Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Microbiology Section of the Medical Laboratory, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2017 Jul;80(7):427-431. doi: 10.1016/j.jcma.2017.02.006. Epub 2017 May 3.
Hospital-acquired infections are a leading cause of morbidity and mortality in neonatal intensive care units (NICU). The aim of the study was to investigate the change of nosocomial infection rate in a NICU during a 4-year surveillance period.
We investigated the changes in nosocomial infection rates, infection sites, and microorganism species in a NICU before and after the unit was moved to a new location, extending from November 2008 to October 2012.The new facility was opened on November 1, 2010 and the old NICU was closed on the same day. In the meantime, three catheter-based bundles were implemented in the new NICU and all intensive care units in our hospital due to the new policy. Data collection was performed by independent, experienced infection control nurses.
A total of 512 neonates were admitted to the NICU and enrolled in this study. There were 242 infants who were admitted to the old NICU, and 270 infants in the new facility. During the study period, the rate of infection episodes decreased from 19.0% to 11.1% (P = 0.01). Additionally, the average hospital-acquired infection rate decreased from 6.26 cases per 1000 patient-days to 4.09 cases per 1000 patient-days (P = 0.03). The most common infection site was blood stream infection, which decreased from 8.3% to 3.7% (P = 0.03). The total catheter-related infection rates of the blood stream, lower respiratory tract, and urinary tract decreased from 13.6% to 5.9% (P = 0.003). Klebsiella pneumonia, E. coli, Methicillin-resistant Staphylococcus aureus (MRSA), and Coagulase-negative Staphylococci (CoNS) were the most frequently found pathogens in the old NICU, whereas MRSA, CoNS, E. faecalis, and A. baumannii were the most frequently found pathogens in the new NICU.
The change in the environment and implementation of device bundles in the NICU might be associated with the nosocomial infection rate.
医院获得性感染是新生儿重症监护病房（NICU）发病率和死亡率的主要原因。本研究旨在调查 4 年监测期间 NICU 医院感染率的变化。
我们调查了 2008 年 11 月至 2012 年 10 月 NICU 搬迁前后的医院感染率、感染部位和微生物种类。新设施于 2010 年 11 月 1 日开放，旧 NICU 同日关闭。同时，由于新政策，新 NICU 和我院所有重症监护病房均实施了三项基于导管的捆绑包。数据收集由独立、经验丰富的感染控制护士进行。
共有 512 名新生儿入住 NICU 并参与本研究。有 242 名婴儿入住旧 NICU，270 名婴儿入住新设施。在研究期间，感染发作率从 19.0%降至 11.1%（P=0.01）。此外，医院获得性感染率从每千名患者 6.26 例降至每千名患者 4.09 例（P=0.03）。最常见的感染部位是血流感染，从 8.3%降至 3.7%（P=0.03）。血流、下呼吸道和尿路感染的总导管相关感染率从 13.6%降至 5.9%（P=0.003）。肺炎克雷伯菌、大肠杆菌、耐甲氧西林金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（CoNS）是旧 NICU 中最常见的病原体，而 MRSA、CoNS、粪肠球菌和鲍曼不动杆菌是新 NICU 中最常见的病原体。
NICU 环境的变化和器械捆绑包的实施可能与医院感染率有关。
