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Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection Control PowerPoint Presentation
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Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection Control Safe Injection Global Network Meeting in Cambodia, 2002. High rates of sepsis among infants in neonatal ICU - mortality rates > 50% - poor response to antibiotic therapy

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slide1
Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection Control

Safe Injection Global Network Meeting in Cambodia, 2002

slide2
High rates of sepsis among infants in neonatal ICU- mortality rates > 50%- poor response to antibiotic therapy

Early onset sepsis- immediately after admission

Background: Request for Assistance to Prevent Sepsis among NICU Patients at a University Hospital in Egypt
slide3

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
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
slide5

Investigation of Sepsis in Newborn Nursery

Poor infection control

practices

Contamination of IV fluids

Sepsis and death

slide6

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

Rapid Assessment of Sepsis in NICUs

results of iv fluid and blood cultures survey of rapid assessment of sepsis in nicu s egypt 02

Type of

facility

No. pts.

Blood

No. %

cultures pos

IV fluids

No. %

cultures pos

Medications

No. %

Cultures pos

MOE

(n=12)

176

63

75%

70

64%

31

23%

MOHP(n=24)

180

86

69%

100

64%

25

20%

TOTAL

356

149

71%

170

64%

56

21%

Results of IV Fluid and Blood Cultures Survey of Rapid Assessment of Sepsis in NICU’s ,Egypt ‘02
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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

Results: Assessment of Infection Control Practices

Rapid assessment of Sepsis in NICUs

slide9

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

Intervention to Prevent Sepsis in NICUs

slide10
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
Observation Tool to Monitor Infection Control Practices
  • Hand washing before procedures
  • IV fluid mixing and preparation
  • Medication mixing and preparation
  • Cannula insertion steps
slide12
Comparison of Infection Control Practices Related to IV & Medication Preparation before and after Intervention
percentage of iv fluid samples contaminated
Percentage of IV Fluid Samples Contaminated

Post-intervention

Pre-intervention

summary behavior change related to intervention
SummaryBehavior 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
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