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Effect of Infection Control Programs in the Incidence of Nosocomial Infections in a Neonatal Intensive Care Unit
June 2008
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evolved to meet the needs of healthcare workers. Recently, non-aerosol foaming alcohol-based instant hand sanitizers (foam ABIHS) have been introduced into the healthcare setting and have been well received. To date, no data exist regarding the effect of the implementation of foam ABIHS on infection rates compared to other instant hand sanitizer formats (i.e. gel). To generate such data, this outcomes study evaluated a surrogate for nosocomial infection rates (nosocomial infection marker rates), retrospectively for gel and prospectively for foam ABIHS implementation. Methods: A bi-phasic approach was used to evaluate changes in Nosocomial Infection Markerä (NIM) rates with use of a gel ABIHS versus foam ABIHS. The monthly NIM rates (total NIM/total hospital admissions) of Akron General Medical Center in Akron, Ohio, were pooled from the Cardinal Health MedMinedä Infection Control Surveillance Service for each study phase. Phase I was a 21 month PURELLÒ Instant Hand Sanitizer Gel (62% ethanol active) phase, and phase II was a 12 month PURELLÒ Foam (62% ethanol active) implementation phase. A paired samples t-test (alpha 5 0.05) was used to evaluate if the implementation of a foam ABIHS significantly changed hospital NIMs overall. Site specific NIM rates for blood, respiratory and urine were also evaluated. Results: The results of this study correlate with laboratory efficacy data that indicate both gel and foam alcohol based hand sanitizers have equally high antimicrobial efficacy. Hospital NIM rates ranged from 3.58% to 5.92% for the 21-month gel IHS phase and from 4.09% to 5.99% for the foam ABIHS implementation phase. Analysis of overall NIM rates revealed no significant difference between the gel ABIHS phase and the foam ABIHS implementation period (p.0.05). Site specific infection rates for blood, respiratory and urine infections were not significantly different pre-foam and post-foam (p.0.05). Conclusions: d d
d
PURELLÒ Foam and Gel ABIHS have equivalent efficacy in healthcare environments based on NIM rates. Assuming the products have acceptable skin care performance and aesthetic characteristics (e.g. odor, tackiness, etc.), infection control practitioners should not be concerned about potential increases in nosocomial infection rates when making a transition from gel ABIHS to foam ABIHS. Additional research is needed to better understand the impact of dosage and whether there are differences in hand hygiene compliance for gel ABIHS users and foam ABIHS users.
Publication Number 8-72
Effect of Infection Control Programs in the Incidence of Nosocomial Infections in a Neonatal Intensive Care Unit Han Min-kyoung, RN, BSN, ICP, Infection Control Nurse, Hye Ran Choi, RN, BSN, Infection Control Nurse, Sun Hee Kwak, RN, BSN, Infection Control Nurse, Hye Jin Park, RN, BSN, Infection Control Nurse, Hyang Mi Mun, Medical technologist, Infection Control, Asan Medical Center, Seoul, Republic of Korea, Jae Sim Jeong, RN, PhD, ICP, Clinical Assistant Professor, University of Ulsan, Seoul, Republic of Korea, Mi Na Kim, MD, PhD, Laboratory Medicine Doctor, Sang Oh Lee, MD, PhD, Infection Diseases Doctor, Jun Hee Woo, MD, PhD, Infection Control Doctor, Asan Medical Center, Seoul, Republic of Korea. Backgroud/Objectives: Intensive and continuous infection control programs were applied to the Neonatal Intensive Care Unit (NICU) for 4 years from August 2004 to October 2007 in one University-affiliated hospital in Seoul, Korea. This study was aimed to evaluate the effect of intervention programs to the incidence of nosocomial infections (NIs) in the NICU. Methods: A prospective surveillance was performed regularly to identify NIs. Patient-days rates and deviceassociated rates were calculated and stratified by the birth-weight of neonates. Interventions to decrease the
E78
Vol. 36 No. 5
incidence of NIs were intensified every year. Interventions involved the institution of routine surveillance cultures for MRSA in all NICU admitted patients from outside hospitals and for all patients while in the NICU weekly and cohorting or contact precautions were strictly applied to the MRSA isolated patients since 2004. Environment infection control, medical device disinfection, and aseptic technique were emphasized since 2005. From the 3rd year, regular infection control education for rotated and newly allocated health care personnel (HCP) was provided monthly. In 2007, hand hygiene (HH) campaign was promoted. Results: The 1,849 newborns and 36 NICU months of data was available for analysis. The 216 NIs cases were identified and the most common infections were bloodstream infections (BSI) (46.3%); eye, ear, nose, throat, or mouth infections (EENT) (22.7%); skin and soft tissue infections (8.8%). Patient-days rate were decreased continuously from 6.9, 6.3, 4.4, to 4.1 per 1,000 patient-days between 2004 and 2007 (p 5 0.02), respectively. When the patient-days rates were stratified to birth weight and compared yearly, those were significantly decreased in the group of 1,501gm-2,500gm (6.3, 4.7, 2.6, 1.5, p 5 0.01), and those in the group of .2,501gm (10.3, 6.6, 3.1, 4.8, p 5 0.03). The central-line associated BSI showed decreased tendency (3.7, 4.4, 3.0, 3.9, p 5 0.57). Also, EENT infections were declined (2.4, 2.1, 0.6, 0.2, p , 0.001). The MRSA NIs rate per 10,000 patient-days was significantly decreased (9.1, 0.8, 4.3, 3.2, p 5 0.02) and NIs by carbapenem-resistant Pseudomonas aeruginosa were also significantly decreased (9.1, 3.9, 0.0, 0.0, p , 0.001). When the adherence rates for HH of HCP in 2006 were compared to those of 2007, it showed distinct improvement from 40.4% to 65.4% in physicians, from 63.2% to 84.0% in nurses, respectively. Concusions: The intensified infection control programs in NICU were very effective in preventing and decreasing NIs, especially in the infants with more than 1,500gm birth weight. The efforts to decrease NIs with the suitable infection control practices in NICU should be continuously needed.
Publication Number 8-73
Implementation of an Active Screening Program for Methicillin-Resistant Staphylococcus aureus in the Critical Care Setting at a Community Hospital Jennifer Daniel, MSPH, Infection Control Practitioner, Laura Marconnet, BSN, Infection Control Practitioner, Barbara Pearce, MPH, Data Manager, Carlotta Rinke, MD, Medical Director of Quality and Patient Safety, Lynwood Jones, MD, Medical Director of Infection Control, Alexian Brothers Medical Center, Elk Grove Village, IL. Issue: Methicillin resistant Staphylococcus aureus (MRSA) has been well-established as an important cause of healthcare acquired infections. MRSA infection is associated with greater morbidity and mortality, increased costs and longer length of stay. At our 389-bed community hospital, approximately 53% of all S. aureus isolates are MRSA. In August 2007, the state of Illinois enacted a law which mandates each Illinois hospital to institute a MRSA control program which includes active screening for MRSA in the critical care setting and other high risk units as defined by the hospital. Project: In June 2007, active screening for MRSA was initiated in a 24-bed Intensive Care Unit (ICU) and 6-bed Cardiovascular ICU (CVICU). Nasal swabs are collected on all patients within 18 hours of admission to ICU or CVICU. To determine if there is MRSA transmission, a weekly nasal swab is collected on each patient present in the unit on Wednesday. Testing for MRSA is performed utilizing a rapid polymerase chain reaction (PCR) on the admission screen. A culture with chromagenic culture media is performed for the weekly screens. The microbiology lab notifies the units of any positive results and positive patients are placed in contact precautions. A baseline and follow-up MRSA infection rate was established through review of all positive MRSA clinical cultures. Case definitions from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) were applied to determine the number of MRSA infections attributed to the ICU or CVICU. Any type of infection was considered (i.e. pneumonia, bloodstream infection, urinary tract infection, etc.).
E77
evolved to meet the needs of healthcare workers. Recently, non-aerosol foaming alcohol-based instant hand sanitizers (foam ABIHS) have been introduced into the healthcare setting and have been well received. To date, no data exist regarding the effect of the implementation of foam ABIHS on infection rates compared to other instant hand sanitizer formats (i.e. gel). To generate such data, this outcomes study evaluated a surrogate for nosocomial infection rates (nosocomial infection marker rates), retrospectively for gel and prospectively for foam ABIHS implementation. Methods: A bi-phasic approach was used to evaluate changes in Nosocomial Infection Markerä (NIM) rates with use of a gel ABIHS versus foam ABIHS. The monthly NIM rates (total NIM/total hospital admissions) of Akron General Medical Center in Akron, Ohio, were pooled from the Cardinal Health MedMinedä Infection Control Surveillance Service for each study phase. Phase I was a 21 month PURELLÒ Instant Hand Sanitizer Gel (62% ethanol active) phase, and phase II was a 12 month PURELLÒ Foam (62% ethanol active) implementation phase. A paired samples t-test (alpha 5 0.05) was used to evaluate if the implementation of a foam ABIHS significantly changed hospital NIMs overall. Site specific NIM rates for blood, respiratory and urine were also evaluated. Results: The results of this study correlate with laboratory efficacy data that indicate both gel and foam alcohol based hand sanitizers have equally high antimicrobial efficacy. Hospital NIM rates ranged from 3.58% to 5.92% for the 21-month gel IHS phase and from 4.09% to 5.99% for the foam ABIHS implementation phase. Analysis of overall NIM rates revealed no significant difference between the gel ABIHS phase and the foam ABIHS implementation period (p.0.05). Site specific infection rates for blood, respiratory and urine infections were not significantly different pre-foam and post-foam (p.0.05). Conclusions: d d
d
PURELLÒ Foam and Gel ABIHS have equivalent efficacy in healthcare environments based on NIM rates. Assuming the products have acceptable skin care performance and aesthetic characteristics (e.g. odor, tackiness, etc.), infection control practitioners should not be concerned about potential increases in nosocomial infection rates when making a transition from gel ABIHS to foam ABIHS. Additional research is needed to better understand the impact of dosage and whether there are differences in hand hygiene compliance for gel ABIHS users and foam ABIHS users.
Publication Number 8-72
Effect of Infection Control Programs in the Incidence of Nosocomial Infections in a Neonatal Intensive Care Unit Han Min-kyoung, RN, BSN, ICP, Infection Control Nurse, Hye Ran Choi, RN, BSN, Infection Control Nurse, Sun Hee Kwak, RN, BSN, Infection Control Nurse, Hye Jin Park, RN, BSN, Infection Control Nurse, Hyang Mi Mun, Medical technologist, Infection Control, Asan Medical Center, Seoul, Republic of Korea, Jae Sim Jeong, RN, PhD, ICP, Clinical Assistant Professor, University of Ulsan, Seoul, Republic of Korea, Mi Na Kim, MD, PhD, Laboratory Medicine Doctor, Sang Oh Lee, MD, PhD, Infection Diseases Doctor, Jun Hee Woo, MD, PhD, Infection Control Doctor, Asan Medical Center, Seoul, Republic of Korea. Backgroud/Objectives: Intensive and continuous infection control programs were applied to the Neonatal Intensive Care Unit (NICU) for 4 years from August 2004 to October 2007 in one University-affiliated hospital in Seoul, Korea. This study was aimed to evaluate the effect of intervention programs to the incidence of nosocomial infections (NIs) in the NICU. Methods: A prospective surveillance was performed regularly to identify NIs. Patient-days rates and deviceassociated rates were calculated and stratified by the birth-weight of neonates. Interventions to decrease the
E78
Vol. 36 No. 5
incidence of NIs were intensified every year. Interventions involved the institution of routine surveillance cultures for MRSA in all NICU admitted patients from outside hospitals and for all patients while in the NICU weekly and cohorting or contact precautions were strictly applied to the MRSA isolated patients since 2004. Environment infection control, medical device disinfection, and aseptic technique were emphasized since 2005. From the 3rd year, regular infection control education for rotated and newly allocated health care personnel (HCP) was provided monthly. In 2007, hand hygiene (HH) campaign was promoted. Results: The 1,849 newborns and 36 NICU months of data was available for analysis. The 216 NIs cases were identified and the most common infections were bloodstream infections (BSI) (46.3%); eye, ear, nose, throat, or mouth infections (EENT) (22.7%); skin and soft tissue infections (8.8%). Patient-days rate were decreased continuously from 6.9, 6.3, 4.4, to 4.1 per 1,000 patient-days between 2004 and 2007 (p 5 0.02), respectively. When the patient-days rates were stratified to birth weight and compared yearly, those were significantly decreased in the group of 1,501gm-2,500gm (6.3, 4.7, 2.6, 1.5, p 5 0.01), and those in the group of .2,501gm (10.3, 6.6, 3.1, 4.8, p 5 0.03). The central-line associated BSI showed decreased tendency (3.7, 4.4, 3.0, 3.9, p 5 0.57). Also, EENT infections were declined (2.4, 2.1, 0.6, 0.2, p , 0.001). The MRSA NIs rate per 10,000 patient-days was significantly decreased (9.1, 0.8, 4.3, 3.2, p 5 0.02) and NIs by carbapenem-resistant Pseudomonas aeruginosa were also significantly decreased (9.1, 3.9, 0.0, 0.0, p , 0.001). When the adherence rates for HH of HCP in 2006 were compared to those of 2007, it showed distinct improvement from 40.4% to 65.4% in physicians, from 63.2% to 84.0% in nurses, respectively. Concusions: The intensified infection control programs in NICU were very effective in preventing and decreasing NIs, especially in the infants with more than 1,500gm birth weight. The efforts to decrease NIs with the suitable infection control practices in NICU should be continuously needed.
Publication Number 8-73
Implementation of an Active Screening Program for Methicillin-Resistant Staphylococcus aureus in the Critical Care Setting at a Community Hospital Jennifer Daniel, MSPH, Infection Control Practitioner, Laura Marconnet, BSN, Infection Control Practitioner, Barbara Pearce, MPH, Data Manager, Carlotta Rinke, MD, Medical Director of Quality and Patient Safety, Lynwood Jones, MD, Medical Director of Infection Control, Alexian Brothers Medical Center, Elk Grove Village, IL. Issue: Methicillin resistant Staphylococcus aureus (MRSA) has been well-established as an important cause of healthcare acquired infections. MRSA infection is associated with greater morbidity and mortality, increased costs and longer length of stay. At our 389-bed community hospital, approximately 53% of all S. aureus isolates are MRSA. In August 2007, the state of Illinois enacted a law which mandates each Illinois hospital to institute a MRSA control program which includes active screening for MRSA in the critical care setting and other high risk units as defined by the hospital. Project: In June 2007, active screening for MRSA was initiated in a 24-bed Intensive Care Unit (ICU) and 6-bed Cardiovascular ICU (CVICU). Nasal swabs are collected on all patients within 18 hours of admission to ICU or CVICU. To determine if there is MRSA transmission, a weekly nasal swab is collected on each patient present in the unit on Wednesday. Testing for MRSA is performed utilizing a rapid polymerase chain reaction (PCR) on the admission screen. A culture with chromagenic culture media is performed for the weekly screens. The microbiology lab notifies the units of any positive results and positive patients are placed in contact precautions. A baseline and follow-up MRSA infection rate was established through review of all positive MRSA clinical cultures. Case definitions from the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) were applied to determine the number of MRSA infections attributed to the ICU or CVICU. Any type of infection was considered (i.e. pneumonia, bloodstream infection, urinary tract infection, etc.).