Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-28T17:06:59.988Z Has data issue: false hasContentIssue false
  • English
  • Français

Shifting focus toward healthcare-associated bloodstream infections: The need for neonatal intensive care unit–specific NHSN definitions

Published online by Cambridge University Press:  07 November 2019

Sonali D. Advani Open the ORCID record for Sonali D. Advani [Opens in a new window] ,
Thomas S. Murray ,
Christina M. Murdzek ,
Michael J. Aniskiewicz  and
Matthew J. Bizzarro
Sonali D. Advani*
Affiliation:
Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
Thomas S. Murray
Affiliation:
Section of Pediatric Infectious Diseases, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut Department of Infection Prevention, Yale New Haven Hospital, New Haven, Connecticut
Christina M. Murdzek
Affiliation:
Department of Infection Prevention, Yale New Haven Hospital, New Haven, Connecticut
Michael J. Aniskiewicz
Affiliation:
Department of Infection Prevention, Yale New Haven Hospital, New Haven, Connecticut
Matthew J. Bizzarro
Affiliation:
Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
*
Author for correspondence: Sonali Advani, Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Healthcare-associated bloodstream infections (HABSIs) are a significant cause of mortality and morbidity in the neonatal intensive care unit (NICU) population. Our objectives were to review the epidemiology of HABSIs in our NICU and to examine the applicability of National Healthcare Safety Network (NHSN) definitions to the NICU population.

Methods:

We performed a retrospective review of all neonates admitted to the 54-bed, level IV NICU at Yale-New Haven Children’s Hospital with a HABSI between January 1, 2013, and December 31, 2018. Clinical definitions per NICU team and NHSN site-specific definitions used for source identification were compared using the McNemar χ2 test.

Results:

We identified 86 HABSIs with an incidence rate of 0.80 per 1,000 patient days. Only 13% of these were CLABSIs. Both CLABSIs and non–catheter-related bloodstream infections occurred primarily in preterm neonates, but the latter were associated with a significantly higher incidence of comorbidities and the need for respiratory support. The NHSN definitions were less likely to identify a source compared to the clinical definitions agreed upon by our NICU treating team (P < .001). Furthermore, 50% of patients without an identified source of infection by NHSN definitions were bacteremic with a mucosal barrier injury organism, likely from gut translocation.

Conclusions:

HABSIs occur primarily in premature infants with comorbidities, and CLABSIs account for a small proportion of these infections. With the increasing focus on HABSI prevention, there is a need for better NHSN site-specific definitions for the NICU population to prevent misclassification and direct prevention efforts.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 2 , February 2020 , pp. 181 - 186
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: These data were presented as poster #585, “Shifting Focus Towards Healthcare-Associated Bloodstream Infections: The Need for More NICU-Specific NHSN Definitions,” at IDWeek 2019 on October 3, 2019, in Washington, DC.

References

(HACRP) CH-ACRP. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Published 2018. Accessed August 1, 2018.Google Scholar
National and state healthcare-associated infections progress report. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/data/portal/progress-report.html. Published 2017. Accessed August 2018.Google Scholar
Erdei, C, McAvoy, LL, Gupta, M, Pereira, S, McGowan, EC.Is zero central line-associated bloodstream infection rate sustainable? A 5-year perspective. Pediatrics 2015;135:e1485–e1493.10.1542/peds.2014-2523CrossRefGoogle ScholarPubMed
Shepherd, EG, Kelly, TJ, Vinsel, JA, et al.Significant reduction of central-line associated bloodstream infections in a network of diverse neonatal nurseries. J Pediatr 2015;167:41–46.10.1016/j.jpeds.2015.03.046CrossRefGoogle Scholar
Bizzarro, MJ, Sabo, B, Noonan, M, et al.A quality improvement initiative to reduce central line-associated bloodstream infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2010;31:241–248.10.1086/650448CrossRefGoogle Scholar
Dantes, RB, Abbo, LM, Anderson, D, et al.Hospital epidemiologists’ and infection preventionists’ opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric. Infect Control Hosp Epidemiol 2019;40:536–540.CrossRefGoogle ScholarPubMed
Dantes, RB, Rock, C, Milstone, AM, et al.Preventability of hospital onset bacteremia and fungemia: a pilot study of a potential healthcare-associated infection outcome measure. Infect Control Hosp Epidemiol 2019;40:358–361.10.1017/ice.2018.339CrossRefGoogle ScholarPubMed
Verstraete, E, Boelens, J, De Coen, K, et al.Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992–2011): trends in incidence, pathogens, and mortality. Infect Control Hosp Epidemiol 2014;35:511–518.10.1086/675836CrossRefGoogle Scholar
Rock, C, Thom, KA, Harris, AD, et al.A multicenter longitudinal study of hospital-onset bacteremia: time for a new quality outcome measure? Infect Control Hosp Epidemiol 2016;37:143–148.10.1017/ice.2015.261CrossRefGoogle ScholarPubMed
Papoff, P, Ceccarelli, G, d’Ettorre, G, et al.Gut microbial translocation in critically ill children and effects of supplementation with pre- and probiotics. Int J Microbiol 2012;2012:151393.10.1155/2012/151393CrossRefGoogle Scholar
Gatt, M, Reddy, BS, MacFie, J.Review article: bacterial translocation in the critically ill—evidence and methods of prevention. Aliment Pharmacol Ther 2007;25:741–757.10.1111/j.1365-2036.2006.03174.xCrossRefGoogle ScholarPubMed
Collins, A, Weitkamp, JH, Wynn, JL.Why are preterm newborns at increased risk of infection? Arch Dis Child Fetal Neonatal Ed 2018;103:F391–F394.CrossRefGoogle ScholarPubMed
Urao, M, Moy, J, Van Camp, J, Drongowski, R, Altabba, M, Coran, AG.Determinant of bacterial translocation in the newborn: small bowel versus large bowel colonization. J Pediatr Surg 1995;30:831–836.10.1016/0022-3468(95)90759-9CrossRefGoogle ScholarPubMed
Dahan, M, O’Donnell, S, Hebert, J, et al.CLABSI risk factors in the NICU: potential for prevention: a PICNIC study. Infect Control Hosp Epidemiol 2016;37:1446–1452.10.1017/ice.2016.203CrossRefGoogle ScholarPubMed
National Healthcare Safety Network (NHSN) patient safety component manual. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Published January 2018. Accessed January 1, 2018.Google Scholar
Walsh, MC, Kliegman, RM.Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986;33:179–201.10.1016/S0031-3955(16)34975-6CrossRefGoogle ScholarPubMed
Trembath, A, Laughon, MM.Predictors of bronchopulmonary dysplasia. Clin Perinatol 2012;39:585–601.10.1016/j.clp.2012.06.014CrossRefGoogle ScholarPubMed
Papile, LA, Burstein, J, Burstein, R, Koffler, H.Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529–534.10.1016/S0022-3476(78)80282-0CrossRefGoogle ScholarPubMed
Neutropenia definition. American Academy of Asthma Allergy and Immunology website. https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/neutropenia. Accessed June 2018.Google Scholar
Bizzarro, MJ, Shabanova, V, Baltimore, RS, Dembry, LM, Ehrenkranz, RA, Gallagher, PG.Neonatal sepsis 2004–2013: the rise and fall of coagulase-negative staphylococci. J Pediatr 2015;166:1193–1199.10.1016/j.jpeds.2015.02.009CrossRefGoogle ScholarPubMed
Jawad, AJ, Al-Rabie, A, Hadi, A, et al.Spontaneous neonatal gastric perforation. Pediatr Surg Int 2002;18:396–399.10.1007/s00383-002-0749-8CrossRefGoogle ScholarPubMed
Folgori, L, Bielicki, J, Sharland, M.A systematic review of strategies for reporting of neonatal hospital-acquired bloodstream infections. Arch Dis Child Fetal Neonatal Ed 2013;98:F518–F523.10.1136/archdischild-2012-303149CrossRefGoogle ScholarPubMed
Stoll, BJ, Hansen, N, Fanaroff, AA, et al.Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002;110:285–291.10.1542/peds.110.2.285CrossRefGoogle ScholarPubMed
Gray, JW.A 7-year study of bloodstream infections in an English children’s hospital. Eur J Pediatr 2004;163:530–535.10.1007/s00431-004-1489-7CrossRefGoogle Scholar
Horan, TC, Andrus, M, Dudeck, MA.CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.10.1016/j.ajic.2008.03.002CrossRefGoogle ScholarPubMed
Brodie, SB, Sands, KE, Gray, JE, et al.Occurrence of nosocomial bloodstream infections in six neonatal intensive care units. Pediatr Infect Dis J 2000;19:56–65.10.1097/00006454-200001000-00012CrossRefGoogle ScholarPubMed
Sarvikivi, E, Lyytikainen, O, Vaara, M, Saxen, H.Nosocomial bloodstream infections in children: an 8-year experience at a tertiary-care hospital in Finland. Clin Microbiol Infect 2008;14:1072–1075.10.1111/j.1469-0691.2008.02079.xCrossRefGoogle Scholar
Raymond, J, Aujard, Y.Nosocomial infections in pediatric patients: a European, multicenter prospective study. Infect Control Hosp Epidemiol 2000;21:260–263.10.1086/501755CrossRefGoogle ScholarPubMed
Tsai, MH, Hsu, JF, Chu, SM, et al.Incidence, clinical characteristics and risk factors for adverse outcome in neonates with late-onset sepsis. Pediatr Infect Dis J 2014;33:e7–e13.10.1097/INF.0b013e3182a72ee0CrossRefGoogle ScholarPubMed
Perlman, SE, Saiman, L, Larson, EL.Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units. Am J Infect Control 2007;35:177–182.10.1016/j.ajic.2006.01.002CrossRefGoogle ScholarPubMed
Farrell, L, Gilman, M, Teszner, E, Coffin, SE, Sammons, JS.Present or absent on admission: results of changes in National Healthcare Safety Network surveillance definitions. Am J Infect Control 2015;43:1128–1130.CrossRefGoogle ScholarPubMed
Hammadi, AA, Ostrosky-Zeichner, L, Boston, K, McInnis-Cole, T, Butler, J.Accuracy of the NHSN central line-associated bloodstream infection (CLABSI) definition. Open Forum Infect Dis 2018;5 suppl 1:e2328–8957.Google Scholar
Blanchard, AC, Fortin, E, Rocher, I, et al.Central line-associated bloodstream infection in neonatal intensive care units. Infect Control Hosp Epidemiol 2013;34:1167–1173.10.1086/673464CrossRefGoogle ScholarPubMed
Sherman, MP.New concepts of microbial translocation in the neonatal intestine: mechanisms and prevention. Clin Perinatol 2010;37:565–579.10.1016/j.clp.2010.05.006CrossRefGoogle Scholar
MacFie, J, Reddy, BS, Gatt, M, Jain, PK, Sowdi, R, Mitchell, CJ.Bacterial translocation studied in 927 patients over 13 years. Brit J Surg 2006;93:87–93.10.1002/bjs.5184CrossRefGoogle ScholarPubMed
Coffin, SE, Klieger, SB, Duggan, C, et al.Central line-associated bloodstream infections in neonates with gastrointestinal conditions: developing a candidate definition for mucosal barrier injury bloodstream infections. Infect Control Hosp Epidemiol 2014;35:1391–1399.CrossRefGoogle ScholarPubMed
Stoll, B, Hansen, N.Infections in VLBW infants: studies from the NICHD neonatal research network. Semin Perinatol 2003;27:293–301.10.1016/S0146-0005(03)00046-6CrossRefGoogle ScholarPubMed