Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org
Sign in to follow this  
JMGomez

Bundle for reducing bloodstream infection

Recommended Posts

Dear Colleagues,

I am interested in reducing bloodstream infection in the VLBW population in my NICU. Do any of you have bundles that have worked for you and willing to share? Thanks.

Share this post


Link to post
Share on other sites

We use a low dose Fluconazole protocol to reduce systemic fungal infection in VLBW babies less than 1000 gms. Low dose Fluconazole is given for a total of six weeks. The dose is adjusted according to weight q 2 wks. So the dose stays the same for the first 2 weeks, then it's adjusted on the 3rd week and again on the 5th week. We have significantly reduced systemic fungal infctions with this protocol. If the baby does become septic, the infection is treated with a full course of Fluconazole or Abelcet and the protocol is resume subtracting the weeks used for treatment. So if baby becomes infected the start of 3rd week of the protocol and you treat for 2 weeks, then you would resume the protocol at the 5th week. We trialed a type IVIG(Immunoglobulin) as a prophylaxis for bacterial infection but we found no difference in the amount of infections. So, presently we do not have a protocol for prevention bacteria sepsis.

Share this post


Link to post
Share on other sites

We reduced fungus infection in VLBW using this protocol: premature baby less than 1.250 g with three of these situation, not doing well, prolonged parenteral nutrition with more than 3 g of fat, prolonged mechanical ventilation, cephalosporin of third generation, corticosteroid, B2 blocker, neutropenia and trombocytopenia, independent of blood culture we started amphotecyn IV infusion of 1 mg/kd/d. So we reduced from 5 cases/year to 1 case/year. Ernani Miura, Porto Alegre, Brazil.

  • Upvote 1

Share this post


Link to post
Share on other sites
Guest Hortense Jones

JM Gomez,

The March/April 2007, Vol.30, Journal of Infusion Nursing contains an article by Lisa Morgan. The article describes their 3 bundles for catheter used at Miami Childrens Hospital -Insertion bundle, dressing bundle and maintainance bundle.

Share this post


Link to post
Share on other sites
Guest bittybabygrower

Go to IHI.org this is where we adapted our central line and handwashing bundles.

Share this post


Link to post
Share on other sites

Based on current evidence, what is the best skin preparation to use prior to setting PICCs and umbilical lines in extremely low birthweights (ELBW)? You could share with us preparation(s) that you have used without adverse effect on the ELBWs and have documented marked reduction in line-related infections. I am creating an infection control bundle and will value your input.

Thanks.

JM Gomez,

KK Hospital for Women and Children,

SINGAPORE

Share this post


Link to post
Share on other sites
Based on current evidence, what is the best skin preparation to use prior to setting PICCs and umbilical lines in extremely low birthweights (ELBW)? You could share with us preparation(s) that you have used without adverse effect on the ELBWs and have documented marked reduction in line-related infections. I am creating an infection control bundle and will value your input.

Thanks.

JM Gomez,

KK Hospital for Women and Children,

SINGAPORE

I would like to refer you to the March 2008 edition of clinics in perinatalogy. You would find the answer to your querry here.

Also another very important article is

"Andersen C, Hart J, Vemgal P, Harrison C. Prospective evaluation of a multi-factorial prevention strategy on the impact of nosocomial infection in very-low-birthweight infants. J Hosp Infect. 2005;61:162–167"

I will quote from this study:

"Andersen et al showed a reduction in nosocomial bloodstream infections among VLBW infants following the introduction of a bundle of interventions that included: 1) replacement of a combination of povidone-iodine and isopropyl alcohol swabs by a 2% aqueous chlorhexidine solution for skin antisepsis prior to all central and peripheral catheter placements or invasive procedures in extremely low-birthweight infants until day 14 and by 1% chlorhexidine in ethanol for all other peripheral intravenous line placements, 2) introduction of a standardized sterile pack for line insertion, 3) removal of all peripheral lines after 48 hours, 4) removal of all intravascular lines when an infant achieved enteral feedings of 120 mL/kg per day, and 5) use of sterile technique when changing infusate solutions."

I think the short answer to your question is chlorhexidine solution. For details please see the journal.

Edited by JACK

Share this post


Link to post
Share on other sites

Precisely, this is the answer that I was looking for. Many have expressed caution about using 2% chlorhexidine solutions in the premature baby but do not state the alternatives. I have implemented use of 2% chlorhexidine aqueous preparation for the ELBW infants. Monitoring closely for any side-effects. Regards. JM Gomez, Singapore.

Share this post


Link to post
Share on other sites
Precisely, this is the answer that I was looking for. Many have expressed caution about using 2% chlorhexidine solutions in the premature baby but do not state the alternatives. I have implemented use of 2% chlorhexidine aqueous preparation for the ELBW infants. Monitoring closely for any side-effects. Regards. JM Gomez, Singapore.

You may be interested in this article

Chlorhexidine Compared with Povidone-Iodine Solution for Vascular

Catheter–Site Care: A Meta-Analysis

Published in Ann Intern Med. 2002;136:792-801

You will find some side effects of chlorhexidine listed here.

Fortunately this article is free

Just click on the link below and you should be able to download the pdf format of article easily

http://www.annals.org/cgi/reprint/136/11/792

You might also want to check out this article (Review: chlorhexidine gluconate is more effective than povidone-iodine for preventing vascular catheter related bloodstream infection ) published in Evidence Based Nursing

http://ebn.bmj.com/cgi/reprint/6/1/18

(This pdf is also free to download)

Please do share with us your experiences with chlorhexidine.

Share this post


Link to post
Share on other sites

Chlorhexidine plus alcohol ----burns!!!!!

READ

READ

(Moral : DO not forget the alcohol content in commercial products containing chlorhexidine)

Share this post


Link to post
Share on other sites

Dear Collegues.

The Subgroup of the German Robert Koch-Institiut has puplished a 40 page Paper about (I translate because it is in German): "Prevention of nosocomial infection in Very low weight babies under 1500 G". There is a lot of small but interesting details and aspects of prevention. You can find the article on:

http://www.rki.de/cln_091/nn_201414/DE/Content/Infekt/Krankenhaushygiene/Kommission/Downloads/Neo__Rili,templateId=raw,property=publicationFile.pdf/Neo_Rili.pdf (copy it, it works). There they prefer Octinidinhydrochlorid 0,1 % without Phenoxyethanol.

Bernhard Bungert

Share this post


Link to post
Share on other sites
Dear Collegues.

The Subgroup of the German Robert Koch-Institiut has puplished a 40 page Paper about (I translate because it is in German): "Prevention of nosocomial infection in Very low weight babies under 1500 G". There is a lot of small but interesting details and aspects of prevention. You can find the article on:

http://www.rki.de/cln_091/nn_201414/DE/Content/Infekt/Krankenhaushygiene/Kommission/Downloads/Neo__Rili,templateId=raw,property=publicationFile.pdf/Neo_Rili.pdf (copy it, it works). There they prefer Octinidinhydrochlorid 0,1 % without Phenoxyethanol.

Bernhard Bungert

Looks like a great article...but alas I can not understand german....I tried to convert it to english but the document is security locked

Can you somehow get hold of an english version of this article?

Thanks for the effort

Share this post


Link to post
Share on other sites
Chlorhexidine plus alcohol ----burns!!!!!

READ

READ

(Moral : DO not forget the alcohol content in commercial products containing chlorhexidine)

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

×
×
  • Create New...