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Nosocomial Infection Surveillance in a Colombian Neonatal Intensive Care Unit
June 2006
E153
Publication Number 21-187
Withdrawn
Publication Number 21-188
Nosocomial Infection Surveillance in a Colombian Neonatal Intensive Care Unit GA Contreras, MD1,2 AL Leal, MD, MSc1,2 R Prieto, MD3 AL Hermida3 1
Medical Microbiology, Nacional University, Bogota´, Colombia Infection Control, Clinica San Pedro Claver, Bogota´, Colombia 3 Neonatology, Clinica San Pedro Claver, Bogota´, Colombia 2
BACKGROUND/OBJECTIVES: Nosocomial Infections are a major problem at the Neonatal Intensive Care Unit (NICU) in developing countries. Surveillance is considered one the most important measures to control and reduce the rates of infections on the hospital settings. The objective of this study was to describe the epidemiology of Nosocomial Infections in the NICU at the Hospital San Pedro Claver in Bogota´ – Colombia. METHODS: A prospective Nosocomial Infection Surveillance was performed in the NICU during 10 months; from February through November 2005. Centers for Disease Control and Prevention criteria were used as standard definitions for Nosocomial Infection. Birth weight was stratified into four categories. Patient days, device days and device utilization rates were calculated with NNIS (National Nosocomial Infections Surveillance) methods for each of 4 birth-weight categories. These rates were compared with the high-risk nursery surveillance component of the annual report of the NNIS of October 2004. RESULTS: 141 neonates were included during the surveillance. Thirty six neonates developed 39 infections. The accumulative rate of Nosocomial Infection was 1.3 per 100 patients at risk. Bacteremia (56.4%), clinical sepsis (17.9%) pneumonia (17.9%), necrotizing enterocolitis (5.1%) and meningitis (2.5%) were the most common infections. Gram-positive bacteria were the most commonly isolated germs (77%), with coagulase-negative Staphylococcus (50%) being the main pathogen. Results for device utilization and device-associated infections are shown in Table 1. CONCLUSIONS: Device utilization and device-associated Nosocomial infection rates in our institution are higher compared with those of NICUs participating in the NNIS. For this reason, the use of appropriate infection control measures will be a successful strategy to reduce the infection rates.
Table 1 Birth weight Category ,1000 1001-1500 1501-2500 .2500
Patient-days
Central line days
Central line associated BSI
Central line utilization ratio
Percentile (%){
Central line associated BSI rate
Percentile (%){
329 759 988 480
252 681 423 110
2 10 6 2
0.76 0.89 0.42 0.22
.90 .90 .90 50-75
7.9 14.6 14.1 18.1
25-50 .90 .90 .90
E154
Vol. 34 No. 5
Birth weight category ,1000 1001-1500 1501-2500 .2500
Patient-days
Ventilator days
Ventilator associated pneumonia
Ventilator utilization rate
Percentile (%){
Ventilator associated pneumonia rate
Percentile (%){
329 759 988 480
74 96 53 22
1 2 0 0
0.22 0.12 0.05 0.04
10 25-35 25 10
1.3 20.8 0 0
10-25 .90 10 10
BSI 5 Bloodstream infection. { Centile position of our unit.
Publication Number 21-189
Standardization of Data Collection and Reporting Methods for Infection Control (IC) Surveillance of Targeted, High Risk Procedures Via a Web Based Format in a 22 Hospital System Leads to the Development of a Model Process PL Bush, RN, MS, CHE2 DA Blumberg, MD3 JM Weber, RN, BSN, CIC4 DE Lighter, MD1 TA Trottier, RN, BSN1 1
Medical Affairs, Shriners Hospitals for Children-Corporate Headquarters, Tampa, FL, USA Clinical Transformation, Perot Systems, Plano, TX, USA 3 Pediatrics, UC Davis Medical Center, Sacramento, CA, USA 4 Infection Control, Shriners Hospitals for Children-Boston, Boston, MA, USA 2
ISSUE: IC reporting of surgical site infections (SSI) at the system level was revealing no useful prevention/ interventional information for performance improvement. Rates were reported for all surgical sites, but were not stratified by procedure. A new system that promoted procedure specific reporting was needed to allow accurate representation of SSI rates and to facilitate detection and prevention opportunities. PROJECT: A national IC Practitioner (ICP) work group was deployed to revise the processes for surveillance. A review of historical data to identify high volume, problem prone, high risk, high cost and patient outcome related conditions was conducted. Three sub groups were formed to develop indicators for each of the conditions prioritized: spine fusion; skin grafts; and tissue expander procedures. Coded procedure data and patient demographics were pulled from the existing coding system. ICP’s crossmatched patients who developed infections. A process manual was developed to ensure consistency in procedures and to support personnel. Demographic and surveillance data elements were defined and collected through chart abstraction. The data was entered into a web based program for aggregation and analysis. RESULTS: A network of informed ICP’s resulted who now share best practices across the system. Using a standardized process for surveillance improved the comparability of data and helped identify opportunities to improve speed and effectiveness of corrective/preventative interventions. Use of a system driven process using coded data allowed for improved accuracy of reporting. Data analysis, risk stratification and predictive risk modeling are ongoing. LESSONS LEARNED: The development of consistently reported surveillance across a multi hospital system points out the challenges in using comparative data within the health care industry. Constant attention must be provided to data collection in order to ensure data integrity. The need for common surveillance programs becomes self evident when practice changes are shared and improved outcomes are realized for patients who are at risk for infections. In addition, prevention and risk prediction is possible when using common nomenclature and surveillance techniques.
E153
Publication Number 21-187
Withdrawn
Publication Number 21-188
Nosocomial Infection Surveillance in a Colombian Neonatal Intensive Care Unit GA Contreras, MD1,2 AL Leal, MD, MSc1,2 R Prieto, MD3 AL Hermida3 1
Medical Microbiology, Nacional University, Bogota´, Colombia Infection Control, Clinica San Pedro Claver, Bogota´, Colombia 3 Neonatology, Clinica San Pedro Claver, Bogota´, Colombia 2
BACKGROUND/OBJECTIVES: Nosocomial Infections are a major problem at the Neonatal Intensive Care Unit (NICU) in developing countries. Surveillance is considered one the most important measures to control and reduce the rates of infections on the hospital settings. The objective of this study was to describe the epidemiology of Nosocomial Infections in the NICU at the Hospital San Pedro Claver in Bogota´ – Colombia. METHODS: A prospective Nosocomial Infection Surveillance was performed in the NICU during 10 months; from February through November 2005. Centers for Disease Control and Prevention criteria were used as standard definitions for Nosocomial Infection. Birth weight was stratified into four categories. Patient days, device days and device utilization rates were calculated with NNIS (National Nosocomial Infections Surveillance) methods for each of 4 birth-weight categories. These rates were compared with the high-risk nursery surveillance component of the annual report of the NNIS of October 2004. RESULTS: 141 neonates were included during the surveillance. Thirty six neonates developed 39 infections. The accumulative rate of Nosocomial Infection was 1.3 per 100 patients at risk. Bacteremia (56.4%), clinical sepsis (17.9%) pneumonia (17.9%), necrotizing enterocolitis (5.1%) and meningitis (2.5%) were the most common infections. Gram-positive bacteria were the most commonly isolated germs (77%), with coagulase-negative Staphylococcus (50%) being the main pathogen. Results for device utilization and device-associated infections are shown in Table 1. CONCLUSIONS: Device utilization and device-associated Nosocomial infection rates in our institution are higher compared with those of NICUs participating in the NNIS. For this reason, the use of appropriate infection control measures will be a successful strategy to reduce the infection rates.
Table 1 Birth weight Category ,1000 1001-1500 1501-2500 .2500
Patient-days
Central line days
Central line associated BSI
Central line utilization ratio
Percentile (%){
Central line associated BSI rate
Percentile (%){
329 759 988 480
252 681 423 110
2 10 6 2
0.76 0.89 0.42 0.22
.90 .90 .90 50-75
7.9 14.6 14.1 18.1
25-50 .90 .90 .90
E154
Vol. 34 No. 5
Birth weight category ,1000 1001-1500 1501-2500 .2500
Patient-days
Ventilator days
Ventilator associated pneumonia
Ventilator utilization rate
Percentile (%){
Ventilator associated pneumonia rate
Percentile (%){
329 759 988 480
74 96 53 22
1 2 0 0
0.22 0.12 0.05 0.04
10 25-35 25 10
1.3 20.8 0 0
10-25 .90 10 10
BSI 5 Bloodstream infection. { Centile position of our unit.
Publication Number 21-189
Standardization of Data Collection and Reporting Methods for Infection Control (IC) Surveillance of Targeted, High Risk Procedures Via a Web Based Format in a 22 Hospital System Leads to the Development of a Model Process PL Bush, RN, MS, CHE2 DA Blumberg, MD3 JM Weber, RN, BSN, CIC4 DE Lighter, MD1 TA Trottier, RN, BSN1 1
Medical Affairs, Shriners Hospitals for Children-Corporate Headquarters, Tampa, FL, USA Clinical Transformation, Perot Systems, Plano, TX, USA 3 Pediatrics, UC Davis Medical Center, Sacramento, CA, USA 4 Infection Control, Shriners Hospitals for Children-Boston, Boston, MA, USA 2
ISSUE: IC reporting of surgical site infections (SSI) at the system level was revealing no useful prevention/ interventional information for performance improvement. Rates were reported for all surgical sites, but were not stratified by procedure. A new system that promoted procedure specific reporting was needed to allow accurate representation of SSI rates and to facilitate detection and prevention opportunities. PROJECT: A national IC Practitioner (ICP) work group was deployed to revise the processes for surveillance. A review of historical data to identify high volume, problem prone, high risk, high cost and patient outcome related conditions was conducted. Three sub groups were formed to develop indicators for each of the conditions prioritized: spine fusion; skin grafts; and tissue expander procedures. Coded procedure data and patient demographics were pulled from the existing coding system. ICP’s crossmatched patients who developed infections. A process manual was developed to ensure consistency in procedures and to support personnel. Demographic and surveillance data elements were defined and collected through chart abstraction. The data was entered into a web based program for aggregation and analysis. RESULTS: A network of informed ICP’s resulted who now share best practices across the system. Using a standardized process for surveillance improved the comparability of data and helped identify opportunities to improve speed and effectiveness of corrective/preventative interventions. Use of a system driven process using coded data allowed for improved accuracy of reporting. Data analysis, risk stratification and predictive risk modeling are ongoing. LESSONS LEARNED: The development of consistently reported surveillance across a multi hospital system points out the challenges in using comparative data within the health care industry. Constant attention must be provided to data collection in order to ensure data integrity. The need for common surveillance programs becomes self evident when practice changes are shared and improved outcomes are realized for patients who are at risk for infections. In addition, prevention and risk prediction is possible when using common nomenclature and surveillance techniques.