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Reduction in rate of nosocomial infection in the NICU

Reduction in rate of nosocomial infection in the NICU. Peter Krcho, MD, PhD Providence-Košice Partnership. Goals. NI in NICU – specific problem NI in NICU = NI in PICU Sources of infection What could be done with the same equipment What we need for the future. We would like.

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Reduction in rate of nosocomial infection in the NICU

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  1. Reduction in rate of nosocomial infection in the NICU Peter Krcho, MD, PhD Providence-Košice Partnership

  2. Goals... • NI in NICU – specific problem NI in NICU = NI in PICU • Sources of infection • What could be done with the same equipment • What we need for the future

  3. We would like • ò Nosocomial infection • ò Mortality • ò Morbidity • ò Antibiotics • é TPN then ò TPN • é Number of patients • é More experiences for team • é Regionalization

  4. 1995-00 Admissions , Total Deaths

  5. Nosocomial infections

  6. Results - 1995-00 Used ATB 453 297

  7. ATB per newborn (average)

  8. How did we achieve these results? • Early resuscitation • Surfactant treatment • Appropriate management of the PDA - indomethacin, bedside ultrasound • Short inspiration times, higher RR • We changed ATB policies • More catheters • More discussion/collaboration http://www.aiha.com/English/partners/kosice/chart.htm

  9. Surfactant

  10. How did we achieve these results? • More blood cultures • BACTEC • In severe infections exchange transfusions (arterial and venous) • As soon as possible we stop ATB • More Total Parenteral Nutrition (TPN) in first days • Better use of TPN • Hand washing http://www.aiha.com/English/partners/kosice/chart.htm

  11. Early surfactant (26w-710g)

  12. Longer UPV – More nosocomial infection

  13. Exchange transfusion: Still necessary...

  14. Just 16 hours after...

  15. No other serious problems... Going home at 3 m- 2430g

  16. Exchange transfusions (artery & vein) • When to release? • Necessary volume to exchange (80-160ml)? • How to continue the ATB treatment? • Give or not to give IVIG after exchange? • Multicentric randomised study needed...

  17. Learning from Our Mistakes: • Excess volume, FFP, IG. (50-60/kg) • Excess, frequent ATB changes • Insufficient skills for arterial access • Destruction of the peripheral veins, insufficient venous access • Negative blood cultures – when to take • Not enough surfactant and late...later extubation more CLD • Equipment – increase of NI with more changes!

  18. General ideas... • Maximal control from the start • Right intervention at the right time (ASAP) • Surfactant ASAP, Indocin IV, Blood culture always, precise volume management • LATER • Less is sometimes more (volume, caloric input )

  19. How did we achieve these results? • If caloric input is just enough we stop PN ASAP because of high nosocomial infection rate • Improving infection control • More seminars for other hospitals • PC’s could save time for other work • Internet access – Cochrane Library http://www.aiha.com/English/partners/kosice/chart.htm

  20. We would like to continue... • E-mail communications • Videoconferences • Grant writing - participation in multicentric trials – database • Team building http://www.aiha.com/English/partners/kosice/chart.htm

  21. Needs... • NICU – need for neonatal professionals • Medical supplies and equipment: IV, ventilation tubes, humidifiers, HANDS not only • More effort for the right diagnosis • More skills, more Surfactant, better transport, more equipment-concentration, regionalisation IU .

  22. BW 540g

  23. About us in www...

  24. Resources from the www... • www.google.com • Nosocomial Infections in Newborn • Open Medical Club • www.neonatology.sk under construction

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