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Reduction in rate of nosocomial infection in the NICU Reduction in rate of nosocomial infection in the NICU Peter Krcho, MD, PhD Providence-Košice Partnership.

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Presentation on theme: "Reduction in rate of nosocomial infection in the NICU Reduction in rate of nosocomial infection in the NICU Peter Krcho, MD, PhD Providence-Košice Partnership."— Presentation transcript:

1 Reduction in rate of nosocomial infection in the NICU Reduction in rate of nosocomial infection in the NICU Peter Krcho, MD, PhD Providence-Košice Partnership Peter Krcho, MD, PhD Providence-Košice Partnership

2 Goals... n NI in NICU – specific problem NI in NICU = NI in PICU n Sources of infection n What could be done with the same equipment n What we need for the future

3 We would like  Nosocomial infection  Mortality  Morbidity  Antibiotics  TPN then  TPN  Number of patients  More experiences for team  Regionalization

4 Admissions, Total Deaths

5 Nosocomial infections

6 Results Used ATB

7 ATB per newborn (average)

8 How did we achieve these results? n Early resuscitation n Surfactant treatment n Appropriate management of the PDA - indomethacin, bedside ultrasound n Short inspiration times, higher RR n We changed ATB policies n More catheters n More discussion/collaboration

9 Surfactant

10 How did we achieve these results? n More blood cultures n BACTEC n In severe infections exchange transfusions (arterial and venous) n As soon as possible we stop ATB n More Total Parenteral Nutrition (TPN) in first days n Better use of TPN n Hand washing

11 Early surfactant (26w-710g)

12 Longer UPV – More nosocomial infection

13 Exchange transfusion: Still necessary...

14 Just 16 hours after...

15 No other serious problems... Going home at 3 m- 2430g

16 Exchange transfusions (artery & vein) n When to release? n Necessary volume to exchange ( ml)? n How to continue the ATB treatment? n Give or not to give IVIG after exchange? n Multicentric randomised study needed...

17 Learning from Our Mistakes: n Excess volume, FFP, IG. (50-60/kg) n Excess, frequent ATB changes n Insufficient skills for arterial access n Destruction of the peripheral veins, insufficient venous access n Negative blood cultures – when to take n Not enough surfactant and late...later extubation more CLD n Equipment – increase of NI with more changes!

18 General ideas... n Maximal control from the start n Right intervention at the right time (ASAP) n Surfactant ASAP, Indocin IV, Blood culture always, precise volume management n LATER n Less is sometimes more (volume, caloric input )

19 How did we achieve these results? n If caloric input is just enough we stop PN ASAP because of high nosocomial infection rate n Improving infection control n More seminars for other hospitals n PC’s could save time for other work n Internet access – Cochrane Library

20 We would like to continue... n communications n Videoconferences n Grant writing - participation in multicentric trials – database n Team building

21 Needs... n NICU – need for neonatal professionals n Medical supplies and equipment: IV, ventilation tubes, humidifiers, HANDS not only n More effort for the right diagnosis n More skills, more Surfactant, better transport, more equipment-concentration, regionalisation IU.

22 BW 540g

23 About us in

24 Resources from the n n Nosocomial Infections in Newborn n Open Medical Club n under construction


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