1. Reducing Neonatal Catheter-Associated Bloodstream Infection Yevgeniy (Eugene) Statnikov, Data Manager Neonatal Data Analysis Unit (NDAU)

2. Outline The system Types of data captured Recording requirements Catheter associated bloodstream infection extra

3. The system Neonatal.Net Centralised information Used by over 160 neonatal units extra

4. Types of data captured Static: recorded only once – eg birthweight Daily: recorded every day – eg line in situ today Episodic: recorded as required – eg date culture taken Neonatal.Net

5. Data requirements SOME BABIES Cultures taken with clinical signs, recorded at the time NOT retrospectively Culture results: including “no growth” ALL BABIES Risk factors Static: birthweight, gestational age, gender Daily: parenteral nutrition, type of milk feed, vascular lines in situ

6. Data requirements FOUR STEP PROCESS: 1)ONCE ONLY(ALL BABIES): Ensure static items are recorded (gestational age, birthweight, gender) 2)DAILY(ALL BABIES): Ensure daily items are recorded every day (presence of umbilical arterial catheter and central venous lines, parenteral nutrition, milk feeds) 3)EPISODIC (BABIES THAT HAVE A BLOOD CULTURE TAKEN): Record blood culture information 4)EPISODIC (BABIES THAT HAVE A BLOOD CULTURE TAKEN): Record microbiological results

7. Recording requirements: Log-in https://nww.neonatal.nhs.uk/ Click on ‘select existing or admit new baby’

8. Recording requirements: Log-in https://nww.neonatal.nhs.uk/ Enter ‘UK User authentication...’ details issued by your unit

9. Recording requirements: Static items (ALL BABIES) Select baby (use Name or NHS Number) Search for existing baby using Surname, Forename or NHS Number Or select baby from list of patients

10. Recording requirements: Daily items (ALL BABIES) Switch to daily-details form (to record umbilical and central venous catheters, parenteral nutrition, milk feeds) On the Patient home page, under Things to do..., click on Day-details form for DD-Month-YY

11. Recording tequirements: Daily items Enter catheter information in line in situ today, milk feeds and parenteral nutrition, and save (must be recorded daily for ALL BABIES) Scroll down the Extended daily summary (Daily-form) filling out all details including Lines (click on relevant listed option) and Fluids and feeding (tick boxes and click on relevant listed option) Click on Save and Close to exit

12. Recording requirements: Episodic items Select the ad hoc events form: Infection (bloodcsf cultures) On the Patient home page, under Ad-Hoc Event Forms, click on Infection (bloodcsf cultures)

13. Episodic Items: ALL BABIES THAT HAVE BLOOD CULTURES TAKEN Enter: date/time, culture type and clinical signs when culture taken and save (DO NOT ENTER RETROSPECTIVELY) Inside the Infection form enter Sample taken (date and time), select Sample type and from drop- down menu select Signs present when culture obtained Click on Save and Close to exit

14. Episodic items: Culture results Microbiology reports return with results of blood test Follow the log-in steps and patient search steps outlined previously

15. Episodic items: Culture results Enter the results of microbiology report in the new (2011) Reminders section on the home page Select the culture form from the ‘Reminders’ section

16. Episodic items: Alternative culture results collection Enter the results of microbiology report on the patient data page where you will find all dates of samples taken Change page by clicking on patient data tab Find previously entered sample details inside Daily data

17. Episodic items: Culture results In Days during stay box click on the day on which culture sample was taken Click on Day of sample draw Double click on the displayed Infection information to open the Infection form

18. Episodic items: Culture results Click to select pathogens… Click on Pathogens to record the results of the microbiology report

19. Episodic items: Culture results Enter results including “no growth” Select pathogen from common list or type pathogen name to locate others Confirm your record

20. Episodic items: Culture results Save Infection form Click on Save and Close

21. Summary Static and daily items are required for all babies Episodic items are required for babies having a blood culture taken Analysis requires complete data entry Positive AND negative blood culture results must be entered Data must be NOT be entered retrospectively

22. Analysis of infection Static Line in Situ (Catheter) Clinical signs Daily Episodic Sample type Pathogen (+/- Growth) Date Link

23. Analysis and presentation of results CABSI will be risk adjusted or risk stratified Presentation format to be decided in discussion with NPSA

24. “Two birds with one stone” The exact same data entry is needed for the National Neonatal Audit Programme 2011 audit of Neonatal Bloodstream Infection