Session:

Infection Control, Nosocomial Infections & Critical Care

Abstract No.:

54.038

Title:

Effectiveness of simple strategies in reducing multidrug resistant bloodstream infections in the NICU of a tertiary care hospital in Karachi, Pakistan

Author(s):

M. Qadir¹, S. Resham¹, F. Naz¹, K. Ahmad¹, S. Ahmed¹, R. Ali¹, H. Amin², S. Musani²; ¹Aga Khan university, Pediatrics and child health, Karachi/PK, ²Aga Khan University Hospital, Medicine, Karachi/PK

Abstract:

Background: Nosocomial infections in the neonatal intensive care unit (NICU) are a cause of increased mortality, length of stay and cost of management. There is limited data on strategies for reducing these infections from developing countries. Therefore we evaluated the effectiveness of implementation of six strategies in reducing the rate of nosocomial bloodstream infections (BSI) due to multidrug resistant organisms (MDRO) in the NICU.
Methods: Using a pre and post design, the study was carried out (from June 2010-August 2011) at the NICU of the Aga Khan University, a tertiary care hospital with a 12-bed, level III NICU. The intervention comprised of hand washing certification for all NICU staff, use of chlorhexidine instead of povidone iodine for skin preparation, use of non-sterile gloves for diaper change, implementation of barrier nursing for clinically suspected and culture proven infections, provision of separate intubation & central line trolley for each room and limiting the use of umbilical catheters to7 days. Within unit transmission of multidrug resistant acinetobacter, pseudomonas, vancomycin resistant enterococcus (VRE), extended spectrum β lactamase producer (ESBL) and methicillin resistant staphylococcus aureus (MRSA), were used as markers for nosocomial BSI. Average rates of BSI due to within unit transmission of MDRO are reported (3months pre-intervention period, 3 months implementation phase and 3months post intervention). Average number of admissions within the unit was used as denominator.
Results: The average pre intervention rates of BSI due to ESBL, Acinetobacter, Pseudomonas and MRSA were 4.7, 3.3, 1.2 and zero respectively. In the implementation phase the BSI rates for all organisms dropped except for ESBL. A significant reduction in rates was observed in the post implementation period (ESBL 1.3, Acinetobacter 1.0, no case due to Pseudomonas and MRSA). No case of BSI due to VRE was reported during the entire study period. The average number of admissions during the 3 phases was almost similar (64, 49 and 51 respectively). There was sustained reduction in rates for all organisms, six months after the post intervention period.
Conclusion: Nosocomial transmission of MDRO within the NICU can be effectively reduced by adoption of simple strategies.