Reduction of nosocomial infection in a neonatal intensive care unit (NICU)

Singapore Med J. 1998 Jul;39(7):319-23.


New measures aimed at reducing nosocomial infection in our neonatal intensive care unit (NICU) were introduced over a 3-month period from 1 July to 30 September 1994.

Objective: The aim of this study was to evaluate the impact of these measures on the incidence of nosocomial infection in our NICU.

Methods: The new measures introduced were: 1. grouping of all blood investigations to allow for fewer blood samplings per baby per day; 2. reduction of routine blood investigations after the acute illness has stabilised, and 3. a system of aseptic delivery of drugs through a central venous catheter, thereby reducing the need for peripheral intravenous lines. Nosocomial infections were defined according to the criteria spelt out in the Centres for Disease Control (CDC) guidelines. Data for the study was obtained from the ongoing surveillance carried out by the hospital's infection control team. Period 1 (1 year duration) was prior to the implementation of the new measures. Period 2 (1 year duration) was after implementation of the new measures.

Results: The overall nosocomial infection patient rates (expressed as number of infections per 100 intensive care unit patients) were 17.6 for Period 1 and 7.5 for Period 2. The overall nosocomial infection patient-day rates (expressed as number of infections per 1000 patient-days) were 13.5 and 6.1 respectively (p < 0.01). When the infants' birth weights were stratified as < 1500 g, 1500-2500 g, and > 2500 g, the greatest decline in both the overall nosocomial infection patient rate and nosocomial infection patient-day rate was seen in infants weighing < 1500 g. There was also a significant decline in the rates of blood-stream infections in infants weighing < 1500 g (from 7.5 to 2.8 per 1000 patient-days) (p < 0.05). Ventilator associated pneumonias also showed a decline from 3.3 to 1.0 pneumonia per 1000 ventilator days. The organisms responsible for the majority of blood stream infections in Period 1 were methicillin-resistant Staphylococci Aureus (MRSA), coagulase-negative staphylococci, gram-negative bacilli and candida. In Period 2, coagulase-negative staphylococci was the predominant organism.

Conclusion: We conclude that there was a reduction in nosocomial infection rates. The new measures introduced may have contributed to this reduction.

MeSH terms

  • Bacteremia / microbiology
  • Bacteremia / prevention & control
  • Blood Specimen Collection / methods
  • Catheterization, Central Venous
  • Chi-Square Distribution
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Drug Delivery Systems
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Premature
  • Infection Control / methods*
  • Intensive Care Units, Neonatal / organization & administration*
  • Program Evaluation
  • Statistics, Nonparametric