reduction in rate of nosocomial infection in the nicu reduction in rate of nosocomial infection in...
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Reduction in rate of nosocomial infection in the NICUReduction in rate of nosocomial infection in the NICU
Peter Krcho, MD, PhDProvidence-Košice Partnership
Peter Krcho, MD, PhDProvidence-Košice Partnership
Goals...Goals...
NI in NICU – specific problem
NI in NICU = NI in PICU Sources of infection What could be done with the same
equipment What we need for the future
We would likeWe would like
Nosocomial infection Mortality Morbidity Antibiotics TPN then TPN Number of patients More experiences for team Regionalization
1995-00 Admissions , Total Deaths1995-00 Admissions , Total Deaths
Addmissions/Mortality
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 Dec 6
Year
Ad
dm
issi
on
s
0
5
10
15
20
25
30
Mortality in %
Addmisions
Mortality
Nosocomial infectionsNosocomial infectionsTotal number of nosocomial
infections
0
10
20
30
40
50
60
70
1995 1996 1997 1998 1999 2000Dec 6
Year
Po
siti
ve b
loo
d c
ult
ure
STHAEMO
STREPVIR
CANDIDA
STENOTR
STEPID
STAUR
PSEUD
KLEBS
ENTERB
ECOLI
CITROB
ACINET
Results - 1995-00 Used
ATB
Results - 1995-00 Used
ATB 453 297
Cost for ATB in $ and No of admitted newborns
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 July
0
2000
4000
6000
8000
10000
12000
14000Number of new borns
Ammount for ATB in $
ATB per newborn (average)ATB per newborn (average)
ATB in $ per newborn
117
36
24
9 5 9
0
20
40
60
80
100
120
140
1995 1996 1997 1998 1999 2000
How did we achieve these results?How did we achieve these results?
Early resuscitation Surfactant treatment Appropriate management of the PDA -
indomethacin, bedside ultrasound Short inspiration times, higher RR We changed ATB policies More catheters More discussion/collaboration
http://www.aiha.com/English/partners/kosice/chart.htmhttp://www.aiha.com/English/partners/kosice/chart.htm
SurfactantSurfactant
Surfaktant
10
46 4638 40
53
9
4
16
37
0
10
20
30
40
50
60
70
80
90
100
1995 1996 1997 1998 1999 2000 Dec
Curosurf
Alveofact
Exosurf
How did we achieve these results?How did we achieve these results?
More blood cultures BACTEC In severe infections exchange transfusions
(arterial and venous) As soon as possible we stop ATB More Total Parenteral Nutrition (TPN) in first
days Better use of TPN Hand washing
http://www.aiha.com/English/partners/kosice/chart.htmhttp://www.aiha.com/English/partners/kosice/chart.htm
Early surfactant (26w-710g)Early surfactant (26w-710g)
Longer UPV – More nosocomial infectionLonger UPV – More nosocomial infection
Exchange transfusion: Still necessary...Exchange transfusion: Still necessary...
Just 16 hours after...Just 16 hours after...
No other serious problems...No other serious problems...
Going home at 3 m- 2430gGoing home at 3 m- 2430g
Exchange transfusions (artery & vein)Exchange transfusions (artery & vein)
When to release? Necessary volume to exchange (80-
160ml)? How to continue the ATB treatment? Give or not to give IVIG after exchange? Multicentric randomised study needed...
Learning from Our Mistakes:Learning from Our Mistakes:
Excess volume, FFP, IG. (50-60/kg) Excess, frequent ATB changes Insufficient skills for arterial access Destruction of the peripheral veins, insufficient
venous access Negative blood cultures – when to take Not enough surfactant and late...later extubation
more CLD Equipment – increase of NI with more changes!
General ideas...General ideas... Maximal control from the start Right intervention at the right time
(ASAP) Surfactant ASAP, Indocin IV, Blood
culture always, precise volume management
LATER Less is sometimes more (volume, caloric
input )
How did we achieve these results?How did we achieve these results?
If caloric input is just enough we stop PN ASAP because of high nosocomial infection rate
Improving infection control More seminars for other hospitals PC’s could save time for other work Internet access – Cochrane Library
http://www.aiha.com/English/partners/kosice/chart.htmhttp://www.aiha.com/English/partners/kosice/chart.htm
We would like to continue...We would like to continue...
E-mail communications Videoconferences Grant writing - participation in
multicentric trials – database Team building
http://www.aiha.com/English/partners/kosice/chart.htmhttp://www.aiha.com/English/partners/kosice/chart.htm
Needs...Needs...
NICU – need for neonatal professionals Medical supplies and equipment: IV,
ventilation tubes, humidifiers, HANDS not only
More effort for the right diagnosis More skills, more Surfactant, better
transport, more equipment-concentration, regionalisation IU .
BW 540g BW 540g
About us in www...About us in www...
Resources from the www...Resources from the www...
www.google.com Nosocomial Infections in Newborn Open Medical Club www.neonatology.sk under
construction