Effect of neonatal intensive care unit environment on the incidence of hospital-acquired infection in neonates
Introduction
Critically ill infants receiving care in neonatal intensive care units (NICUs) are at increased risk of hospital-acquired infection (HAI) due to immunological immaturity and a host of invasive diagnostic and therapeutic procedures.1 Coagulase-negative staphylococci and Staphylococcus aureus are the main cause of sepsis in NICUs, including outbreaks, and are associated with a significant increase in morbidity, mortality, length of stay and cost.2, 3
The inanimate hospital environment is thought to contribute only negligibly towards endemic nosocomial infections.4 Despite major environmental differences between old and new hospitals, the incidence of nosocomial infection in patients remains unchanged.5
Understaffing, overcrowding and poor access to sinks have been linked to HAI in NICU patients. Relocation of a NICU to a better-staffed facility with more space, more sinks and more isolation facilities was associated with a decrease in the infection rate.6 Conversely, moving from a crowded 18-bed unit to a new, larger 32-bed unit was not accompanied by a reduction in HAI.7
Regulatory and professional bodies have issued guidelines for nursery design in terms of adequate space for the infant, equipment and number of sinks.8 Increased rates of infection have been associated with facilities that cannot provide care in an organized manner and lack adequate space for equipment, sinks and isolation rooms to house infants with transmissible infections.7
The aim of the present study was to evaluate the impact of the NICU built environment on the risk of HAI by surveillance during a four-year period, in which the NICU was moved from an old building to a temporary unit and finally to a new and better-designed unit in the absence of a change in staffing.
Section snippets
Methods
The study was conducted in the NICU of the Uberlândia University Hospital. The new unit has 10 beds, rated level 3, and admits an average of 400 infants each year.
From January to September 2003 the unit was refurbished and the design of the new facility was much more conducive to good infection control practices. Surveillance was performed over three different periods: (A) in the original facilities between January 2001 and December 2002; (B) in temporary accommodation from January to September
Results
The original (period A) and temporary (period B) units had smaller floor areas than the new (period C) unit with archaic ventilation systems, whereas the new unit had more space and central air conditioning. The average of admissions per month was highest (38 per month) in period B compared to 33 and 30 per month in periods A (P = 0.00002) and C (P = 0.0002) respectively. Though the number of nurses (N = 5) and cots (N = 10) remained the same throughout all periods, the ratio of NICU nurses to number
Discussion
During the past decade, advances in intensive care have facilitated survival of critically ill neonates that might well have died in the past. However, nosocomial infection remains a major problem in NICUs.6 There are few articles on the impact of the built environment on nosocomial infections.3, 4, 5, 6, 7 Maki et al. found no difference in the rate of nosocomial infections in an old hospital compared with a new hospital facility.5 Another report demonstrated that a new NICU with improved
Acknowledgements
This work was supported by the Brazilian Agency FAPEMIG.
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Cited by (25)
Outbreaks in Health Care Settings
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Reduced nosocomial infection rate in a neonatal intensive care unit during a 4-year surveillance period
2017, Journal of the Chinese Medical AssociationCitation Excerpt :In spite of the use of various infection control strategies such as prophylactic antibiotics, immunoglobulins, and physical barriers,4 the prevalence of nosocomial infections in NICUs still remains high. For several decades, there has been controversy over whether or not the inanimate environment of a NICU is associated with the risk of nosocomial infection, but there have been scant few studies on this issue.6,8–11 Furthermore, the Institute for Healthcare Improvement recently developed the concept of “bundles” to help health care providers more reliably deliver the best possible care for patients undergoing particular treatments with inherent risks.12–15
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ISBI Practice Guidelines for Burn Care
2016, BurnsLate onset sepsis in newborn babies: Epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit
2015, Brazilian Journal of Infectious DiseasesCitation Excerpt :It should also be pointed out the decrease of infection rates observed in this study when the unit was transferred to an improvised area, probably because of more isolation facilities, more space per cot, and enforcement of hand washing compliance during in that temporary place. These aspects have also been shown in other studies with impact on infection rates.18,19 Despite some unexpected events during the study period, we could demonstrate an important reduction in LOS rate among the neonates after a sustained effort in February 2012 that were maintained at lower rates over five months, probably due the implementation of the bundle.
Nosocomial infections caused by Staphylococcus aureus biofilm producer in the neonatal unit of the hospital specialist mother-child of Tlemcen, Algeria
2014, Journal de Pediatrie et de Puericulture