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Prevention of Late Onset Sepsis and Central-line Associated Blood Stream Infection in Preterm Infants

Sinha, Ajay K. MB BS, FRCPCH, MD; Murthy, Vadivelam MB BS, DCH, MRCPCH; Nath, Puneet MB BS, DCH, MRCPCH; Morris, Joan K. PhD; Millar, Mike MB ChB, MA, MD, PhD, FRCPath

The Pediatric Infectious Disease Journal: April 2016 - Volume 35 - Issue 4 - p 401–406
doi: 10.1097/INF.0000000000001019
Original Studies

Aim: Late onset sepsis (LOS) and central-line associated blood stream infection (CLA-BSI) contribute toward the mortality and morbidity in prematurely born infants. The aim of this study is to investigate the effects of hospital-wide and unit-based interventions on LOS and CLA-BSI in infants born at <32 weeks gestation.

Methods: Intensive care, high dependency days and catheter days were obtained from the unit database and blood culture results from a microbiology laboratory database. Poisson regression was used to evaluate the effects of interventions on LOS and CLA-BSI.

Results: Quarterly rates of LOS reduced from 26.1 to 2.9 per 1000 intensive care, high dependency days and CLA-BSI from 31.6 to 4.3 per 1000 catheter days between 2007 and 2012. Appointment of a hospital specialist vascular device nurse, a change in the mode of administration of vancomycin, standardization of the hospital skin and hub disinfection policy and the introduction of a venous infusion phlebitis scoring system were associated with a reduction of LOS to 55% (95% confidence interval: 40–74%) and CLA-BSI 45% (95% confidence interval: 33–61%) of pre-intervention levels. The standardization of the neonatal unit policy for skin disinfection and a move to a new building were associated with reductions of LOS to 64% (47–87%) and 54% (34–88%), respectively, and aseptic no touch technique for infusion access with CLA-BSI to 53% (37–75%) of pre-intervention levels.

Conclusion: A multifaceted approach involving changes in antimicrobial and skin disinfection policy, training for aseptic no touch technique and surveillance resulted in sustained reduction in LOS and CLA-BSI rates.

From the *Neonatal Medicine, Barts Health NHS Trust, London, United Kingdom; Centre for Paediatrics, Blizard Institute, Barts and the London School of Medicine and Dentistry, Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, London, United Kingdom; and §Department of Microbiology, Barts Health NHS Trust, London, United Kingdom.

Accepted for publication October 6, 2015.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Ajay K. Sinha, MB BS, FRCPCH, MD, Neonatal Unit, Ward 8D, Royal London Trust, Whitechapel, London E1 1BB, United Kingdom. E-mail: ajay.sinha@bartshealth.nhs.uk.

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