Effectiveness of simple strategies in reducing multidrug resistant blood stream infections in Neonatal Intensive Care Unit of tertiary care hospital in Karachi, Pakistan

Objectives: To report reduction in transmission of multidrug resistant organisms from the neonatal intensive care unit after the implementation of simple risk-reduction strategies. Methods: Using a pre-and-post design, the study was carried out from June 2010 to December 2011 at the neonatal intensive care unit of Aga Khan University Hospital, Karachi, which is 12-bed, level III facility. The intervention comprised hand washing certification for all staff, use of chlorhexidine instead of povodine iodine for skin preparation, use of non-sterile gloves for diaper change, implementation of barrier nursing for clinically-suspected and culture-proven infections, provision of separate intubation and central line trolley for each room and limiting the use of umbilical catheters to 7 days. Data is reported for 3-month pre-intervention period, one- month implementation phase, and for 3-month post-intervention phase. Data for 12 months post- implementation is reported to show sustainability. Results: The average pre intervention rates of bloodstream infections due to extended spectrum lactamase, Acinetobacter, Pseudomonas and methicillin resistant staphylococcus aureus were 4.7, 3.3, 1.2 and zero respectively. The average number of admissions during the 3 phases was almost similar (49, 46 and 53 respectively). There was sustained reduction in rates for all organisms 12 months after the intervention period. Conclusion: Nosocomial transmission of multi drug resistant organisms within the neonatal intensive care unit can be effectively reduced by adopting simple strategies.