559 - Impact of an infection team on Healthcare-Associated infections in a neonatal intensive care unit

Poster Number: 559
Publication Number: 559.336

Soledad Urzúa, Pontificia universidad catolica de chile, Santiago, Region Metropolitana, Chile; Alberto Toso, Pontificia Universidad Catolica de Chile, Santiago, Region Metropolitana, Chile; Liliana Leguizamon, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile; Daniela Masoli, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile; Angelica Dominguez, Pontificia Universidad Católica de Chile, Santiago, Region Metropolitana, Chile

Background: Infections increase morbidity and mortality in hospitalized newborn infants. The creation of a multi-disciplinary infection team should allow significant changes in clinical practice and improve outcomes.

Objective: The aim of this study is to assess the impact of a neonatal infection team (NIT) on the incidence of late-onset sepsis (LOS), healthcare-associated infections (HAIs), and antibiotic use in the NICU.

Design/Methods: This is a retrospective cohort study comparing 2 periods, before (P1, 2012-2015) and after (P2, 2015-2019) implementation of an NIT. NIT was created with the purpose of implementing and supervising strategies for the prevention and control of infections and is responsible for antimicrobial stewardship in the NICU. Baseline population characteristics, infectious episodes and antibiotic use were analyzed in both periods. A multivariable analysis was done within the infected subgroup of infants, comparing between those who presented HAI and non-HAI events.

Results: Among 3153 hospitalized neonates, 1503 were born in P1 and 1650 in P2. Lower APGAR scores of ≤ 3, more severe illnesses, more ECMO patients and longer hospital length of stay occurred in P2 (Table 1). 76 episodes of LOS and 69 of other infections occurred in P1; 105 episodes of LOS and 71 of other infections in P2. The cumulative incidence of infection episodes per 1000 patient-days decreased from 5.7 to 4.6 days between P1 and P2 (p 0.003). Analyzing HAIs, there was a significant decrease in CLABSIs (from 2.42 to 1.13 per 1000 days of central line use, p 0.012), as well as in Ventilator-associated Pneumonia (VAP) (from 2.87 to 0.33 per 1000 days of mechanical ventilation, p< 0.001) despite an increased use of devices (Table 2). There was no difference in the mortality rate among periods. Among patients who developed HAIs, there was a significant reduction of patients with HAIs in P2, from 2,9 % to 1,8 % (p 0.041) (Table 2). If we analyze non-HAI and HAI separately in relation to patients without infection, we see that the risk factors associated with having a non-HAI are the additional days of hospitalization, the duration of CVC and MV, being subjected to surgery, requiring ECMO, and having an NEC. If we look at the risks of having an HAI, the length of hospitalization and the prolonged use of CVC and MV stand out. When analyzing HAI, it is observed that P2 was a protective factor against developing HAIs (Figure 1). In addition, broad-spectrum antibiotics decreased in P2 (p < 0.05).Conclusion(s): The creation of an NIT in a single NICU decreased the incidence of infections, specially HAIs, and antibiotic use.
Table 1. Baseline characteristics of the study population.
Table 2. Infection episodes and Healthcare-associated infections. LOS: late onset sepsis; OI: other infections; HP: hospitalized patients; HD: hospitalized days; CL: central line; MV: mechanichal ventilation; UC: urinary catheter; HAI: Healthcare-associated infection; CLABSI: central line-associated bloodstream infection; VAP: ventilator-associated pneumonia; CAUTI: catheter-associated Urinary Tract Infection.