Changes in skin disinfection, nontouch policies reduce neonatal infections

A series of interventions, such as skin disinfection standards and nontouch techniques, decreased the rate of late-onset sepsis and central line-associated bloodstream infections among neonates, according to research in Pediatric Infectious Disease Journal.

“This study has demonstrated a substantial reduction in late-onset sepsis rates and central line-associated bloodstream infection [CLABSI] rates and identified interventions that were significantly associated with the reduction in these rates,” Ajay K. Sinha, MBBS, FRCPCH, MD, honorary senior lecturer of neonatal medicine at Barts Health NHS Trust, London, and colleagues wrote. “A multifaceted approach involving changes in antimicrobial and skin disinfection policy, training for aseptic nontouch technique and surveillance resulted in sustained reduction.”

Sinha and colleagues retrospectively studied the impact of numerous disinfection and quality control interventions implemented on babies born at less than 32 weeks gestation at a neonatal ICU (NICU) from January 2007 through December 2012. The interventions were hospitalwide and NICU-specific, including monthly audits of peripheral cannula site insertion and other care practices, hand hygiene, skin disinfection, training in aseptic nontouch technique and a new NICU building. Other changes included switching from intermittent doses of vancomycin in patients with suspected late-onset sepsis to continuous vancomycin use.

Study results showed significant reduction in late-onset sepsis and CLABSI. Cases of late-onset sepsis decreased from 26.1 to 2.9 per 1,000 intensive care high dependency days, while CLABSI decreased from 31.6 to 4.3 per 1,000 catheter days.

The researchers said the interventions responsible for this reduction were the introduction of a nurse specializing in vascular devices, a switch in vancomycin administration practices, standardization of disinfection policy and implementation of a venous infusion phlebitis scoring system. These resulted in a decrease of 55% (95% CI, 40%-74%) for late-onset sepsis and a 45% reduction (95% CI, 33%-61%) in CLABSI compared with pre-intervention levels. Aseptic nontouch technique also was associated with a reduction in CLABSI.

“This study has identified interventions such as changes to skin disinfectants, antimicrobial administration through a central catheter, aseptic nontouch technique training and regular surveillance should be further investigated as a part of randomized controlled trials or included in care bundles interventions,” Sinha wrote. “The findings from this study could be useful to inform design of future studies.” – by David Costill


Disclosure: The researchers report no relevant financial disclosures.

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