Unit based procedures: impact on the incidence of nosocomial infections in the newborn intensive care unit

Infection control measures in neonatal units: implementation of change in the Gaza-Strip

Introduction: Low-income countries rarely report infection control measures although they are key to reducing mortality and morbidity in healthcare. This audit examined healthcare personnel's adherence to infection control measures before entry to the NICU and in both minor and major procedures' bundles. Furthermore, it examined the effect of subsequent authorization and dissemination of infection control guidelines followed by education and training sessions on the adherence of healthcare personnel to infection control policies.Methods: This prospective observational study was conducted in two NICUs at two separate hospitals in the Gaza-Strip, Palestine. The initial observation period was June-August 2016 during which healthcare professionals' adherence to infection control policies was assessed by direct observation. This was followed by NICU feedback dissemination and on-site educational and training sessions. Then, the reaudit, following the same protocol, was carried out throughout February 2017.Results: There was a statistically significant improvement in the adherence to infection control measures among healthcare personnel. Significant improvements were found in both minor and major procedure infection control protocols' adherence rates. However, when comparing the general neonatal handling adherence rate between both audits, no significant change was noted.Discussion: This study highlights the effectiveness of using audit feedback and on-site educational and training sessions in the enhancement of adherence to infection control policies, demonstrating significant improvement in areas covered by the staff training program. Therefore, including regular infection control training combined with feedback in the curriculum of healthcare professionals can improve the sustainability of infection control programs. Further studies must examine the impact of such training also on the incidence of healthcare-associated infection rates as well as morbidity and mortality within neonatal units.

Infection Control and the Need for Family-/Child-Centered Care

Patient- and family-centered care (FCC) has become central to the delivery of medical care over the last 20 years and has been shown to improve patient outcomes. Infection control practices have the potential to greatly influence family centeredness and care providers, and hospital personnel must consider the potential impacts of isolation and the use of personal protective equipment (PPE). Approaching infection control with the perspective of FCC requires balancing patient safety and overall patient well-being. In this chapter, authors consider infection control and the benefits of FCC, family and sibling visitation, the use of playrooms, animals in healthcare settings including animal-assisted interventions, the potential adverse effects of infection control practices, and strategies to mitigate these impacts.

Expanding PVL positive MRSA healthcare-associated infections outbreak in a newborns unit, caused by hospital hygiene shortcomings

A prolonged outbreak of Healthcare-Associated Infections (HCAIs) evolved since December 2013, in a Newborns Unit from Hospital A, sited in the North-Eastern development region, Romania. A first cluster consisted of 19 cases, of which 18 infections in newborns and 1 labour infectious complication in a mother. Except for five cases declared and treated in the Neonatology Unit as hospital-acquired infections, the other cases were discharged and further required rehospitalisation and treatment.

Eight of these innitialy discharged cases were readmitted to the Pediatric Surgery Unit and two others to the Pediatrics Unit of Hospital B, while three others were readmitted to three hospitals: one to the Pediatrics Unit of Hospital C, and other two to Hospital A and Hospital D, respectively. The mother with the labour infectious complication was readmitted to the Gynecology Unit of the Hospital A.

A number of fifteen Staphylococcus aureus (S. aureus) strains isolated from the HCAI first episode and 8 strains from 7 HCWs were received by „Cantacuzino” Institute, Nosocomial Infections and Antibiotic Resistance Laboratory from the County Public Health Directorate, for confirmation and molecular typing.

After a first round of interventions for infection control, a second episode bursted in Hospital A and our laboratory received six other S. aureus isolates from newborns, hospital environment, and HCWs.

Public Health interventions based on epidemiologic data and molecular microbiology results were finally successful. The evolution of all cases was favorable.

An important factor favoring the outbreak was the moving of the Birth Unit of Hospital A to an innapropriate location for an 18-month interval, more than innitially estimated, in relation to rehabilitation of the ward.

We considered to report this episode taking into account the unusual evolution, the risk of multiresistant bacterial strains spreading, and multiple unwanted consequences caused by shortcomings in providing appropriate hygiene conditions.

Investigation and Control of an Outbreak of Enterobacter aerogenes Bloodstream Infection in a Neonatal Intensive Care Unit in Fiji

Ten neonates developed blood stream infection with extended-spectrum β-lactamase-producing Enterobacter aerogenes in a neonatal intensive care unit in Fiji. The source of the outbreak was traced to a bag of contaminated normal saline in the ward, which was used for multiple patients. All isolates recovered from patients were indistinguishable from the bacteria recovered from the normal saline by pulsed-field gel electrophoresis. The outbreak was controlled using simple infection control practices such as reinforcement of strict hand hygiene policy, provision of single use vials of normal saline, and strict aseptic technique for injections.

Investigating Jordanian nurses' handwashing beliefs, attitudes, and compliance

BACKGROUND

Low rates of handwashing compliance among nurses are still reported in literature. Handwashing beliefs and attitudes were found to correlate and predict handwashing practices. However, such an important field is not fully explored in Jordan.

OBJECTIVES

This study aims at exploring Jordanian nurses' handwashing beliefs, attitudes, and compliance and examining the predictors of their handwashing compliance.

METHODS

A cross-sectional multicenter survey design was used to collect data from registered nurses and nursing assistants (N = 198) who were providing care to patients in governmental hospitals in Jordan. Data collection took place over 3 months during the period of February 2011 to April 2011 using the Handwashing Assessment Inventory.

RESULTS

Participants' mean score of handwashing compliance was 74.29%. They showed positive attitudes but seemed to lack knowledge concerning handwashing. Analysis revealed a 5-predictor model, which accounted for 37.5% of the variance in nurses' handwashing compliance. Nurses' beliefs relatively had the highest prediction effects (β = .309, P < .01), followed by skin assessment (β = .290, P < .01).

CONCLUSION

Jordanian nurses reported moderate handwashing compliance and were found to lack knowledge concerning handwashing protocols, for which education programs are recommended. This study raised the awareness regarding the importance of complying with handwashing protocols.

Neonatal PICC: one unit's six-year experience with limiting catheter complications

Safe dressing techniques for neonatal peripherally inserted central catheters (PICCs) remain controversial in the literature. This article describes one unit's experience with the placement and management of 491 PICCs during a six-year period with more than 5,600 catheter days. The dressing technique described in this article differs from that seen in the literature with the addition of a protective base layer. Catheter complication rates are low, and catheter dressing changes are minimized with this dressing technique.

Minimizing catheter-related bloodstream infections: one unit's approach

Catheter-related bloodstream infection (CRBSI) is the most common complication related to peripherally inserted central catheters in the neonatal intensive care unit. CRBSIs are responsible for many morbidities and mortalities occurring in special care nurseries. However, these vascular access devices are an essential aspect of neonatal care and therefore are indispensable. To minimize CRBSI incidences and improve patient outcomes, objectives must be established to focus on the prevention of these potentially life-threatening infections. This article identifies the interventions incorporated by our facility to prevent nosocomial bloodstream infections.

Nosocomial infection in neonates: inevitable or preventable?

In the neonatal intensive care unit population the nosocomial infection rate is highest in the lowest-birth-weight infants. It is this group of infants who require the most therapeutic interventions to support them leading to frequent invasive procedures and the longest exposure to the hospital environment. However, infection rates vary from one unit to another, suggesting that there are differences in either how infection rates are determined or the care provided in the various units. This article will describe nosocomial infections and rates in the neonatal intensive care unit and identify strategies of care to minimize the risks of nosocomial infection in low-birth-weight infants.

Access to intensive care units: a survey in North-East Italy

The factors associated with policies for allowing visitors into intensive care units (ICUs) are a debated issue in the nursing literature. The aim of this survey was to describe visiting policies in the ICUs of North-East Italy and to verify the hypothesis of an association between attitudes regarding accessibility to visitors and environmental, organisational or logistic variables. Data were collected by means of questionnaires sent by mail to head nurses of ICUs. The questionnaires were completed for 104 of the 110 ICUs contacted (94.5%). Visiting hours were generally less than 4h a day (86%) and only 14% of the ICUs reported imposing no restrictions. Children under 12 years old were rarely admitted (22%). Twenty-one percent of the ICUs reported always allowing exceptions, while 77% did so only under 'particular' circumstances. Visiting times were not associated with logistic and organisational factors, but rather with the type of ICU (p=0.000), city setting (p=0.009), exceptions to rules (p=0.029), allowing more than one person (p=0.016) and opening to children (p=0.001). Restrictive visiting policies emerged; paediatric units were generally more flexible. The association between the variables regarding visiting policy, such as visiting times and exceptions to rules, or allowing more than one person or children, seem to confirm how the rules are influenced mainly by the staff's attitude, which could be changed by continuing professional education.