NICU. Hospital Dona Estefânia. Centro Hospitalar de Lisboa Central EPE, Faculdade de Ciências Médicas, UNL
- Neonatal Infection I. Parallel Session. 3rd International Congress of UENPS – 2012. Porto 14-17/11 (Palestra).
Nosocomial infections are a major problem in neonatal intensive care units. They are responsible for increased morbidity worsening previous respiratory and CNS conditions.
They account for increased mortality rates, length of stay and antibiotics use. Nosocomial infection rates vary among NICU and are influenced by care practices. Blaming patients because they are ELBW accepting nosocomial infection as a "normal occurrence" does not fit because some NICUs have better results than others. It is everyone´s duty to eliminate hospital-acquired infection in the NICU. To decrease HCAI information on the basal rates of infection is needed. This is obtained through a prospective surveillance program. The next step is to promote the change implementing evidence-based PBP and after to audit, to check results of the new practices.
Surveillance may be done based on a sentinel event. This identifies the most severe and rare events; has no denominator; identifies failure in the security system. The best way to do surveillance is based on the population, studying patients with similar risks. This studies require a nominator – affected patients – and a denominator – patients at risk or days at risk. Prevalence studies take a one day photo. Identify the number of cases in that day. They are used to measure the importance of an illness in a population in order to define the needs of health care, to compare the prevalence of an illness between two or more groups of people and to evaluate trends – frequency, severity – over time. Incidence studies identify new cases in a defined period of time and give knowledge on the endemic rate of infection. The denominator is the people at risk. Objectives of the surveillance program should be clear, well defined and feasible; they should be reviewed and up dated periodically because patients, pathology, risks and interventions, change over time. The surveillance programme should be part of a prevention strategy. In order to know the endemic rate of infection ratios and events that should be under surveillance have to be chosen: septicaemia, CVC-related bloodstream infection, pneumonia, tracheal tube-related pneumonia, UTI. The surveillance system has to be evaluated on its rigor, effectiveness and economics impact. In order to reduce the rate of infection the entire staff has to be empowered to encourage maximal compliance with infection control practices.
Conclusions: A surveillance system should have clear objectives, to be programmed according to local reality and be joined to a prevention programme. Although its main objective be to reduce the risk of infection, its main value is due to the knowledge of basal rate of infection. To diagnose, to quantify, to change to improve, and to evaluate results of change, is the big challenge.
Key-words: control of infection, HCAI, surveillance systems.