Abstract

Objective: Healthcare related infections (HCRI) are important causes of morbidity and mortality in neonatal intensive care units (NICUs). The aim of this study was to evaluate HCRI and related factors in the ICU over a six-year period.

Material and Methods: The study was conducted in the NICU between 1 January 2013 and 31 December 2018. NICU-derived HCRI was evaluated retrospectively. The NICU was followed by daily active surveillance. HCRI was diagnosed according to the Center for Disease Control (CDC) criteria. The number of inpatients, patient days, HCRI, invasive device use and pathogens were evaluated.

Results: A total of 2196 patients, 33652 patient days, 4157 ventilator days, 3343 umbilical catheter days, 5210 central venous catheter days,  and  92  urinary  catheter  days  were  observed.  The  HCRI  rate  was  4.78%  (105/2196)  and  the  incidence  density  was  3.12‰ (105/33652). When evaluated according to HCRI, 101 (96.1%) bloodstream infections (BSI), two (1,90%) pneumonia, one (0.95%) central nervous system infection and one (0.95%) soft tissue infection were detected. The incidence of HCRI was less (1.02%) in infants older than 2500 grams, whereas it was higher in infants between 751-1000 grams (23.95%) (p <0.001). According to the distribution of bacteria, 59.0% (62/105) of them were from gram-negative bacteria (GNB) and 41.0% (43/105) of them were from gram-positive bacteria (GPB). Commonly isolated GNBs were Klebsiella spp. (34.2%) and Enterobacter spp. (12.3%) whereas the most frequently isolated GPBs were Staphylococci (37.0%). When invasive devices-related infection rates were evaluated; The central venous catheter-related BSI rate was 0.95‰, and the umbilical catheter-related BSI rate was 2.09‰.

Conclusion: The most common HCRI was BSI in our hospital. Invasive procedures and low birth weight were the factors that increased the risk of infection. The incidence of HCRI was inversely related to birth weight. It was thought that more sensitive infection control measures were needed in low birth weight infants.

Keywords: Healthcare-associated ınfections, use of invasive devices

References

  1. Kumar S, Shankar B, Arya S, Deb M, Chellani H. Healthcare associated infections in neonatal intensive care unit and its correlation with environmental surveillance. Journal of Infection and Public Health 2018;11:275–9.
  2. Chen YC, Lin CF, Rehn YJF, Chen JC, Chen PC, Chen CH, et al. Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period. J Chin Med Assoc 2017;80:e427-31.
  3. Mohammed D, El Seifi SO. Bacterial nosocomial infections in neonatal intensive care unit, Zagazig University Hospital Egypt. Egyptian Pediatric Association Gazette 2014;62:72–79.
  4. Bowen JR, Callander I, Richards R, Lindrea KB. Decreasing infection in neonatal intensive care units through quality improvement. Arch Dis Child Fetal Neonatal Ed 2017;102:F51–F57.
  5. Djordjevic ZM, Markovic-Denic L, Folic MM, Igrutinovic Z, Jankovic SM. Healthcare Acquired infections in neonatal intensive care units: Risk factors and etiology. Am J Infect Control 2015;43:86-8.
  6. Sultan AM, Seliem WA. Identifying Risk Factors for Healthcare-Associated Infections Caused by Carbapenem-Resistant Acinetobacter baumannii in a Neonatal Intensive Care Unit.Sultan Qaboos Univ Med J 2018;18:e75-e80.
  7. Parlak E, Kahveci H, Alay HK. Yenidoğan Yoğun Bakım Ünitesindeki Hastane Enfeksiyonları. Güncel Pediatri 2014;1:1-8.
  8. Sadeghi-Moghaddam S, Arjmandnia M, Shokrollahi M, Aghaali M. Does training improve compliance with hand hygiene and decrease infections in the neonatal intensive care unit? A prospective study. J Neonatal Perinatal Med 2015;8:221–5.
  9. Huang YC. Device-associated Healthcare-associated Infections in the Neonatal Intensive Care Unit. Pediatr Neonatol 2013;54:e293-4.
  10. Garcia H, Torres-Gutierrez J, Peregrino-Bejarano L, Cruz-Castaneda MA. Risk factors for nosocomial infection in a level III. Gac Med Mex 2015;151:660-8.
  11. Dramowski A, Madide A, Bekker A. Neonatal nosocomial bloodstream infections at a referral hospital in a middle-income country: burden, pathogens, antimicrobial resistance and mortality. Paediatr Int Child Health 2015;35:265-72.
  12. https://dosyaism.saglik.gov.tr/Eklenti/15719,ulusal-saglik-hizmeti-ilişkili-enf-sürveyans-rehberipdf.pdf?0, ET: 06.07.2019, 20:06
  13. Satar M, Arısoy AE, Çelik İH. Turkish Neonatal Society guideline on neonatal infections-diagnosis and treatment. Turk Pediatri Ars2018; 25;53 (Suppl 1):S88-S100.
  14. Mobley RE, Bizzarro MJ. Central line-associated bloodstream infections in the NICU: Successes and controversies in the quest for zero.Seminars in Perinatology 2017;41:166-74.
  15. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics2002;110:285-91.
  16. Stoll BJ, Gordon T, Korones SB, Shankaran S, Tyson JE, Bauer CR, et al. Early-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr 1996;129:72-80.
  17. Pogorzelska-Maziarz M, The Use and Effectiveness of Bundles for Prevention of Central Line-Associated Bloodstream Infections in Neonates: A Review of the Literature. J Perinat Neonatal Nurs2016;30:148-59.
  18. Balaban I, Tanır G, Timur OM, Oz FN, Teke TA, Bayhan GI, et al. Nosocomial Infections in the General Pediatric Wards of a Hospital in Turkey, Jpn. J Infect Dis 2012; 65:318-21.
  19. Mai JY, Dong L, Lin ZL, Chen SQ. Investigation and analysis of nosocomial infection in neonates. Zhonghua Er Ke Za Zhi.2011;49:915-20.
  20. Maoulainine FM, Elidrissi NS, Chkil G, Abba F, Soraa N, Chabaa L, et al. Epidemiology of nosocomial bacterial infection in a neonatal intensive care unit in Morocco. Arch Pediatr 2014;21:938-43.
  21. Tseng YC, Chiu YC, Wang JH, Lin HC, Lin HC, Su BH, et al. Nosocomial bloodstream infection in a neonatal intensive care unit of a medical center: a three-year review. J Microbiol Immunol Infect. 2002;35:168-72.
  22. Dowey LC, Smith PB, Benjamin DK Jr. Risk factors and prevention of late-onset sepsis in premature infants. Early Hum Dev 2010;86 Suppl 1:7-12.

Copyright and license

Copyright © 2021 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Karabay M, Kaya G, Güçlü E, Öğütlü A, Karabay M, Caner İ. Healthcare-associated ınfections in the neonatal intensive care unit: Review of the last 6 years. Turk J Pediatr Dis [Internet]. 2021 Mar. 30 [cited 2025 Aug. 23];15(2):87-92. Available from: https://turkjpediatrdis.org/article/view/798