Upload
morgan-bussell
View
216
Download
2
Tags:
Embed Size (px)
Citation preview
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