Reducing Neonatal Catheter-Associated Bloodstream Infection

Yevgeniy (Eugene) Statnikov, Data ManagerNeonatal Data Analysis Unit (NDAU)

Outline

• The system

• Types of data captured

• Recording requirements

• Catheter associated bloodstream infection

extra

The system

• Neonatal.Net

• Centralised information

• Used by over 160 neonatal units

extra

Types of data captured

• Static: recorded only once– eg birthweight

• Daily: recorded every day– eg line in situ today

• Episodic: recorded as required – eg date culture taken

Neonatal.Net

Data requirements

SOME BABIES• Cultures taken with clinical signs, recorded at the

time NOT retrospectively• Culture results: including “no growth”

ALL BABIES• Risk factors • Static: birthweight, gestational age, gender• Daily: parenteral nutrition, type of milk feed, vascular

lines in situ

Data requirements

FOUR STEP PROCESS:1) ONCE ONLY(ALL BABIES): Ensure static items

are recorded (gestational age, birthweight, gender)

2) DAILY(ALL BABIES): Ensure daily items are recorded every day (presence of umbilical arterial catheter and central venous lines, parenteral nutrition, milk feeds)

3) EPISODIC (BABIES THAT HAVE A BLOOD CULTURE TAKEN): Record blood culture information

4) EPISODIC (BABIES THAT HAVE A BLOOD CULTURE TAKEN): Record microbiological results

Recording requirements: Log-in

• https://nww.neonatal.nhs.uk/

Click on ‘select existing or admit new baby’

Recording requirements: Log-in

• https://nww.neonatal.nhs.uk/

Enter ‘UK User authentication...’ details issued by your unit

Recording requirements: Static items (ALL BABIES)

• Select baby (use Name or NHS Number)Search for existing baby using Surname, Forename or NHS Number

Or select baby from list of patients

Recording requirements: Daily items (ALL BABIES)

• Switch to daily-details form (to record umbilical and central venous catheters, parenteral nutrition, milk feeds)

On the Patient home page, under Things to do..., click on Day-details form for DD-Month-YY

Recording tequirements: Daily items

• Enter catheter information in line in situ today, milk feeds and parenteral nutrition, and save (must be recorded daily for ALL BABIES) Scroll down the Extended daily

summary (Daily-form) filling out all details including Lines (click on relevant listed option) and Fluids and feeding (tick boxes and click on relevant listed option) Click on Save and

Close to exit

Recording requirements: Episodic items

• Select the ad hoc events form: Infection (bloodcsf

cultures)

On the Patient home page, under Ad-Hoc Event Forms, click on Infection (bloodcsf cultures)

Episodic Items: ALL BABIES THAT HAVE BLOOD CULTURES TAKEN

• Enter: date/time, culture type and clinical signs when culture taken and save (DO NOT ENTER RETROSPECTIVELY)

Inside the Infection form enter Sample taken (date and time), select Sample type and from drop-down menu select Signs present when culture obtained

Click on Save and Close to exit

Episodic items: Culture results

•Microbiology reports return with results of blood test

•Follow the log-in steps and patient search steps outlined previously

Episodic items: Culture results

• Enter the results of microbiology report in the new (2011) Reminders section on the home page

Select the culture form from the ‘Reminders’ section

Episodic items: Alternative culture results collection

• Enter the results of microbiology report on the patient data page where you will find all dates of samples taken

Change page by clicking on patient data tab

Find previously entered sample details inside Daily data

Episodic items: Culture results

• In Days during stay box click on the day on which culture sample was taken

Click on Day of sample draw

Double click on the displayed Infection information to open the Infection form

Episodic items: Culture results

• Click to select pathogens…

Click on Pathogens to record the results of the microbiology report

Episodic items: Culture results

• Enter results including “no growth”

Select pathogen from common list or type pathogen name to locate others

Confirm your record

Episodic items: Culture results

• Save Infection form

Click on Save and Close

Summary

• Static and daily items are required for all babies

• Episodic items are required for babies having a blood

culture taken

• Analysis requires complete data entry

• Positive AND negative blood culture results must be

entered

• Data must be NOT be entered retrospectively

Analysis of infection

Static

Line in Situ (Catheter)

Clinical signs

Daily Episodic

Sample type

Pathogen (+/- Growth)

Date DateLink

Analysis and presentation of results

• CABSI will be risk adjusted or risk stratified

• Presentation format to be decided in discussion

with NPSA

“Two birds with one stone”

The exact same data entry is needed for the

National Neonatal Audit Programme 2011

audit of Neonatal Bloodstream Infection