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Rangelova V, Kevorkyan A, Raycheva R, Krasteva M. Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit-Incidence and Strategies for Prevention. Diagnostics (Basel) 2024; 14:240. [PMID: 38337756 PMCID: PMC10854825 DOI: 10.3390/diagnostics14030240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
The second most prevalent healthcare-associated infection in neonatal intensive care units (NICUs) is ventilator-associated pneumonia (VAP). This review aims to update the knowledge regarding the incidence of neonatal VAP and to summarize possible strategies for prevention. The VAP incidence ranges from 1.4 to 7 episodes per 1000 ventilator days in developed countries and from 16.1 to 89 episodes per 1000 ventilator days in developing countries. This nosocomial infection is linked to higher rates of illness, death, and longer hospital stays, which imposes a substantial financial burden on both the healthcare system and families. Due to the complex nature of the pathophysiology of VAP, various approaches for its prevention in the neonatal intensive care unit have been suggested. There are two main categories of preventative measures: those that attempt to reduce infections in general (such as decontamination and hand hygiene) and those that target VAP in particular (such as VAP care bundles, head of bed elevation, and early extubation). Some of the interventions, including practicing good hand hygiene and feeding regimens, are easy to implement and have a significant impact. One of the measures that seems very promising and encompasses a lot of the preventive measures for VAP are the bundles. Some preventive measures still need to be studied.
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Affiliation(s)
- Vanya Rangelova
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Ani Kevorkyan
- Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Maya Krasteva
- Department of Obstetrics and Gynecology, Neonatology Unit, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria;
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Bilgin H, Sili U, Pazar N, Kucuker I, Kepenekli E, Yanar MA, Memisoglu A, Ozek E, Adhikari NK, Pinto R, Korten V. Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study. Am J Infect Control 2023; 51:1028-1033. [PMID: 36603809 DOI: 10.1016/j.ajic.2022.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). METHODS AND MATERIALS This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. RESULTS We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). CONCLUSION In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.
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Affiliation(s)
- Huseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nazli Pazar
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Isil Kucuker
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Eda Kepenekli
- Department of Pediatric Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Meral Agirman Yanar
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Asli Memisoglu
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Eren Ozek
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Neill Kj Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Volkan Korten
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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Ou-Yang MC, Hsu JF, Chu SM, Chang CM, Chen CC, Huang HR, Yang PH, Fu RH, Tsai MH. Influences of Initial Empiric Antibiotics with Ampicillin plus Cefotaxime on the Outcomes of Neonates with Respiratory Failure: A Propensity Score Matched Analysis. Antibiotics (Basel) 2023; 12:antibiotics12030445. [PMID: 36978311 PMCID: PMC10044461 DOI: 10.3390/antibiotics12030445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Background: Empiric antibiotics are often prescribed in critically ill and preterm neonates at birth until sepsis can be ruled out. Although the current guideline suggests narrow-spectrum antibiotics, an upgrade in antibiotics is common in the neonatal intensive care unit. The impacts of initial broad-spectrum antibiotics on the outcomes of critically ill neonates with respiratory failure requiring mechanical intubation have not been well studied. Methods: A total of 1162 neonates from a tertiary level neonatal intensive care unit (NICU) in Taiwan who were on mechanical ventilation for respiratory distress/failure at birth were enrolled, and neonates receiving ampicillin plus cefotaxime were compared with those receiving ampicillin plus gentamicin. Propensity score-matched analysis was used to investigate the effects of ampicillin plus cefotaxime on the outcomes of critically ill neonates. Results: Ampicillin plus cefotaxime was more frequently prescribed for intubated neonates with lower birth weight, higher severity of illness, and those with a high risk of early-onset sepsis. Only 11.1% of these neonates had blood culture-confirmed early-onset sepsis and/or congenital pneumonia. The use of ampicillin plus cefotaxime did not significantly contribute to improved outcomes among neonates with early-onset sepsis. After propensity score-matched analyses, the critically ill neonates receiving ampicillin plus cefotaxime had significantly worse outcomes than those receiving ampicillin plus gentamicin, including a higher risk of late-onset sepsis caused by multidrug-resistant pathogens (11.2% versus 7.1%, p = 0.027), longer duration of hospitalization (median [IQR], 86.5 [47–118.8] days versus 78 [45.0–106.0] days, p = 0.002), and a significantly higher risk of in-hospital mortality (14.2% versus 9.6%, p = 0.023). Conclusions: Ampicillin plus cefotaxime should not be routinely prescribed as the empiric antibiotics for critically ill neonates at birth because they were associated with a higher risk of infections caused by multidrug-resistant pathogens and final worse outcomes.
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Affiliation(s)
- Mei-Chen Ou-Yang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Jen-Fu Hsu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shih-Ming Chu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ching-Min Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Gastrointestinal Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Chih-Chen Chen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Hsuan-Rong Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Peng-Hong Yang
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Pediatric Gastrointestinal Disease, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan
| | - Ren-Huei Fu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology, Department of Pediatrics, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Horng Tsai
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
- Correspondence: ; Tel.:+886-5-691-5151 (ext. 2878); Fax: +886-5-691-3222
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Raoofi S, Pashazadeh Kan F, Rafiei S, Hosseinipalangi Z, Noorani Mejareh Z, Khani S, Abdollahi B, Seyghalani Talab F, Sanaei M, Zarabi F, Dolati Y, Ahmadi N, Raoofi N, Sarhadi Y, Masoumi M, sadat Hosseini B, Vali N, Gholamali N, Asadi S, Ahmadi S, Ahmadi B, Beiramy Chomalu Z, Asadollahi E, Rajabi M, Gharagozloo D, Nejatifar Z, Soheylirad R, Jalali S, Aghajani F, Navidriahy M, Deylami S, Nasiri M, Zareei M, Golmohammadi Z, Shabani H, Torabi F, Shabaninejad H, Nemati A, Amerzadeh M, Aryankhesal A, Ghashghaee A. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One 2023; 18:e0274248. [PMID: 36706112 PMCID: PMC9882897 DOI: 10.1371/journal.pone.0274248] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/24/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Hospital-acquired infections (HAIs) are significant problems as public health issues which need attention. Such infections are significant problems for society and healthcare organizations. This study aimed to carry out a systematic review and a meta-analysis to analyze the prevalence of HAIs globally. METHODS We conducted a comprehensive search of electronic databases including EMBASE, Scopus, PubMed and Web of Science between 2000 and June 2021. We found 7031 articles. After removing the duplicates, 5430 studies were screened based on the titles/ abstracts. Then, we systematically evaluated the full texts of the 1909 remaining studies and selected 400 records with 29,159,630 participants for meta-analysis. Random-effects model was used for the analysis, and heterogeneity analysis and publication bias test were conducted. RESULTS The rate of universal HAIs was 0.14 percent. The rate of HAIs is increasing by 0.06 percent annually. The highest rate of HAIs was in the AFR, while the lowest prevalence were in AMR and WPR. Besides, AFR prevalence in central Africa is higher than in other parts of the world by 0.27 (95% CI, 0.22-0.34). Besides, E. coli infected patients more than other micro-organisms such as Coagulase-negative staphylococci, Staphylococcus spp. and Pseudomonas aeruginosa. In hospital wards, Transplant, and Neonatal wards and ICU had the highest rates. The prevalence of HAIs was higher in men than in women. CONCLUSION We identified several essential details about the rate of HAIs in various parts of the world. The HAIs rate and the most common micro-organism were different in various contexts. However, several essential gaps were also identified. The study findings can help hospital managers and health policy makers identify the reason for HAIs and apply effective control programs to implement different plans to reduce the HAIs rate and the financial costs of such infections and save resources.
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Affiliation(s)
- Samira Raoofi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Pashazadeh Kan
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sima Rafiei
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Zahra Hosseinipalangi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Noorani Mejareh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saghar Khani
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Bahare Abdollahi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Seyghalani Talab
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohaddeseh Sanaei
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Farnaz Zarabi
- Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Yasamin Dolati
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Ahmadi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Raoofi
- Cardiovascular Research Center Kermanshah, Kermanshah, Iran
| | - Yasamin Sarhadi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Masoumi
- Clinical Research and Development Center, Qom University of Medical Sciences, Qom, Iran
| | - Batool sadat Hosseini
- Department of Anesthesia, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Negin Vali
- Shahid AkbarAbadi Clinical Research Development unit (SHACRDU), Iran University of Medical Sciences, Tehran, Iran
| | - Negin Gholamali
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Asadi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Ahmadi
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Behrooz Ahmadi
- Clinical Research Development Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Beiramy Chomalu
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Elnaz Asadollahi
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mona Rajabi
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Dorsa Gharagozloo
- Department of Molecular and Cellular Sciences, Faculty of Advanced Sciences and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Zahra Nejatifar
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Rana Soheylirad
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Shabnam Jalali
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farnaz Aghajani
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mobina Navidriahy
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Sama Deylami
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Nasiri
- Researcher at Toward Evidence (http://towardevidence.co.uk/), Glasgow, United Kingdom
| | - Mahsa Zareei
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Golmohammadi
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamideh Shabani
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Torabi
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Shabaninejad
- Population Health Sciences Institute (PHSI), Newcastle University, Newcastle, United Kingdom
| | - Ali Nemati
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ghashghaee
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
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