Protocol Reduced Neonatal Blood Infections

Major Finding: At one hospital, the incidence of late-onset bloodstream infections among very low-birth-weight infants was 38% before the start of a comprehensive infection-control program, and 23% afterward, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None reported.

PHILADELPHIA — A comprehensive infection-control protocol was associated with a significant decrease in the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

After implementation of the protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, the rate of infections fell from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital. “The reported incidence of these late-onset bloodstream infections ranges from 7% to 20%. Before 2004, the incidence in our NICU was about 38%. The comprehensive infection-control measures were instituted in January 2005 to reduce this rate.”

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches, and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines.

Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection-control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69, or 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

Major Finding: At one hospital, the incidence of late-onset bloodstream infections among very low-birth-weight infants was 38% before the start of a comprehensive infection-control program, and 23% afterward, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None reported.

PHILADELPHIA — A comprehensive infection-control protocol was associated with a significant decrease in the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

After implementation of the protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, the rate of infections fell from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital. “The reported incidence of these late-onset bloodstream infections ranges from 7% to 20%. Before 2004, the incidence in our NICU was about 38%. The comprehensive infection-control measures were instituted in January 2005 to reduce this rate.”

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches, and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines.

Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection-control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69, or 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.

Major Finding: At one hospital, the incidence of late-onset bloodstream infections among very low-birth-weight infants was 38% before the start of a comprehensive infection-control program, and 23% afterward, a significant difference.

Data Source: A retrospective study of preintervention (n = 334) and postintervention (n = 303) groups.

Disclosures: None reported.

PHILADELPHIA — A comprehensive infection-control protocol was associated with a significant decrease in the incidence of late-onset neonatal blood infections in very low-birth-weight infants, according to Linda Wicker, R.N.

After implementation of the protocol, which focused on hand hygiene, environmental contamination control, education, and intravenous line care, the rate of infections fell from 38% to 23%, she said at the annual meeting of the Eastern Society for Pediatric Research.

In 2004, the neonatal intensive care unit at Cooper University Hospital, Camden, N.J., found itself exceeding commonly reported neonatal ICU infection rates, said Ms. Wicker, a clinical educator at the hospital. “The reported incidence of these late-onset bloodstream infections ranges from 7% to 20%. Before 2004, the incidence in our NICU was about 38%. The comprehensive infection-control measures were instituted in January 2005 to reduce this rate.”

A multidisciplinary team developed the protocol, which targeted several areas. “First, we launched a hand hygiene campaign,” Ms. Wicker said. “We banned all rings, watches, and bracelets, and artificial nails. We also put clocks at all the sinks to ensure a full 2-minute scrub.”

A second focus of the protocol was reducing catheter-related infections. A dedicated central line management team cared for all the lines. Sterile technique was used for all line insertions. Staff also limited blood draws and heel sticks, and focused on early removal of all central lines.

Environmental controls included keyboard covers for all computers, removal of stuffed animals at the bedside, separate equipment for each incubator, cleaning bedside equipment during every shift, and daily sink bleaching.

Before entering the NICU, residents and nurses took a special infection-control education course. “We also reinforced the judicious use of antibiotics and early feeding with breast milk,” Ms. Wicker said.

She and her colleagues analyzed the protocol's effectiveness by comparing pre- and postintervention groups. The preintervention group consisted of 334 infants treated from 2001 to 2004; the postintervention group consisted of 303 infants treated from 2005 to 2008. There were no significant differences between the infants' birth weight (average, 1,010 g), gestational age (27 weeks), sex (50% male), 5-minute Apgar score (8), or days on total parenteral nutrition (21).

Before the intervention, 126 infants (38%) experienced a late-onset bloodstream infection. The infections occurred in significantly fewer infants in the postintervention group (69, or 23%). The number of infections was also significantly lower in the postintervention era (92 vs. 145).

Gram-positive bacteria were the most commonly cultured organism in both the pre- and postintervention groups (115 and 70). Coagulase-negative staphylococcus was the next most commonly seen pathogen in the pre- and postintervention groups (81 and 51). Staphylococcus aureus was seen in 26 preintervention and 10 postintervention infections.