Major Article
Nosocomial infection in a neonatal intensive care unit: A prospective study in Taiwan

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Background

We performed a prospective analysis to determine the prevalence of nosocomial infection and associated risk factors in our neonatal intensive care unit (NICU).

Methods

Data were collected prospectively on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes at 9 am every day from November 2004 through October 2005. Prevalence of nosocomial infection and infection site definitions were according to the National Nosocomial Infections Surveillance system of the Centers for Disease Control and Prevention.

Results

Among 528 infants enrolled, 60 (11.4%) had 97 nosocomial infections. The survival rate was 92%. The prevalence of nosocomial infections was 17.5%: bloodstream infection, 4.7%, clinical sepsis, 6.3%, pneumonia, 5.1%, urinary tract infections (UTIs), 0.7%, surgical site infection, 0.7%. Intervention-associated infection rate: central intravascular catheter–associated bloodstream infection, 13.7%, TPN-associated bloodstream infection, 15.8%, ventilator-associated pneumonia, 18.6%, surgical site infection 13.7%, urinary catheter–associated UTI, 17.3%. Cut-off values of onset of central intravascular catheter–associated bloodstream infection and ventilator-associated pneumonia were 6 days and 10 days after intervention, respectively. Patients with a birth weight <1000 g (relative risk, 11.8, 95% confidence interval, 7.66-18.18; P < .001) were at the greatest risk for nosocomial infection.

Conclusions

This study revealed the high prevalence of nosocomial infections in NICU patients, and the urgent need for a national surveillance and more effective prevention interventions.

Section snippets

Methods

China Medical University Hospital is a 1700-bed teaching facility that provides tertiary care in the central part of Taiwan. It has a level-III NICU with a total of 30 beds. Around 2100 live births occur annually; an average of 60 very low birth weight infants is born annually in the hospital. The distances between each NICU bed are 90 cm. There are 10 sinks in our NICU; the antimicrobial handwashing solutions Hibiscrub (4% solution of chlorhexidine gluconate, Zeneca Limited, London, UK) and

Demographic data of all infants admitted

During the study period, 528 infants were admitted to our NICU; 197 were inborn and 331 were outborn infants, the median gestational age was 35 weeks (range, 21-44 weeks), and the median birth weight was 2265 g (range, 310-4429 g). Among them, 30.1% of the babies weighed <1500 g and 86.7% of all infections were found in this population (Table 1). The survival rate was 92% (486/528). Prematurity was the most common reason (321/528, 60.8%) for admission to the NICU. Other reasons for admission

Discussion

This is the first prospective study of nosocomial infection in a NICU in Taiwan; 11.4% of the patients in our NICU had at least one nosocomial infection, with an overall 17.6% prevalence rate of nosocomial infections. Most nosocomial infections (61.8%) occurred in extremely low birth weight infants (<1000 g). Previous studies have reported a wide range of infection rates (<10% to >20%) among individual NICUs.1, 11, 12, 13, 14, 15, 16 It is difficult to compare our data with these data because

Conclusions

In our study, the positive blood culture rate was low. Predominantly, patients who were in critical condition were very premature; an adequate blood sample might have been difficult to obtain, which could have resulted in false negative cultures. We prospectively observed patients every day, if nosocomial infection was suspected clinically, the patient was defined as has clinical sepsis until the bloodstream infection was proved. The prevalence of clinical sepsis in our study was 6.3%. Because

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