Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-23T14:16:56.868Z Has data issue: false hasContentIssue false

Infection Prevention Practices in Neonatal Intensive Care Units Reporting to the National Healthcare Safety Network

Published online by Cambridge University Press:  10 May 2016

Susan N. Hocevar*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Fernanda C. Lessa
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Lauren Gallagher
Affiliation:
Illinois Department of Public Health, Chicago, Illinois
Craig Conover
Affiliation:
Illinois Department of Public Health, Springfield, Illinois
Rachel Gorwitz
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Martha Iwamoto
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Road NE, MS A-35, Atlanta, GA 30333 (shocevar@cdc.gov).

Extract

Background.

Patients in the neonatal intensive care unit (NICU) are at high risk for healthcare-associated infections. Variability in reported infection rates among NICUs exists, possibly related to differences in prevention strategies. A better understanding of current prevention practices may help identify prevention gaps and areas for further research.

Methods

We surveyed infection control staff in NICUs reporting to the National Healthcare Safety Network (NHSN) to assess strategies used to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and central line–associated bloodstream infections in NICUs.

Results

Staff from 162 of 342 NICUs responded (response rate, 47.3%). Most (92.3%) NICUs use central line insertion and maintenance bundles, but maintenance practices varied, including agents used for antisepsis and frequency of dressing changes. Forty-two percent reported routine screening for MRSA colonization upon admission for all patients. Chlorhexidine gluconate (CHG) use for central line care for at least 1 indication (central line insertion, dressing changes, or port/cap antisepsis) was reported in 82 NICUs (51.3%). Among sixty-five NICUs responding to questions on CHG use restrictions, 46.2% reported no restrictions.

Conclusions

Our survey illustrated heterogeneity of CLABSI and MRSA prevention practices and underscores the need for further research to define optimal strategies and evidence-based prevention recommendations for neonates.

Infect Control Hosp Epidemiol 2014;35(9):1126-1132

Type
Original Article
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2009, device-associated module. Am J Infect Control 2011;39(5):349367.Google Scholar
2. Lessa, FC, Edwards, JR, Horan, TC, Morell, , et al. Trends in incidence of methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in U.S. neonatal intensive care units, 1998–2008. In: Fifth Decennial International Conference on Healthcare-Associated Infections; 2010; Atlanta, GA. Abstract 405.Google Scholar
3. Lessa, FC, Edwards, JR, Fridkin, SK, Tenover, FC, Horan, TC, Gorwitz, RJ. Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995–2004. Pediatr Infect Dis J 2009;28(7):577581.Google Scholar
4. Carey, AJ, Duchon, J, Della-Latta, P, Saiman, L. The epidemiology of methicillin-susceptible and methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit, 2000–2007. J Perinatol 2010;30(2):135139.Google Scholar
5. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):e162–e193.Google Scholar
6. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10 suppl 2):S165S193.CrossRefGoogle ScholarPubMed
7. SurveyMonkey. http://www.surveymonkey.com. Accessed April 8, 2013.Google Scholar
8. Klieger, SB, Potter-Bynoe, G, Quach, C, Sandora, TJ, Coffin, SE. Beyond the bundle: a survey of central line–associated bloodstream infection prevention practices used in US and Canadian pediatric hospitals. Infect Control Hosp Epidemiol 2013;34(11):12081210.CrossRefGoogle Scholar
9. Tamma, PD, Aucott, SW, Milstone, AM. Chlorhexidine use in the neonatal intensive care unit: results from a national survey. Infect Control Hosp Epidemiol 2010;31(8):846849.Google Scholar
10. Milstone, AM, Song, X, Coffin, S, Elward, A. Identification and eradication of methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit: results of a national survey. Infect Control Hosp Epidemiol 2010;31(7):766768.Google Scholar
11. Bryant, KA, Zerr, DM, Huskins, WC, Milstone, AM. The past, present, and future of healthcare-associated infection prevention in pediatrics: catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 2010;31(suppl 1):S27S31.Google Scholar
12. Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997–2007. JAMA 2009;301(7):727736.Google Scholar
13. Schulman, J, Stricof, R, Stevens, TP, et al. Statewide NICU central-line-associated bloodstream infection rates decline after bundles and checklists. Pediatrics 2011;127(3):436444.Google Scholar
14. Miller, MR, Griswold, M, Harris, JM 2nd, et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts. Pediatrics 2010;125(2):206213.Google Scholar
15. Jeffries, HE, Mason, W, Brewer, M, et al. Prevention of central venous catheter–associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative. Infect Control Hosp Epidemiol 2009;30(7):645651.Google Scholar
16. Wirtschafter, DD, Pettit, J, Kurtin, P, et al. A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections. J Perinatol 2010;30(3):170181.Google Scholar
17. Wirtschafter, DD, Powers, RJ, Pettit, JS, et al. Nosocomial infection reduction in VLBW infants with a statewide quality-improvement model. Pediatrics 2011;127(3):419426.CrossRefGoogle ScholarPubMed
18. Lachman, P, Yuen, S. Using care bundles to prevent infection in neonatal and paediatric ICUs. Curr Opin Infect Dis. 2009;22(3):224228.Google Scholar
19. US Food and Drug Administration (FDA). 2% Chlorhexidine Gluconate (CHG) Cloth: Safety Labeling Changes Approved by FDA Center for Drug Evaluation and Research (CDER)—May 2012. Silver Spring, MD: FDA, 2012. http://www.fda.gov/Safety/MedWatch/SafetyInformation/Safety-RelatedDrugLabelingChanges/ucm307387.htm.Google Scholar
20. Gellert, GA, Ewert, DP, Bendana, N, et al. A cluster of coagulase-negative staphylococcal bacteremias associated with peripheral vascular catheter colonization in a neonatal intensive care unit. Am J Infect Control 1993;21(1):1620.Google Scholar
21. Mahieu, LM, De Dooy, JJ, Lenaerts, AE, Ieven, MM, De Muynck, AO. Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients. J Hosp Infect 2001;48(1):2026.Google Scholar
22. Murga, R, Miller, JM, Donlan, RM. Biofilm formation by gram-negative bacteria on central venous catheter connectors: effect of conditioning films in a laboratory model. J Clin Microbiol 2001;39(6):22942297.Google Scholar
23. van Gelder, MM, Bretveld, RW, Roeleveld, N. Web-based questionnaires: the future in epidemiology? Am J Epidemiol 2010;172(11):12921298.Google Scholar