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:
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
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
We would like Nosocomial infection Mortality Morbidity Antibiotics TPN then TPN Number of patients More experiences for team Regionalization
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 http://www.aiha.com/English/partners/kosice/chart.htm
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 http://www.aiha.com/English/partners/kosice/chart.htm
No other serious problems... Going home at 3 m- 2430g
Exchange transfusions (artery & vein) n When to release? n Necessary volume to exchange (80- 160ml)? n How to continue the ATB treatment? n Give or not to give IVIG after exchange? n Multicentric randomised study needed...
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!
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 )
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 http://www.aiha.com/English/partners/kosice/chart.htm
We would like to continue... n E-mail communications n Videoconferences n Grant writing - participation in multicentric trials – database n Team building http://www.aiha.com/English/partners/kosice/chart.htm
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.