Kalu Ibukunoluwa C, Curless Melanie S, Ponnampalavanar Sasheela, Milstone Aaron M, Ahmad Kamar Azanna
Department of Pediatrics, Division of Pediatric Infectious Disease, Duke University School of Medicine, Durham, NC, USA.
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD, USA.
Antimicrob Steward Healthc Epidemiol. 2023 Sep 1;3(1):e144. doi: 10.1017/ash.2023.415. eCollection 2023.
Hospitalized neonates are at high risk for hospital-associated bloodstream infections (HA-BSI) and require locally contextualized interventions to prevent HA-BSI.
The collaborative aimed to reach a 50% decrease in neonatal HA-BSI rates for a 27-bed Level IV neonatal intensive care unit (NICU). Using quality improvement (QI) methodologies, a multidisciplinary cross-cultural collaborative implemented phased and bundled interventions from July 2017 to September 2019. Descriptive statistics and statistical process control charts were used to analyze infection rates.
There were 916 admissions, 19,812 patient-days, and 4264 central line days in the NICU during the project period. Monthly baseline preintervention HA-BSI median rate was 3.95/1000 patient-days and decreased to 1.73/1000 patient-days (56% change) during the bundled interventions. Quarterly HA-BSI rates also decreased from the preintervention median of 4.5/1000 patient-days to 3.3/1000 patient-days during the intervention period (IRR 0.73; 95%CI 0.39, 1.36). Staff were highly compliant with hand hygiene and environmental cleaning. Through project efforts, compliance with bundle elements increased from 25% at baseline to a peak of 97% for central line (CL) insertion checklists and from 13% to a peak of 56% for CL maintenance checklists.
Unit-based bundled interventions can reduce neonatal HA-BSI in limited resource settings. Future studies can assess similar practices in other units and the impact of the pandemic on interventions to reduce HA-BSIs.
住院新生儿发生医院相关血流感染（HA-BSI）的风险很高，需要因地制宜采取干预措施以预防HA-BSI。
该合作项目旨在使一家拥有27张床位的四级新生儿重症监护病房（NICU）的新生儿HA-BSI发生率降低50%。采用质量改进（QI）方法，一个多学科跨文化合作团队在2017年7月至2019年9月期间实施了分阶段的综合干预措施。使用描述性统计和统计过程控制图分析感染率。
在项目期间，NICU有916例入院病例、19812个患者日和4264个中心静脉置管日。干预前每月HA-BSI的基线中位数发生率为3.95/1000患者日，在综合干预期间降至1.73/1000患者日（变化56%）。季度HA-BSI发生率也从干预前的中位数4.5/1000患者日降至干预期间的3.3/1000患者日（发病率比值0.73；95%置信区间0.39，1.36）。工作人员对手卫生和环境清洁的依从性很高。通过项目努力，综合措施各要素的依从性从基线时的25%增加到中心静脉置管（CL）插入检查表的峰值97%，CL维护检查表的依从性从13%增加到峰值56%。
基于病房的综合干预措施可在资源有限的环境中降低新生儿HA-BSI。未来的研究可以评估其他病房的类似做法以及大流行对减少HA-BSI干预措施的影响。
