[Five steps to decreasing nosocomial infections in large immature premature infants: A quasi-experimental study]

Abstract

Objectives: An evaluation is made of the impact of a series of five interventions on the incidence of hospital-related infections in a level iii neonatal unit.

Material and methods: Quasi-experimental, pre-post intervention study, which included preterm infants weighing 1,500g at birth or delivered at <32 weeks gestation, admitted in the 12 months before and after the measures were implemented (January 2014). The measures consisted of: optimising hand washing, following a protocol for insertion and handling of central intravenous catheters, encouraging breastfeeding; applying a protocol for rational antibiotic use, and establishing a surveillance system for multi-resistant bacteria. The primary endpoint was to assess the incidence of hospital-acquired infections before and after implementing the interventions.

Results: Thirty-three matched patients were included in each period. There was an incidence of 8.7 and 2.7 hospital-related infections/1,000 hospital stay days in the pre- and post-intervention periods, respectively (P<.05). Additionally, patients in the treatment group showed a statistically-significant decrease in days on mechanical ventilation, use of blood products, and vasoactive drugs.

Conclusions: The strategy, based on implementing five specific measures in a unit with a high rate of hospital-related infections, proved effective in reducing their incidence. This reduction could contribute to lowering the use of mechanical ventilation, blood products, and vasoactive drugs.

Keywords: Breastfeeding; Catheter-associated infections; Estrategias para disminuir las infecciones; Infecciones asociadas a catéter; Infección relacionada con la asistencia sanitaria; Lactancia materna; Neonato prematuro; Nosocomial infection; Preterm neonate; Strategies to reduce infections.