Abstract
Objectives: To assess the relationship between organisational and structural factors of UK neonatal intensive care units (NICUs) with risk adjusted probable nosocomial bacteraemia.
Design of study: A prospective observational study of infants concurrently admitted to 54 randomly selected UK NICUs between March 1998 and April 1999.
Results: Of the 13 334 infants admitted, 402 (2.97%) had probable nosocomial bacteraemia. The median unit level percentage of infants with probable nosocomial bacteraemia was 2.48% (minimum 0%, maximum 9%). The risk adjusted odds of probable nosocomial bacteraemia were increased by 1.13 (95% CI 1.07 to 1.20) for each additional level 1 cot per hand washbasin and decreased by 0.53 (95% CI 0.35 to 0.79) in infants admitted to units with an NICU infection control nurse compared with units without. There was no relation with an increase in the floor space of the unit per cot (odds ratio 0.99 (95% CI 0.98 to 1.00) per m2) or with the quality of hand washing signs (odds ratio 1.04 (95% CI 0.93 to 1.16) per increase in quality score).
Conclusions: There is widespread variation in rates of probable nosocomial bacteraemia in UK NICUs. Probable nosocomial bacteraemia is reduced in units with a dedicated infection control nurse and with the presence of more hand washbasins. Further research is required to identify methods to eliminate nosocomial bacteraemia.
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Selected References
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- Benneyan J. C., Lloyd R. C., Plsek P. E. Statistical process control as a tool for research and healthcare improvement. Qual Saf Health Care. 2003 Dec;12(6):458–464. doi: 10.1136/qhc.12.6.458. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Berwick Donald M. Errors today and errors tomorrow. N Engl J Med. 2003 Jun 19;348(25):2570–2572. doi: 10.1056/NEJMe030044. [DOI] [PubMed] [Google Scholar]
- Brodie S. B., Sands K. E., Gray J. E., Parker R. A., Goldmann D. A., Davis R. B., Richardson D. K. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J. 2000 Jan;19(1):56–65. doi: 10.1097/00006454-200001000-00012. [DOI] [PubMed] [Google Scholar]
- Brodie S. B., Sands K. E., Gray J. E., Parker R. A., Goldmann D. A., Davis R. B., Richardson D. K. Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J. 2000 Jan;19(1):56–65. doi: 10.1097/00006454-200001000-00012. [DOI] [PubMed] [Google Scholar]
- Burke John P. Infection control - a problem for patient safety. N Engl J Med. 2003 Feb 13;348(7):651–656. doi: 10.1056/NEJMhpr020557. [DOI] [PubMed] [Google Scholar]
- Ferguson J. K., Gill A. Risk-stratified nosocomial infection surveillance in a neonatal intensive care unit: report on 24 months of surveillance. J Paediatr Child Health. 1996 Dec;32(6):525–531. doi: 10.1111/j.1440-1754.1996.tb00967.x. [DOI] [PubMed] [Google Scholar]
- Fowlie P. W., Gould C. R., Parry G. J., Phillips G., Tarnow-Mordi W. O. CRIB (clinical risk index for babies) in relation to nosocomial bacteraemia in very low birthweight or preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996 Jul;75(1):F49–F52. doi: 10.1136/fn.75.1.f49. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gillespie T. Patient empowerment to improve handwashing compliance by healthcare workers. J Hosp Infect. 2001 Dec;49(4):298–299. doi: 10.1053/jhin.2001.1072. [DOI] [PubMed] [Google Scholar]
- Harbarth S., Sudre P., Dharan S., Cadenas M., Pittet D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol. 1999 Sep;20(9):598–603. doi: 10.1086/501677. [DOI] [PubMed] [Google Scholar]
- Horbar J. D., Rogowski J., Plsek P. E., Delmore P., Edwards W. H., Hocker J., Kantak A. D., Lewallen P., Lewis W., Lewit E. Collaborative quality improvement for neonatal intensive care. NIC/Q Project Investigators of the Vermont Oxford Network. Pediatrics. 2001 Jan;107(1):14–22. doi: 10.1542/peds.107.1.14. [DOI] [PubMed] [Google Scholar]
- Hugonnet Stéphane, Perneger Thomas V., Pittet Didier. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med. 2002 May 13;162(9):1037–1043. doi: 10.1001/archinte.162.9.1037. [DOI] [PubMed] [Google Scholar]
- Ketring Susan Penn, White James P. Developing a systemwide approach to patient safety: the first year. Jt Comm J Qual Improv. 2002 Jun;28(6):287–295. doi: 10.1016/s1070-3241(02)28028-1. [DOI] [PubMed] [Google Scholar]
- Kilbride Howard W., Powers Richard, Wirtschafter David D., Sheehan Michael B., Charsha Dianne S., LaCorte Meena, Finer Neil, Goldmann Donald A. Evaluation and development of potentially better practices to prevent neonatal nosocomial bacteremia. Pediatrics. 2003 Apr;111(4 Pt 2):e504–e518. [PubMed] [Google Scholar]
- Kurlat I., Corral G., Oliveira F., Farinella G., Alvarez E. Infection control strategies in a neonatal intensive care unit in Argentina. J Hosp Infect. 1998 Oct;40(2):149–154. doi: 10.1016/s0195-6701(98)90094-9. [DOI] [PubMed] [Google Scholar]
- Leape L. L., Brennan T. A., Laird N., Lawthers A. G., Localio A. R., Barnes B. A., Hebert L., Newhouse J. P., Weiler P. C., Hiatt H. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991 Feb 7;324(6):377–384. doi: 10.1056/NEJM199102073240605. [DOI] [PubMed] [Google Scholar]
- López Sastre J. B., Coto Cotallo D., Fernández Colomer B., Grupo de Hospitales Castrillo Neonatal sepsis of nosocomial origin: an epidemiological study from the "Grupo de Hospitales Castrillo". J Perinat Med. 2002;30(2):149–157. doi: 10.1515/JPM.2002.019. [DOI] [PubMed] [Google Scholar]
- Pittet D., Hugonnet S., Harbarth S., Mourouga P., Sauvan V., Touveneau S., Perneger T. V. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet. 2000 Oct 14;356(9238):1307–1312. doi: 10.1016/s0140-6736(00)02814-2. [DOI] [PubMed] [Google Scholar]
- Pittet D., Mourouga P., Perneger T. V. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 1999 Jan 19;130(2):126–130. doi: 10.7326/0003-4819-130-2-199901190-00006. [DOI] [PubMed] [Google Scholar]
- Stoll Barbara J., Hansen Nellie I., Adams-Chapman Ira, Fanaroff Avroy A., Hintz Susan R., Vohr Betty, Higgins Rosemary D., National Institute of Child Health and Human Development Neonatal Research Network Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004 Nov 17;292(19):2357–2365. doi: 10.1001/jama.292.19.2357. [DOI] [PubMed] [Google Scholar]
- Stoll Barbara J., Hansen Nellie, Fanaroff Avroy A., Wright Linda L., Carlo Waldemar A., Ehrenkranz Richard A., Lemons James A., Donovan Edward F., Stark Ann R., Tyson Jon E. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002 Aug;110(2 Pt 1):285–291. doi: 10.1542/peds.110.2.285. [DOI] [PubMed] [Google Scholar]
- Stoll Barbara J., Hansen Nellie. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol. 2003 Aug;27(4):293–301. doi: 10.1016/s0146-0005(03)00046-6. [DOI] [PubMed] [Google Scholar]
- Teare E. L., Peacock A. J., Dakin H., Bates L., Grant-Casey J. Build your own infection control link nurse: an innovative study day. J Hosp Infect. 2001 Aug;48(4):312–319. doi: 10.1053/jhin.2001.1016. [DOI] [PubMed] [Google Scholar]
