Title: Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection Control
1- Prevention of Sepsis Among Neonates Admitted to
Intensive Care Units through Promotion of
Infection Control - Safe Injection Global Network Meeting in
Cambodia, 2002
2Background Request for Assistance to Prevent
Sepsis among NICU Patients at a University
Hospital in Egypt
- High rates of sepsis among infants in neonatal
ICU- mortality rates gt 50- poor response to
antibiotic therapy - Early onset sepsis- immediately after admission
3 Methods Investigation of Sepsis among NICU
Patients in Egypt
- Observation of infection control practices
-
-
- Epidemiology - laboratory-based surveillance
for BSI (blood - culture) - culture of IV fluids (opened
and unopened) - - culture of medications - monitor
mortality
4Results Investigation of Sepsis in NICU
- Clinical practice
- All infants placed on IV fluids and antibiotics
- Assessment of Infection control practices
- Poor understanding of infection control
- Unsafe practices in the preparation of IV fluids
- Opened IV fluids Contaminated (klebsiella
predominant) - Unopened IV fluids no growth
- NICU environmental surfaces Klebsiella
predominant -
- Prospective surveillance
- 70 of infants with sepsis (most is early onset)
- 55 mortality
5 Investigation of Sepsis in Newborn Nursery
Poor infection control practices
Contamination of IV fluids
Sepsis and death
6- Rapid Assessment of Sepsis in NICUs
- Sample - NICUs throughout the country (n
36) - Assessment - sepsis and mortality rates -
culture of IVF - BSI among patients with
clinical sepsis - infection control practices
with emphasis on management of IV fluids - Team - laboratory, epidemiologist,
neonatologist -
7Results of IV Fluid and Blood Cultures Survey of
Rapid Assessment of Sepsis in NICUs ,Egypt 02
8- Results Assessment of Infection Control
Practices - Rapid assessment of Sepsis in NICUs
- General - poor understanding of infection
control - Preparation of IV fluids - mixing of fluids
on ward - poor adherence to aseptic
techniques - prolonged usage of individual
bags - no assigned nurse or special area for
IV preparation - reuse of syringes to
prepare IV fluids - Infection control supplies - gloves, syringes,
appropriately sized IV fluids -
9- Intervention to Prevent Sepsis in NICUs
- Task analysis on preparation of IV fluids
- - SOPs for preparation of IV fluids
- Training - 3 days onsite, applied and
didactic - follow-up with monthly site visits - Supplies and reagents - distribution of
critical infection control materials - Supervision and monitoring
- - key indicators
10- Key Indicators to Monitor Intervention
- Infection Control Practices
- - observational tool
- - score developed for critical
- procedures
-
- IV fluid contamination
- Admissions, deaths, mortality rates
11Observation Tool to Monitor Infection Control
Practices
-
- Hand washing before procedures
- IV fluid mixing and preparation
- Medication mixing and preparation
- Cannula insertion steps
12Comparison of Infection Control Practices Related
to IV Medication Preparation before and after
Intervention
13Percentage of IV Fluid Samples Contaminated
Pre-intervention
Post-intervention
14Admissions, Deaths and Mortality Rates in 22
NICUs from Dec 01 to Jun 02
15SummaryBehavior Change Related to Intervention
-
- Improved hand washing
- Improved aseptic techniques for
- IV fluid mixing and preparation
- Medication mixing and preparation
- Cannula insertion
16Summary Promotion of Infection Control
- Evidence-based monitoring and evaluation is
essential - Applied training is vital
- Availability of critical supplies
- Promotion of infection control is the key
strategy to reduce nosocomial infections - Investment in infection control has great
potential to - reduce disease in patients -
lower health care costs
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