Methods Investigation of Sepsis among NICU Patients in Egypt

1. Prevention of Sepsis Among Neonates Admitted to Intensive Care Units through Promotion of Infection Control Safe Injection Global Network Meeting in Cambodia, 2002

2. High rates of sepsis among infants in neonatal ICU- mortality rates > 50%- poor response to antibiotic therapy Early onset sepsis- immediately after admission Background: Request for Assistance to Prevent Sepsis among NICU Patients at a University Hospital in Egypt

3. Methods Investigation of Sepsis among NICU Patients in Egypt • Observation of infection control practices • Epidemiology - laboratory-based surveillance for BSI (blood • culture) - culture of IV fluids (opened and unopened) • - culture of medications - monitor mortality

4. Results: Investigation of Sepsis in NICU • Clinical practice • All infants placed on IV fluids and antibiotics • Assessment of Infection control practices • Poor understanding of infection control • Unsafe practices in the preparation of IV fluids • Opened IV fluids: Contaminated (klebsiella predominant) • Unopened IV fluids: no growth • NICU environmental surfaces: Klebsiella predominant • Prospective surveillance • 70% of infants with sepsis (most is early onset) • 55% mortality

5. Investigation of Sepsis in Newborn Nursery Poor infection control practices Contamination of IV fluids Sepsis and death

6. Sample - NICUs throughout the country (n= 36) • Assessment- sepsis and mortality rates-culture of IVF - BSI among patients with clinical sepsis - infection control practices with emphasis on management of IV fluids • Team - laboratory, epidemiologist, neonatologist Rapid Assessment of Sepsis in NICUs

7. Type of facility No. pts. Blood No. % cultures pos IV fluids No. % cultures pos Medications No. % Cultures pos MOE (n=12) 176 63 75% 70 64% 31 23% MOHP(n=24) 180 86 69% 100 64% 25 20% TOTAL 356 149 71% 170 64% 56 21% Results of IV Fluid and Blood Cultures Survey of Rapid Assessment of Sepsis in NICU’s ,Egypt ‘02

8. General - poor understanding of infection control • Preparation of IV fluids - mixing of fluids on ward - poor adherence to aseptic techniques - prolonged usage of individual bags - no assigned nurse or special area for IV preparation - reuse of syringes to prepare IV fluids • Infection control supplies - gloves, syringes, appropriately sized IV fluids Results: Assessment of Infection Control Practices Rapid assessment of Sepsis in NICUs

9. Task analysis on preparation of IV fluids • - SOPs for preparation of IV fluids • Training - 3 days onsite, applied and didactic - follow-up with monthly site visits • Supplies and reagents- distribution of critical infection control materials • Supervision and monitoring • - key indicators Intervention to Prevent Sepsis in NICUs

10. Key Indicators to Monitor Intervention • Infection Control Practices • - observational tool • - score developed for critical • procedures • IV fluid contamination • Admissions, deaths, mortality rates

11. Observation Tool to Monitor Infection Control Practices • Hand washing before procedures • IV fluid mixing and preparation • Medication mixing and preparation • Cannula insertion steps

12. Comparison of Infection Control Practices Related to IV & Medication Preparation before and after Intervention

13. Percentage of IV Fluid Samples Contaminated Post-intervention Pre-intervention

14. Admissions, Deaths and Mortality Rates in 22 NICUs from Dec 01 to Jun 02

15. SummaryBehavior Change Related to Intervention • Improved hand washing • Improved aseptic techniques for • IV fluid mixing and preparation • Medication mixing and preparation • Cannula insertion

16. Summary Promotion of Infection Control • Evidence-based monitoring and evaluation is essential • Applied training is vital • Availability of critical supplies • Promotion of infection control is the key strategy to reduce nosocomial infections • Investment in infection control has great potential to: - reduce disease in patients - lower health care costs