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Successful elimination of extended-spectrum betalactamase(ESBL)-producing nosocomial bacteria at a neonatal intensive care unit 
 
Successful elimination of extended-spectrum betalactamase(ESBL)-producing nosocomial bacteria at a neonatal intensive care unit
  Borb¨¢la Sz¨¦l, Zsolt Reiger, Edit Urb¨¢n, Andrea L¨¢z¨¢r, Krisztina Mader, Ivelina Damjanova, Kamilla Nagy, Gyula T¨¢losi
 [Abstract] [Full Text] [PDF]   Pageviews: 322 Times
 
Background: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates. At our Neonatal Intensive Care Unit (NICU), the presence of these bacteria became so threatening in 2011 that immediate intervention was required.
Methods: This study was conducted during a nearly two-year period consisting of three phases: retrospective (9 months), educational (3 months) and prospective (9 months). Based on retrospective data analysis, a complex management plan was devised involving the introduction of the INSURE protocol, changes to the antibiotic regimen, microbiological screening at short intervals, progressive feeding, a safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients. During these intervals, a total of 355 patients were monitored.
Results: Both ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples). In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients; P=0.029) and infected (3/167 patients; P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients. There was a decrease in the average number of patient days (from 343.72 to 292.44 days per months), though this difference is not significant (P=0.058). During the prospective period, indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day, P<0.001).
Conclusion: Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.
 
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