Methods Investigation of Sepsis among NICU Patients in Egypt
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Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection
Control
Safe Injection Global Network Meeting in Cambodia, 2002
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Background: 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 > 50%- poor response to antibiotic therapy
• Early onset sepsis- immediately after admission
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MethodsInvestigation 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
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Results: 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
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Investigation of Sepsis in Newborn Nursery
Poor infection control practices
Contamination of IV fluids
Sepsis and death
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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
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Results of IV Fluid and Blood Cultures Survey of Rapid Assessment of Sepsis in NICU’s ,Egypt ‘02
Type of facility
No. pts.
Blood No. %cultures pos
IV fluidsNo. % cultures pos
MedicationsNo. %Cultures pos
MOE(n=12)
176 63 75% 70 64% 31 23%
MOHP(n=24)
180 86 69% 100 64% 25 20%
TOTAL 356 149 71% 170 64% 56 21%
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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
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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
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Key Indicators to Monitor Intervention
• Infection Control Practices - observational tool - score developed for critical procedures • IV fluid contamination • Admissions, deaths, mortality rates
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Observation Tool to Monitor Infection Control Practices
• Hand washing before procedures
• IV fluid mixing and preparation
• Medication mixing and preparation
• Cannula insertion steps
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Comparison of Infection Control Practices Related to IV & Medication Preparation before and after Intervention
01020304050607080
before training
after training
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Percentage of IV Fluid Samples Contaminated
63.4
36.6
Positive
Negative
31.1
68.9
Pre-intervention Post-intervention
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Admissions, Deaths and Mortality Rates in 22 NICUs from Dec 01 to Jun 02
0
100
200
300
400
500
600
700
800
900
1000
Dec Jan Feb March April May June
0.1
0.15
0.2
0.25
0.3
0.35
Admission
Deaths
MortalityRate
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SummaryBehavior Change Related to Intervention • Improved hand washing
• Improved aseptic techniques for – IV fluid mixing and preparation– Medication mixing and preparation– Cannula insertion
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Summary 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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