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The Implementation of an Evidence-Based Bundle for Bloodstream Infections in Neonatal Intensive Care Units in Germany: A Controlled Intervention Study to Improve Patient Safety

Published online by Cambridge University Press:  05 April 2016

Florian Salm ,
Frank Schwab ,
Christine Geffers ,
Petra Gastmeier  and
Brar Piening
Florian Salm*
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm, Berlin, Germany
Frank Schwab
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm, Berlin, Germany
Christine Geffers
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm, Berlin, Germany
Petra Gastmeier
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm, Berlin, Germany
Brar Piening
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm, Berlin, Germany
*
Address correspondence to Florian Salm, MD, Institute of Hygiene and Environmental Medicine, Charité University Medical Center Berlin, German National Reference Center for the Surveillance of Nosocomial Infections, Hindenburgdamm 27, D-12203 Berlin, Germany (florian.salm@charite.de).
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Abstract

OBJECTIVE

To improve the patient safety of very-low-birthweight infants in neonatal departments in Germany.

DESIGN

Multicenter cohort study with a baseline (24 months), an intervention (12 months), and a postinterventional follow-up period (12 months) and time series analysis.

STUDY POPULATION

Very-low-birthweight patients from 32 neonatal departments in Germany.

METHODS

Neonatal departments showing a standardized infection ratio of bloodstream infection 10% higher than the expected number (standardized infection ratio ≥1.1) were invited to participate in the study. To reduce the occurrence of primary bloodstream infections, evidence-based bundles to improve catheter maintenance routines, insertion practice, and hand-hygiene compliance were implemented in the participating infirmaries.

RESULTS

Thirty-four departments participated in the study and 32 reported data. In total, 6,222 very-low-birthweight infants with 231,868 patient-days and 1,405 cases of bloodstream infections were analyzed. In the baseline period the pooled mean bloodstream infection rate was 6.63 (95% CI, 6.17–7.12) per 1,000 patient-days. The bloodstream infection rate decreased in the intervention period to 5.68 (relative risk, 0.86 [95% CI, 0.76–0.97]) and in the 1-year follow-up period to 5.31 per 1,000 patient-days (relative risk, 0.80 [95% CI, 0.70–0.92]). The multivariable time series analysis of monthly aggregated data showed a significant change in the slope for the frequency of bloodstream infections from the start to the end of the intervention (change in slope incidence rate ratio, 0.97; P=.001).

CONCLUSION

The implementation of an intervention bundle is feasible and can reduce bloodstream infections in neonatal departments.

Infect Control Hosp Epidemiol 2016;37:798–804

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 798 - 804
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

1. Schwab, F, Gastmeier, P, Piening, B, Geffers, C. The step from a voluntary to a mandatory national nosocomial infection surveillance system: the influence on infection rates and surveillance effect. Antimicrob Resist Infect Control 2012;1:24.CrossRefGoogle ScholarPubMed
2. Horbar, JD, Carpenter, JH, Badger, GJ, et al. Mortality and neonatal morbidity among infants 501 to 1500 grams from 2000 to 2009. Pediatrics 2012;129:1019–1026.Google Scholar
3. Payne, NR, Carpenter, JH, Badger, GJ, Horbar, JD, Rogowski, J. Marginal Increase in cost and excess length of stay associated with nosocomial bloodstream infections in surviving very low birth weight infants. Pediatrics 2004;114:348–355.Google Scholar
4. Verstraete, E, Boelens, J, De Coen, K, et al. Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011): trends in incidence, pathogens, and mortality. Infect Control Hosp Epidemiol 2014;35:511–518.CrossRefGoogle Scholar
5. Cartlidge, P. The epidermal barrier. Semin Neonatol 2000;5:273–280.Google Scholar
6. Geffers, C, Gastmeier, A, Schwab, F, Groneberg, K, Rüden, H, Gastmeier, P. Use of central venous catheter and peripheral venous catheter as risk factors for nosocomial bloodstream infection in very-low-birth-weight infants. Infect Control Hosp Epidemiol 2010;31:395–401.CrossRefGoogle ScholarPubMed
7. Leistner, R, Thürnagel, S, Schwab, F, Piening, B, Gastmeier, P, Geffers, C. The impact of staffing on central venous catheter-associated bloodstream infections in preterm neonates—results of nation-wide cohort study in Germany. Antimicrob Resist Infect Control 2013;2:11.CrossRefGoogle ScholarPubMed
8. Leistner, R, Piening, B, Gastmeier, P, Geffers, C, Schwab, F. Nosocomial infections in very low birthweight infants in Germany: current data from the National Surveillance System NEO-KISS. Klin Padiatr 2013;225:75–80.Google Scholar
9. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
10. Lachman, P, Yuen, S. Using care bundles to prevent infection in neonatal and paediatric ICUs. Curr Opin Infect Dis 2009;22:224–228.Google Scholar
11. Powers, RJ, Wirtschafter, DW. Decreasing central line associated bloodstream infection in neonatal intensive care. Clin Perinatol 2010;37:247–272.CrossRefGoogle ScholarPubMed
12. Wirtschafter, DD, Powers, RJ, Pettit, JS, et al. Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model. Pediatrics 2011;127:419–426.Google Scholar
13. Kilbride, HW, Wirtschafter, DD, Powers, RJ, Sheehan, MB. Implementation of Evidence-based potentially better practices to decrease nosocomial infections. Pediatrics 2003;111:e519–e533.CrossRefGoogle ScholarPubMed
14. NEO-KISS (nosocomial infection surveillance system for preterm infants on neonatology departments and ICUs). German National Reference Center for Surveillance of Nosocomial Infections (Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen) website. http: //www.nrz-hygiene.de/en/surveillance/hospital-infection-surveillance-system/neo-kiss. Accessed March 16, 2016.Google Scholar
15. Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27:299–309.CrossRefGoogle ScholarPubMed
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