Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system

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Summary

A national nosocomial surveillance system for neonatal intensive care patients with a very low birthweight was set up in Germany in 2000 (NEO-KISS). Forty-eight neonatal intensive care units (NICUs) participated in the programme, which focused upon nosocomial bloodstream infections (BSIs) and pneumonia. Only data from NICUs participating for at least three years were included and the years compared. The relative risks and their 95% confidence intervals (CIs) were calculated and a multiple logistic regression analysis performed to identify significant risk factors. Twenty-four units that met the selection criteria accumulated data for 3856 patients and 152 437 patient-days in their first three years of participation. The incidence density of BSIs decreased significantly by 24% from 8.3 BSIs per 1000 patient-days in the first year to 6.4 in the third year. In the multiple logistic regression analysis, BSI in the third year of participation was significantly lower than in the first year of participation (odds ratio = 0.73, 95% CI 0.60–0.89). The year of participation was an independent risk factor for BSI but not for pneumonia. Our data suggest that participation in ongoing surveillance of nosocomial infections in NICUs, requiring individual units to feedback data, may lead to a reduction in BSI rates.

Introduction

Critically ill premature infants are especially vulnerable to nosocomial infections due to their immature immune systems, poor skin integrity, contact with invasive devices and contact with multiple carers.1 Nosocomial infections (NIs) in neonatal intensive care units (NICUs) have been reported to increase length of stay, costs and mortality.2, 3, 4, 5, 6

Surveillance of NIs is an essential part of quality patient care. A national nosocomial surveillance system purely for NICU patients with a very low birthweight (VLBW, <1500 g) was created in Germany in 2000 (Krankenhaus-Infektions-Surveillance-System, NEO-KISS).7 It concentrates on nosocomial bloodstream infections (BSI) and pneumonia, using modified Centers for Disease Control and Prevention (CDC) definitions for diagnosing NIs, and follows VLBW infants from birth to discharge, or until a weight of 1800 g or death. NI rates are standardized according to device use and stratified according to birthweight categories. The number of NICUs participating has increased steadily since the establishment of the surveillance system and most of them participate continuously.

The objective of this study was to determine the extent of the risk reduction achieved by continuous surveillance and data feedback in those NICUs with at least three years participation.

Section snippets

Methods

Data were collected through the NEO-KISS surveillance system. Participation in NEO-KISS was voluntary and confidential. Hospitals with NICUs may participate in the programme any time after attending an introductory course.

Details of the following variables were collected for all patients: birthweight, sex, multiple labour, gestational age and type of delivery (vaginal or Caesarean section). Cases of BSI and pneumonia were determined using modified CDC definitions.7 Patient-days and device-days

Results

Data from 48 NICUs (representing about one-third of all neonatal units caring for neonates <1500 g) were reported to NEO-KISS up to June 2005. This represented 7536 patients, 296 158 patient-days and 2210 NIs (1959 BSIs, 89%; and 231 pneumonia cases, 11%).

Twenty-four units met the selection criteria and data were gathered for 3856 patients resulting in 152 437 patient-days during their first three years of participation (Table I). The incidence for both types of NI was 26.0%. The most frequent

Discussion

Our data suggest that participation in surveillance systems, like the German nosocomial infection surveillance system, and feeding back individual NICU data for comparison with reference data can significantly lower BSI rates and reduce pneumonia rates.

In contrast to other studies which have investigated the effect of surveillance in combination with other interventions, our work shows a significant reduction of NI as a result of participation in a surveillance system alone.3–6 Other studies

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