A multi modal approach to reduce bloodstream infections in a large neonatal intensive-care unit

Carmel Scott 1

Infection Control Consultant, Monash Health, Clayton, VIC, Australia
Introduction
The incidence of line related bacteraemias, particularly Enterococcus faecalis bacteraemia over 12months was an issue in a large neonatal intensive care unit. In 2012 the overall line related bacteraemia rate per 1000 device days for all organisms was 2.18( E.faecalis 0.5). 2013 overall rate was 2.2 (E.faecalis 0.24). 2014 overall rate 2.3 (E.faecalis 1.5. )

Method
Whole genome sequencing indicated that the E. faecalis outbreak was not clonal in nature but was due to many strains.
Multi modal measures taken:
• Plastic bags were introduced for soiled nappies in January 2015.
• A standard CVC “bundle” was introduced in 2014 including checklists.
• Larger alcohol swabs were procured for effective hub disinfection combined with an intensive campaign to scrub the hub for 20 secs.
• Routine line changes, previously conducted overnight were changed to daytime.
• Monthly graphs were posted on noticeboard.

Results
Rate per 1000 line days for overall line related bacteraemias in 2015 was 1.1 and E.faecalis was 0.5. Rate not yet available for 2016 but overall 5 line related bacteraemias have occurred including one E.faecalis.

Conclusion
The introduction of plastic bags had a significant effect on reducing E.faecalis infections. Three of five infections in 2015 occurred in late July/August when bags were unavailable. Since supply has been maintained, only one E.faecalis line related infection has occurred. With a multi-modal approach the reduction in all line related bacteraemias has been sustained

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