1. Reduction in rate of nosocomial infection in the NICU Reduction in rate of nosocomial infection in the NICU Peter Krcho, MD, PhD Providence-Košice Partnership Peter Krcho, MD, PhD Providence-Košice Partnership

2. Goals... n NI in NICU – specific problem NI in NICU = NI in PICU n Sources of infection n What could be done with the same equipment n What we need for the future

3. We would like  Nosocomial infection  Mortality  Morbidity  Antibiotics  TPN then  TPN  Number of patients  More experiences for team  Regionalization

4. 1995-00 Admissions, Total Deaths

5. Nosocomial infections

6. Results - 1995-00 Used ATB 453297

7. ATB per newborn (average)

8. How did we achieve these results? n Early resuscitation n Surfactant treatment n Appropriate management of the PDA - indomethacin, bedside ultrasound n Short inspiration times, higher RR n We changed ATB policies n More catheters n More discussion/collaboration http://www.aiha.com/English/partners/kosice/chart.htm

9. Surfactant

10. How did we achieve these results? n More blood cultures n BACTEC n In severe infections exchange transfusions (arterial and venous) n As soon as possible we stop ATB n More Total Parenteral Nutrition (TPN) in first days n Better use of TPN n Hand washing http://www.aiha.com/English/partners/kosice/chart.htm

11. Early surfactant (26w-710g)

12. Longer UPV – More nosocomial infection

13. Exchange transfusion: Still necessary...

14. Just 16 hours after...

15. No other serious problems... Going home at 3 m- 2430g

16. Exchange transfusions (artery & vein) n When to release? n Necessary volume to exchange (80- 160ml)? n How to continue the ATB treatment? n Give or not to give IVIG after exchange? n Multicentric randomised study needed...

17. Learning from Our Mistakes: n Excess volume, FFP, IG. (50-60/kg) n Excess, frequent ATB changes n Insufficient skills for arterial access n Destruction of the peripheral veins, insufficient venous access n Negative blood cultures – when to take n Not enough surfactant and late...later extubation more CLD n Equipment – increase of NI with more changes!

18. General ideas... n Maximal control from the start n Right intervention at the right time (ASAP) n Surfactant ASAP, Indocin IV, Blood culture always, precise volume management n LATER n Less is sometimes more (volume, caloric input )

19. How did we achieve these results? n If caloric input is just enough we stop PN ASAP because of high nosocomial infection rate n Improving infection control n More seminars for other hospitals n PC’s could save time for other work n Internet access – Cochrane Library http://www.aiha.com/English/partners/kosice/chart.htm

20. We would like to continue... n E-mail communications n Videoconferences n Grant writing - participation in multicentric trials – database n Team building http://www.aiha.com/English/partners/kosice/chart.htm

21. Needs... n NICU – need for neonatal professionals n Medical supplies and equipment: IV, ventilation tubes, humidifiers, HANDS not only n More effort for the right diagnosis n More skills, more Surfactant, better transport, more equipment-concentration, regionalisation IU.

22. BW 540g

23. About us in www...

24. Resources from the www... n www.google.com www.google.com n Nosocomial Infections in Newborn n Open Medical Club n www.neonatology.sk under construction www.neonatology.sk