Background and aims Infection is one of the major causes of mortality and morbidity amongst preterm babies in neonatal intensive care units (NICUs). Preterm babies have immature immune systems, poor skin integrity and have repeated invasive procedures making them vulnerable to blood stream infections. Hand hygiene, low nurse: patient ratios, environmental colonisation (especially of water systems) and injudicious use of antibiotics, all contribute to infection in preterm babies.
The NICU at Homerton University Hospital, is a large tertiary level unit serving a high-risk population. In October 2005, we discussed the Epic Guidelines and introduced a number of infection care bundles with the aim to reduce the number of positive blood cultures.
Method From 2005 to 2007, we adapted the adult visual inspection score (VIP) for peripheral IV cannulae. From 2008 to 2010 the care bundles included dedicated cleaned trollies with sterile packs for insertion of intravenous cannulas, blood cultures and obtaining blood samples from arterial lines and we used a closed system of suctioning and closed system to sample arterial blood. We used sterile cotton wool for taking blood from heel prick. In May 2010 we introduced 0.5% chlorhexidine for all sterile procedures and a separate thermometer for each cot. Throughout the 5 years we carried out education, training sessions and audit on aseptic techniques.
Here, we compared the rate of positive blood cultures before and after the introduction of measures infection care bundles.
Results Data on the number of blood cultures and the percentage that were positive during the calendar years 2007–2012 are shown in the Table.
The number of blood cultures performed during the 6 year period increased as a result of increased activity during that period (data not shown). After the introduction of the care bundles, the rate of positive blood cultures halved and was maintained at the lower level. There number of blood cultures positive for coagulase negative staphylococcus, Staphylococcus aureus and E coli was halved. There was no change in the number of positive blood cultures for GBS and pseudomonas infection.
Conclusions Introduction of infection care bundles following the Epic Guidelines involved a change in culture in the Neonatal unit. The most important changes that resulted in a reduction of CONS were the introduction of sterile packs on disinfected trollies and the use of 0.5% chlorhexidine. Previous studies have shown that introduction of care bundles to reduce positive blood culture or blood stream infection were not sustainable. We have shown that introduction of infection care bundles and sustained education and training can result in a persistent reduction in blood stream positive blood cultures.