Evaluation of 3 year surveillance of device associated infections in a neonatal intensive care unit

Year 2020, Volume: 10 Issue: 3, 319 - 323, 30.09.2020

Nuran Üstün Sibel Özümüt Özgül Bulut Sertaç Arslanoğlu Fahri Ovalı

https://doi.org/10.16899/jcm.680314

Abstract

Aim: The aim of this study was to determine the rates of healthcare associated infections (HAIs) and device associated healthcare associated infections (DA-HAIs) as well as the rates of invasive device utilization in a neonatal intensive care unit (NICU); and to compare findings with national and international reports.
Materials and methods: A total of 1984 patients who admitted to NICU between January 2016 and December 2018 were enrolled. We retrospectively analysed patient’s characteristics, etiologic pathogens and antibiotic susceptibility, mortality from medical charts and infection control committee surveillance reports. Infections were defined using the standart Centers for Disease Control and Prevention criteria.
Results: During the 3-year period, total 98 HAI cases 69 of which were DA-HAI were detected. The overall incidence of HAIs was 4.9% and rate was 3.7 per 1000 patient days. The most common HAI was blood stream infection (BSI) (n=64, 65.3%) of those 52 were central line-associated (CLA). The CLA-BSI rate was 8.6 per 1000 central line days with central line utilization ratio of 0.22. Ventilator associated pneumonia (VAP) rate was 5.1 per 1000 ventilator days with ventilator utilization ratio of 0.12. The most common pathogens were Klebsiella pneumonia. (38.9%), Staphylococcus epidermidis (22.1%) and Candida spp. (11.6%). The overall mortality rate was 3%. The HAI-related mortality rate was 9.2%.
Conclusion: Our findings highlight the importance of an surveillance approach in the NICU setting. HAI rates were lower than the rates reported from developing countries. However, with device utilization rates similar to those in developed countries our HAI rates were higher than that of the developed countries. Continous monitoring and implementation of necessary precautions are essential to decrease the rates of HAIs.

Keywords

healthcare associated infections, neonatal intensive care unit, device associated infections, surveillance

References

• 1. Moore DL. Nosocomial infections in newborn nurseries and neonatal intensive care units. In: Mayhall CG (ed). Hospital epidemiology and infection control. Baltimore: Williams-Wilkins, 1996: 535-64.
• 2. Couto RC, Pedrosa TM, Tofani Cde P, Pedrosa ER. Risk factors for nosocomial Infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2006; 27: 571-575.
• 3. Hacımustafaoglu M, Celebi S, Koksal N, Kavurt S, Ozkan H, Cetinkaya M, et al. Nosocomial infections in neonatology clinic and neonatal intensive care unit. Turk Arch Ped 2011;46: 302e7.
• 4. Goldmann DA, Durbin WA Jr, Freeman J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis. 1981;144(5):449–459
• 5. Edwards JR, Peterson KD, Mu Y, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37(10):783–805
• 6. Polin RA, Denson S, Brady MT. Epidemiology and Diagnosis of Health Care-Associated Infections in the NICU. the COMMITTEE ON FETUS AND NEWBORN INFECTIOUS DISEASES. Pediatrics 2012;129;e1104
• 7. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128e40.
• 8. Haley RW, Quade D, Freeman HE, Bennett JV. The SENIC Project. Study on the Efficacy of Nosocomial Infection Control (SENIC Project). Summary of study design. Am J Epidemiol 1980;111:472e85.
• 9. Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377: 228-241.
• 10. CDC definitionof health-care associated infection2015.Available at: www.cdc.gov/nhsn/PDFs/pscManual/2PSC_IdentifyingHAIs_NHSNcurrent. pdf. Accessed February 7, 2019
• 11. Emori TG, Culver DH, Horan TC, Jarwis WR, White JW, Olson DR, Banerjee S, Edwards JR, Martone WJ, Gaynes RP. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991; 19: 19-35.
• 12. Public Health Institution of Turkey, Department of ContagiousDiseases, National Nosocomial Infections Surveillance System,Summary Report; (Halk Sağlığı Genel Müdürlüğü, Bulaşıcı HastalıklarDairesi Başkanlığı, Ulusal Sağlık Hizmeti İlişkili EnfeksiyonlarSürveyans Ağı Özet Raporu) 2017. Available at: http://hsgm.saglik.gov.tr
• 13. Rosenthal VD, Al-Abdely HM, El-Kholy AA, et al; Remaining authors. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: deviceassociated module. Am J Infect Control 2016;44(12):1495–1504
• 14. Dudeck MA, Edwards JR, Allen-Bridson K, et al. National Healthcare Safety Network report, data summary for 2013, deviceassociated module. Am J Infect Control 2015;43(03):206–221
• 15. Gadallah MAH, Fotouh AMA, Habil I.S, Wassef I.G. Surveillance of health care associated infections in a tertiary hospital neonatal intensive care unit in Egypt: 1-year follow-up Am J Infect Control, 42 (November (11)) (2014), pp. 1207-1211
• 16. Fortaleza M.C.B, Padoveze M.C, Kiffer R.V. Multi-state survey of healthcare-associated infections in acute care hospitals in Brazil. Journal of Hospital Infection 2017; 96 139e144
• 17. Efird MM, Rojas MA, Lozano JM, et al. Epidemiology of nosocomial infections in selected neonatal intensive care units in Colombia, South America. J Perinatol 2005;25:531e536
• 18. Zingg W, Hopkins S, Gayet-Ageron A, et all. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. Lancet Infect Dis. 2017 Apr;17(4):381-389
• 19. Turkish Neonatal Society, Nosocomial Infections Study Group. Nasocomial infections in neonatal units in Turkey : epidemiology problems, unit policies and opinions of healthcare workers. Turk J Pediatr 2010; 52: 50-7.
• 20. Yapicioglu H, Satar M, Ozcan K, et al. A 6-year prospective surveillance of healthcare-associated infections in a neonatal intensive care unit from southern part of Turkey. J Paediatr Child Health 2010; 46: 337-342.
• 21. Tekin R, Dal T, Pirinccioglu H, Oygucu SE. A 4-year surveillance of device-associated nosocomial infections in a neonatal intensive care unit. Pediatr Neonatol. 2013 Oct;54(5):303-8
• 22. Kilic A, Okulu E, Kocabas BA, Alan S, Cakir U, Yildiz D et al. Health care-associated infection surveillance: A prospective study of a tertiary neonatal intensive care unit. J Infect Dev Ctries 2019; 13(3):181-187
• 23. Sohn AH, Garrett DO, Sinkowitz-Cochran RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139:821e827
• 24. Urrea M, Iriondo M, Thio M, et al. A prospective incidence study of nosocomial infections in a neonatal care unit. Am J Infect Control 2003;31:505e507.
• 25. Foglia E, Meier MD, Elward A. Ventilator associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev.2007;20(3):409–425
• 26. Yalaz M, Altun-Koroglu O, Ulusoy B, Yıldız B, Akisu M, Vardar F, et al. Evaluation of device-associated infections in a neonatal intensive care unit. Turk J Pediatr 2012;54:128e35.
• 27. Isaacs D. A ten years multicenter study of coagulase negative staphylococcal infections in Australian neonatal units. Archs Dis Childh Fetal Neonatal Ed 2003;88:89e93.
• 28. Srivastava S, Shetty N. Healthcare-associated infections in neonatal units: lessons from contrasting worlds. J Hosp Infect 2007; 65: 292-306.
• 29. Abdel-Wahab F, Ghoneim M, Khashaba M, El-Gilany AH, Abdel-Hady D (2013) Nosocomial infection surveillance in an Egyptian neonatal intensive care unit. J Hosp Infect 83: 196-199.