Effect of camera monitoring and feedback along with training on hospital infection rate in a neonatal intensive care unit

Meltem Karabay, Gulsum Kaya, Taner Hafizoglu, Oguz Karabay, Meltem Karabay, Gulsum Kaya, Taner Hafizoglu, Oguz Karabay

Abstract

Background: In terms of pediatric healthcare-associated infections (HAI), neonatal intensive care units (NICU) constitute the greatest risk. Contacting a health care personnel, either directly or indirectly, elevates NICU occurrence rate and risks other infants in the same unit. In this study, it is aimed to retrospectively analyze the effect of the training along with camera monitoring and feedback (CMAF) to control the infection following a small outbreak.

Methods: ESBL producing Klebsiella pneumoniae was detected on three infants in May 2014 at the isolation room of Sakarya University Hospital NICU. Precautions were taken to prevent further spread of the infection. The infected infants were isolated and the decolonization process was initiated. For this aspect, health care workers (HCWs) in NICU were trained for infection control measures. An infection control committee has monitored the HCWs. Before monitoring, an approval was obtained from the hospital management and HCWs were informed about the CMAF, who were then periodically updated. On a weekly basis, NICU workers were provided with the feedbacks. Epidemic period and post-epidemic control period (June-July-August 2014) were evaluated and p value < 0.05 was considered statistically significant.

Results: Healthcare-associated infection (HAI) density was 9.59% before the onset of the CMAF, whereas it was detected as 2.24% during the CMAF period (p < 0.05). Following the precautions, HAI and HAI density rates have reduced to 76.6% and 74.85%, respectively. Moreover, hand hygiene compliance of health care workers was found 49.0% before the outbreak, whereas this rate has elevated to 62.7% after CMAF.

Conclusions: Healthcare workers should be monitored in order to increase their compliance for infection control measures. Here, we emphasized that that CMAF of health workers may contribute reducing the HAI rate in the NICU.

Keywords: Camera monitoring and feedback; Healthcare-associated infections; Neonatal; Training.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Hand hygiene compliance before and after the camera observation
Fig. 2
Fig. 2
Hand hygiene compliance according to five indication rules before and after the camera observation

References

    1. Collins A, Weitkamp J-H, Wynn JL. Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed. 2018;103:F391–F394. doi: 10.1136/archdischild-2017-313595.
    1. Whittaker E, Goldblatt D, McIntyre P, Levy O. Neonatal immunization: rationale, current state, and future prospects. Front Immunol. 2018;9:532. doi: 10.3389/fimmu.2018.00532.
    1. Nzegwu NI, Rychalsky MR, Nallu LA, Song X, Deng Y, Natusch AM, et al. Implementation of an antimicrobial stewardship program in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2017 doi: 10.1017/ice.2017.151.
    1. Rastogi V, Nirwan PS, Jain S, Kapil A. Nosocomial outbreak of septicaemia in neonatal intensive care unit due to extended spectrum β-lactamase producing Klebsiella pneumoniae showing multiple mechanisms of drug resistance. Indian J Med Microbiol. 2010 doi: 10.4103/0255-0857.71834.
    1. Mavroidi A, Liakopoulos A, Gounaris A, Goudesidou M, Gaitana K, Miriagou V, et al. Successful control of a neonatal outbreak caused mainly by ST20 multidrug-resistant SHV-5-producing Klebsiella pneumoniae, Greece. BMC Pediatr. 2014;14:105. doi: 10.1186/1471-2431-14-105.
    1. Bizzarro MJ. Health care-associated infections in the neonatal intensive care unit: barriers to continued success. Semin Perinatol. 2012;36:437–444. doi: 10.1053/j.semperi.2012.06.006.
    1. Suwantarat N, Logan LK, Carroll KC, Bonomo RA, Simner PJ, Rudin SD, et al. The prevalence and molecular epidemiology of multidrug-resistant enterobacteriaceae colonization in a pediatric intensive care unit. Infect Control Hosp Epidemiol. 2016 doi: 10.1017/ice.2016.16.
    1. Hartz LE, Bradshaw W, Brandon DH. Potential NICU environmental influences on the neonateʼs microbiome. Adv Neonatal Care. 2015 doi: 10.1097/anc.0000000000000220.
    1. Decembrino L, Maini A, Decembrino N, Maggi I, Lacerenza S. Management of outbreaks in neonatal intensive care units. Early Hum Dev. 2014 doi: 10.1016/s0378-3782(14)70018-0.
    1. Johnson J, Quach C. Outbreaks in the neonatal ICU: a review of the literature. Curr Opin Infect Dis. 2017;30:395–403. doi: 10.1097/QCO.0000000000000383.
    1. Ortegón L, Puentes-Herrera M, Corrales IF, Cortés JA. Colonization and infection in the newborn infant: does chlorhexidine play a role in infection prevention? Arch Argent Pediatr. 2017;115:65–70.
    1. Sumer S, Dagi HT, Findik D, Arslan U, Demir NA, Ural O, et al. Two outbreaks of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit. Pediatr Int. 2014 doi: 10.1111/ped.12234.
    1. Dashti AA, Jadaon MM, Gomaa HH, Noronha B, Udo EE. Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital. J Med Microbiol. 2010;59:687–692. doi: 10.1099/jmm.0.019208-0.
    1. Fernández-Prada M, Martínez-Ortega C, Santos-Simarro G, Morán-Álvarez P, Fernández-Verdugo A, Costa-Romero M. Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: Risk factors and key preventive measures for eradication in record time. Anales de Pediatría (Engl Ed). 2019 doi: 10.1016/j.anpede.2018.11.002.
    1. Tamma PD, Savard P, Pál T, Sonnevend Á, Perl TM, Milstone AM. An outbreak of extended-spectrum β-lactamase—producing Klebsiella pneumoniae in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2012 doi: 10.1086/665715.
    1. Pittet D, Boyce JM, Allegranzi B. Hand hygiene: a handbook for medical professionals. Hoboken: Wiley; 2017.
    1. Armellino D, Hussain E, Schilling ME, Senicola W, Eichorn A, Dlugacz Y, et al. Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis. 2012;54:1–7. doi: 10.1093/cid/cir773.
    1. Overdyk FJ, Dowling O, Newman S, Glatt D, Chester M, Armellino D, et al. Remote video auditing with real-time feedback in an academic surgical suite improves safety and efficiency metrics: a cluster randomised study. BMJ Qual Saf. 2016;25:947–953. doi: 10.1136/bmjqs-2015-004226.
    1. Karaaslan A, Kadayifci EK, Atıcı S, Sili U, Soysal A, Çulha G, et al. Compliance of healthcare workers with hand hygiene practices in neonatal and pediatric intensive care units: overt observation. Interdiscip Perspect Infect Dis. 2014 doi: 10.1155/2014/306478.
    1. Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, et al. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol. 2014 doi: 10.1086/677145.

Source: PubMed

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