Late onset sepsis (LOS) and central line associated blood stream infection (CLA-BSI) contribute towards the mortality and morbidity in prematurely born infants.
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AIM: To investigate the effects of hospital wide and unit based interventions on LOS and CLA-BSI in infants born at <32 weeks gestation.
METHODS: Intensive care, high dependency (IC-HD) days and catheter days were obtained from the unit database and blood culture results from a Microbiology laboratory database. Poisson regression was used to evaluate the effects of interventions on LOS and CLA-BSI.
RESULTS: Quarterly rates of LOS reduced from 26.1 to 2.9 per 1000 IC-HD days and CLA-BSI from 31.6 to 4.3 per 1000 catheter days between 2007 and 2012. Appointment of a specialist vascular device nurse, a change in the mode of administration of vancomycin, standardization of the hospital skin and hub disinfection policy, and the introduction of a venous infusion phlebitis scoring system was associated with a reduction of LOS to 55%(95% CI 40-74%) and CLA-BSI 45%(95% CI 33-61%) of pre-intervention levels. The standardization of the neonatal unit policy for skin disinfection and a move to a new building were associated with reductions of LOS to 64%(47%-87%) and 54%(34% – 88%) respectively, and aseptic no touch technique (ANTT) for infusion access with CLA-BSI to 53%(37-75%) of pre-intervention levels.
CONCLUSION: A multifaceted approach involving changes in antimicrobial and skin disinfection policy, training for ANTT and surveillance resulted in sustained reduction in LOS and CLA-BSI rates.
Sinha, A.K., Murthy, V., Nath, P., Morris, J.K. and Millar, M. (2015) Prevention of Late Onset Sepsis and Central Line Associated Blood Stream Infection in Preterm Infants. The Pediatric Infectious Disease Journal. November 30th. [epub ahead of print].
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