to Monitor Intervention

• Infection Control Practices - observational tool - score developed for critical procedures • IV fluid contamination • Admissions, deaths, mortality rates

Observation Tool to Monitor Infection Control Practices

• Hand washing before procedures

• IV fluid mixing and preparation

• Medication mixing and preparation

• Cannula insertion steps

Comparison of Infection Control Practices Related to IV & Medication Preparation before and after Intervention

01020304050607080

before training

after training

Percentage of IV Fluid Samples Contaminated

63.4

36.6

Positive

Negative

31.1

68.9

Pre-intervention Post-intervention

Admissions, Deaths and Mortality Rates in 22 NICUs from Dec 01 to Jun 02

0

100

200

300

400

500

600

700

800

900

1000

Dec Jan Feb March April May June

0.1

0.15

0.2

0.25

0.3

0.35

Admission

Deaths

MortalityRate

SummaryBehavior Change Related to Intervention • Improved hand washing

• Improved aseptic techniques for – IV fluid mixing and preparation– Medication mixing and preparation– Cannula insertion

Summary Promotion of Infection Control

• Evidence-based monitoring and evaluation is essential

• Applied training is vital

• Availability of critical supplies

• Promotion of infection control is the key strategy to reduce nosocomial infections

• Investment in infection control has great potential to: - reduce disease in patients - lower health care costs