Evaluation and Monitoring of Infection Control Practices

Nosocomial infections on neonatal intensive care units (NICUs) have been a recognized cause for concern for many years. Blood stream infections are the most frequent nosocomial infections in NICUs. This work was done to evaluate the impact of infection control practices implementation on intravenous fluid (IVF), medication contamination and neonatal sepsis at NICUs. The study was designed to conduct an infection control practice training course at six private neonatal intensive care units at three governorates with evaluation of the results before and after the study. Samples of all available in-use intravenous fluid bottles and previously used bottles, opened medication ampoules and blood samples from the clinically suspected infants were collected and cultured to detect the organisms and their sensitivity to antimicrobial agents before and one month later after the training course. Also, infection control practice observation tool was designed and used for evaluation of the infection control practice at each NICU before the study and one month later. The results showed that K. Pneumonia, K. Terregina and Enterobacterspp were the commonest types of organisms at the pre-training visit; while at the post-training visit, K. Pneumoniae and coagulase negative Staph. were the commonest types of organisms. At the pre-training visit, the IVF contamination rate was 62%, the medication contamination rate was I 6.1 % and the blood infection rate was 64.8%. At the post-training visit, IVF contamination rate dropped to 32%, medication contamination dropped to 0% and the blood infection rate to 50%. There was a significant reduction in both IVF and medication contamination frequency (p value = 0.000). The mean score of infection control practices concerning the training aspects was significantly increased at the post-training visit at the six NICUs. A significant positive correlation was found between infection control practice score in the six NICUs and the negative IV fluid (free samples) (r = 0.5 and p = 0.003 ). Conclusions: Surveillance of nosocomial infections in NICUs and successful strategies to decrease infections, such as infection control practice and optimal antibiotic use, are warranted. The significant decrease in contamination rate of IV fluids and medications and positive blood culture results after the training practice point to the importance of microbiological culture of in-use IV fluids which could be a helpful adjunct to epidemiologic studies to directly assess the effectiveness of infection control practices related to IV fluid preparation and use, also point to the significance of proper health hygiene in nosocomial infection control.