NICU ProvidenceKoice

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NICU ProvidenceKoice

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1995-00 Admissions , Total Deaths. Nosocomial infections. Results ... More Total Parenteral Nutrition (TPN) in first days. Better use of TPN. Hand washing ... – PowerPoint PPT presentation

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Title: NICU ProvidenceKoice

1
Reduction in rate of nosocomial infection in the
NICU
Peter Krcho, MD, PhD Providence-Koice Partnership
2
Goals...

NI in NICU specific problem
NI in NICU NI in PICU
Sources of infection
What could be done with the same equipment
What we need for the future

3
We would like

ò Nosocomial infection
ò Mortality
ò Morbidity
ò Antibiotics
é TPN then ò TPN
é Number of patients
é More experiences for team
é Regionalization

4
1995-00 Admissions , Total Deaths
5
Nosocomial infections
6
Results - 1995-00 Used ATB
453
297
7
ATB per newborn (average)
8
How did we achieve these results?

Early resuscitation
Surfactant treatment
Appropriate management of the PDA - indomethacin,
bedside ultrasound
Short inspiration times, higher RR
We changed ATB policies
More catheters
More discussion/collaboration

http//www.aiha.com/English/partners/kosice/chart.
htm
9
Surfactant
10
How did we achieve these results?

More blood cultures
BACTEC
In severe infections exchange transfusions
(arterial and venous)
As soon as possible we stop ATB
More Total Parenteral Nutrition (TPN) in first
days
Better use of TPN
Hand washing

http//www.aiha.com/English/partners/kosice/chart.
htm
11
Early surfactant (26w-710g)
12
Longer UPV More nosocomial infection
13
Exchange transfusion Still necessary...
14
Just 16 hours after...
15
No other serious problems...
Going home at 3 m- 2430g
16
Exchange transfusions (artery vein)

When to release?
Necessary volume to exchange (80-160ml)?
How to continue the ATB treatment?
Give or not to give IVIG after exchange?
Multicentric randomised study needed...

17
Learning from Our Mistakes

Excess volume, FFP, IG. (50-60/kg)
Excess, frequent ATB changes
Insufficient skills for arterial access
Destruction of the peripheral veins, insufficient
venous access
Negative blood cultures when to take
Not enough surfactant and late...later extubation
more CLD
Equipment increase of NI with more changes!

18
General ideas...

Maximal control from the start
Right intervention at the right time (ASAP)
Surfactant ASAP, Indocin IV, Blood culture
always, precise volume management
LATER
Less is sometimes more (volume, caloric input )

19
How did we achieve these results?

If caloric input is just enough we stop PN ASAP
because of high nosocomial infection rate
Improving infection control
More seminars for other hospitals
PCs could save time for other work
Internet access Cochrane Library

http//www.aiha.com/English/partners/kosice/chart.
htm
20
We would like to continue...

E-mail communications
Videoconferences
Grant writing - participation in multicentric
trials database
Team building

http//www.aiha.com/English/partners/kosice/chart.
htm
21
Needs...

NICU need for neonatal professionals
Medical supplies and equipment IV, ventilation
tubes, humidifiers, HANDS not only
More effort for the right diagnosis
More skills, more Surfactant, better transport,
more equipment-concentration, regionalisation IU
.