Developing potentially better practices to prevent neonatal nosocomial bloodstream infections

BACKGROUND: Nosocomial infections constitute a leading cause of morbility and mortality in Neonatal Intensive Care Units (NICUs). Late-onset sepsis (occurring after 3 days of age) is frequent in NICUs, particularly in very low birth weight infants (VLBWI). A systematic approach using quality improvement techniques can reduce the incidence of nosocomial sepsis. OBJECTIVE: 1)To evaluate the usefulness of “Potentially Better Practices” to reduce nosocomial sepsis in NICUs 2)To evaluate health-care workers (HCWs) compliance with new protocols. DESIGN/METHODS: Phase 1(June 2007-May 2008). Two “Potentially Better Practices” were evaluated: a) hand hygiene, promoting handrubbing with an alcohol based solution b) proper management of central lines, implementing hub care and reducing the duration of central venous catheter use. Education programs and promotion campaigns were performed to improve HCWs compliance. Phase 2(June 2008-May 2009). Application of the “Potentially Better Practices” developed. Adherence of HCWs to new protocols was evaluated by trained internal observers:1) proper handwashing before entering the ward by cameras 2) proper handwashing during patient care 3)bacterial colony counts on the right hand before patient care 4) proper central lines management 5) duration of central lines use. RESULTS: During the phase 1 we enrolled 597 neonates (mean GA 34 wks, mean BW 1910 g; VLBWI 120) and during the phase 2 574 neonates (mean GA 33 wks, mean BW 1895 g; VLBWI 116). The incidence of nosocomial sepsis decreased globally from 10% (phase 1) to 7.7% (phase 2). In VLBWI, the incidence of late-onset sepsis was 25.8% in phase 1 and 19.8% in phase 2. Late-onset sepsis decreased significantly in neonates with BW 500-749 g (93.3% vs 60%, p<0,02). The incidence of sepsis sustained by S. aureus, K. pneumoniae and E. faecalis/faecium decreased from 22.6 to 8.7%, 16.1 to 0, 12.9 to 4.3 respectively (p<0,01). HCWs adherence to new protocols gradually improved during the phase 2, reaching values above 80% for all the indicators considered. CONCLUSIONS: According to our results, the application of “Potentially Better Practices” is effective in reducing nosocomial sepsis in NICUs. The staff training is essential to improve HCWs adherence with infection control measures, resulting in a reduction of nosocomial infections