NICU ProvidenceKoice

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

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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

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1995-00 Admissions , Total Deaths
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Nosocomial infections
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Results - 1995-00 Used ATB
453
297
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ATB per newborn (average)
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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
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Surfactant
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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
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Early surfactant (26w-710g)
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Longer UPV More nosocomial infection
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Exchange transfusion Still necessary...
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Just 16 hours after...
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No other serious problems...
Going home at 3 m- 2430g
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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...

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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!

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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 )

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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
• PCs could save time for other work
• Internet access Cochrane Library

http//www.aiha.com/English/partners/kosice/chart.
htm
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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
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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
  .

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BW 540g
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About us in www...
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Resources from the www...

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