1. Introduction Materials and methods Results Conclusions
Impact of an intervention based on contact precautions in hospital acquired infections in a neonatal unit
Ivohne Corrales1,2, Jorge Cortes3, Gloria Troncoso1,2, Martha Alvarez1, G. Buitrago3, M. Ibañez2, Aura Lucía Leal3 1. Fundación Cardioinfantil, 2. Universidad del Rosario, 3. Universidad Nacional de Colombia, Bogotá, Colombia
Introduction
Materials and methods
A before and after study was developed. In the first phase, during 5 months, patients were followed without any specific intervention. Then, an educative intervention in contact isolation precautions and hand washing was done. Isolated patients were identified. Educative talks were done at the beginning and repeated every two months for all medical and non-medical personnel.
Isolation criteria: Every newborn with previous stay in a NICU for more than 48 hrs (at admission), or a stay in the NICU for more than 7 days.
For those isolated a skin sample was taken for microbiological identification of colonization. One rectal sample and one axillar sample were taken and processed in the microbiology lab by use of ESBL Chrom ID, (Biomeriuex, France). Positive patients were keeped in isolation while for negative ones, isolation was removed.
The endpoint was the number of HAI during eash one of the study phases. Clinical data at admission and hosital stay were taken and a multivariate analysis was perform to determine if differences existed between the two periods.
It is presumed that surveillance of microbiological colonization and isolation measures and contact precaution might help to diminish the risk of hospital acquired infections (HAI), especially in high risk units like neonatal intensive care units (NICU). Patients in those units usually have important risk factors like immunological immaturity, low weight, great comorbidity and the need for invasive procedures.
Aim: To evaluate the impact of an educative intervention based on contact isolation precautions and colonization detection in a neonatal intensive care unit.
Results
450 patients: 247 before the intervention and 203 after the educative intervention. A HAI was diagnosed in 78 patients, 45 in the first group and 33 patients in the intervention period (16.2%)
Figure 1. Patient flow and outcome after the intervention
Clinical charachteristics of the patients
Hospital acquired infections during the study period
Inconditional multivariate logistic regression model for HAI.
Clinical characteristics
Before intervention n: 247
After interventiona n: 203
Statistical significance p; RR (IC95%)
Males, n (%)
142 (57,5%)
114 (56,2%)
p= 0,77; 0,97 (0,78-1,20)
Vaginal delivery, n (%)
124 (50,2%)
103 (50,7%)
p= 0,43
Parenteral nutrition, n (%)
23 (9,3%)
34 (16,7%)
p= 0,01; 1,08 (1,01-1,17)
Mechanical ventilation, n (%)
26 (10,5%)
42 (20,7%)
p= 0,03; 1,51 (1,10-2,07)
Surgery, n (%)
33 (13,4%)
28 (13,8%)
p= 0,89; 1,01 (0,79-1,30)
Central lines, n (%)
43 (17,4%)
50 (24,6%)
p= 0,254
Congenital cardiopathy, n (%)
32 (13%)
47 (23,2%)
p= 0,05; 1,43 (1,08-1,89)
Fatality, n (%)
9 (3,6%)
12 (5,9%)
p= 0,27
Gestational age (weeks, median)
37,5 (+/-2,59)
36,7 (+/-3,30)
p= 0,02
Weight at birth (grams, media)
2829 (+/-693,3)
2652 (+/-766,2)
p= 0,01
Age at admission (days, media)
15,1 (+/- 13,7)
12,8 (+/-14,9)
p= 0,09
Hospital stay (días, media)
9,3 (+/-12,3)
11,9 (+/-16,4)
p= 0,06
Diagnosis
Before, n: 247
After, n: 203
*p; RR, (IC95%)
Primary bloodstream infection
12 (4,9%)
11 (5,4%)
p= 0,95; 0,94, (0,63-1,41)
Urinary tract infection
14 (5,7%)
8 (3,9%)
p= 0,53; 1,17, (0,84-1,62)
Catheter related blodstream infection
8 (3,2%)
6 (3,0%)
p= 0,91; 1,04, (0,66-1,65)
Clinical sepsis
5 (2,0%)
p= 0,26; 0,69, (0,34-1,38)
Acute viral diarrhea
9 (3,6%)
2 (1,0%)
p= 0,12; 1,50, (1,12-2,02)
Pneumonia
2 (0,8%)
4 (2,0%)
p= 0,25; 0,60, (0,19-1,88)
Conjunctivitis
0 (0%)
p= 0,06; 1,68, (1,30-2,17)
Necrotizing enterocholitis
1 (0,4%)
p= 0,17; 0,45, (0,11-1,81)
Surgical site infection
1 (0,5%)
p= 1; 0,91, (0,22-3,65)
Cellulitis
Bacterial endocarditis
Candidemia
Tracheitis
Meningitis
Peritonitis
Mediastinitis
Variables
O.R.
(IC95%)
Valor p
Before intervention
2,99
1,38-6,46
p= 0,005
Parenteral nutrition
4,12
1,38-12,30
p= 0,011
Congenital cardiopathy
3,07
1,41-6,64
p= 0,004
Hospital stay(per day)
1,09
1,06-1,13
p= 0,000
Mechanical ventilation
2,36
0,78-7,16
p= 0,127
Weight at birth( grams)
1,00
0,99-1,00
p= 0,696
Gestational age at admission (per weeks)
1,03
0,94-1,26
p= 0,765
Conclusions
An educative intervention based on appropiate contact isolation precautions and surveillance of colonization was associated with a lower HAI rate in a NICU in Colombia.
References
Financial support
Auriti C. Risk factors for nosocomial infections in a neonatal intensive-care unit. J Hosp Infect 2003; 53(1):
Borghesi A, Stronati M. Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. J Hosp Infect 2008; 68:
Pittet D. Hand hygiene: improved standards and practice for hospital care. Curr Opin Infect Dis 16:327–335.
Backman C, Zoutman D, Marck P. An integrative review of the current evidence on the relationship between hand hygiee interventions and the incidence of health care–associated infections. Am J Infect Control 2008; 36:
This project had support from Asociación Colombiana de Infectología (ACIN) and Biomeriéux, company that supplied the chromogenic agars.
Acknowledgements: María Amelia Bueno and Anita Montañez, Universidad Nacional de Colombia for their logistic support.