Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection Control Safe Injection Global Network Meeting in Cambodia, 2002

Background: Request for Assistance to Prevent Sepsis among NICU Patients at a University Hospital in Egypt High rates of sepsis among infants in neonatal ICU - mortality rates > 50% - poor response to antibiotic therapy Early onset sepsis - immediately after admission

Methods Investigation of Sepsis among NICU Patients in Egypt Observation of infection control practices Epidemiology - laboratory-based surveillance for BSI (blood culture) - culture of IV fluids (opened and unopened) - culture of medications - monitor mortality

Results: Investigation of Sepsis in NICU Clinical practice –All infants placed on IV fluids and antibiotics Assessment of Infection control practices –Poor understanding of infection control –Unsafe practices in the preparation of IV fluids –Opened IV fluids: Contaminated (klebsiella predominant) –Unopened IV fluids: no growth –NICU environmental surfaces: Klebsiella predominant Prospective surveillance –70% of infants with sepsis (most is early onset) –55% mortality

Investigation of Sepsis in Newborn Nursery Poor infection control practices Contamination of IV fluids Sepsis and death

Rapid Assessment of Sepsis in NICUs Sample - NICUs throughout the country (n= 36) Assessment - sepsis and mortality rates - culture of IVF - BSI among patients with clinical sepsis - infection control practices with emphasis on management of IV fluids Team - laboratory, epidemiologist, neonatologist

Results of IV Fluid and Blood Cultures Survey of Rapid Assessment of Sepsis in NICUs,Egypt 02 Type of facility No. pts. Blood No. % cultures pos IV fluids No. % cultures pos Medications No. % Cultures pos MOE (n=12) %7064%3123% MOHP (n=24) %10064%2520% TOTAL %17064%5621%

Results: Assessment of Infection Control Practices Rapid assessment of Sepsis in NICUs General - poor understanding of infection control Preparation of IV fluids - mixing of fluids on ward - poor adherence to aseptic techniques - prolonged usage of individual bags - no assigned nurse or special area for IV preparation - reuse of syringes to prepare IV fluids Infection control supplies - gloves, syringes, appropriately sized IV fluids

Intervention to Prevent Sepsis in NICUs Task analysis on preparation of IV fluids - SOPs for preparation of IV fluids Training - 3 days onsite, applied and didactic - follow-up with monthly site visits Supplies and reagents - distribution of critical infection control materials Supervision and monitoring - key indicators

Key Indicators to Monitor Intervention Infection Control Practices - observational tool - score developed for critical procedures IV fluid contamination Admissions, deaths, mortality rates

Observation Tool to Monitor Infection Control Practices Hand washing before procedures IV fluid mixing and preparation Medication mixing and preparation Cannula insertion steps

Comparison of Infection Control Practices Related to IV & Medication Preparation before and after Intervention

Percentage of IV Fluid Samples Contaminated Pre-intervention Post-intervention

Admissions, Deaths and Mortality Rates in 22 NICUs from Dec 01 to Jun 02

Summary Behavior Change Related to Intervention Improved hand washing Improved aseptic techniques for –IV fluid mixing and preparation –Medication mixing and preparation –Cannula insertion

Summary Promotion of Infection Control Evidence-based monitoring and evaluation is essential Applied training is vital Availability of critical supplies Promotion of infection control is the key strategy to reduce nosocomial infections Investment in infection control has great potential to: - reduce disease in patients - lower health care costs