Implementación de NeoKissEs en España: un sistema validado de vigilancia de la sepsis nosocomial en recién nacidos de muy bajo peso / mplementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants

Antecedentes: Las sepsis son las infecciones nosocomiales más frecuentes en las Unidades de Cuidados Intensivos Neonatales (UCIN), afectando especialmente a los recién nacidos de muy bajo peso al nacer (RNMBP, ≤ 1.500 g). Un sistema de vigilancia epidemiológica puede contribuir a su prevención mediante una evaluación continua de su frecuencia y factores de riesgo asociados. El objetivo de este artículo es describir la implementación del sistema de vigilancia de las sepsis nosocomiales en RNMBP (NeoKissEs) en un grupo de UCIN españolas. Métodos: Estudio de cohorte de RNMBP con < 28 días de edad ingresados en las UCIN participantes. Dos UCIN tradujeron y adaptaron materiales a partir del sistema original alemán NEO-KISS. Durante la implementación, se desarrollaron 8talleres formativos, con participación de 210 profesionales. Se creó un sistema web para la introducción de datos de pacientes y episodios de sepsis, su monitorización, análisis comparativo y retroalimentación a las unidades. En cada UCIN, un neonatólogo fue responsable de la implementación, recogiendo información sobre las dificultades percibidas durante el proceso. Resultados: De 50 unidades que aceptaron participar, 45 utilizaron NeoKissEs durante la fase de implementación, registrando 1.108 episodios de sepsis asociados a catéter vascular en 3.638 neonatos, con una tasa de 18,4 episodios por 1.000 pacientes-día con catéter (IC del 95%: 17,8-19,1). Conclusiones: El sistema de vigilancia epidemiológica NeoKissEs representa una fuente útil de información para la comparación estandarizada de la incidencia de sepsis de las UCIN, evaluar factores de riesgo y facilitar la evaluación del efecto de futuras intervenciones preventivas

Background: Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500 g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. Methods: We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. Results: Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. Conclusions: The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs

[Implementation of NeoKissEs in Spain: A validated surveillance system for nosocomial sepsis in very low birth weight infants]. / Implementación de NeoKissEs en España: un sistema validado de vigilancia de la sepsis nosocomial en recién nacidos de muy bajo peso.

BACKGROUND: Bloodstream infections (BSIs) are the most frequent nosocomial infections in neonatal intensive care units (NICUs), especially in very low birth weight (VLBW) infants (birth weight ≤ 1500g). An epidemiologic surveillance system may contribute to the prevention of infection by continuous monitoring of its frequency and associated risk factors. The aim of this article was to describe the implementation of the NeoKissEs surveillance system for BSIs in VLBW newborns in a group of Spanish NICUs. METHODS: We assessed the clinical cohort consisting of all VLBW newborns aged less than 28 days admitted to the participating units. In the pilot phase, 2NICUs translated and adapted materials from the original German NEO-KISS system. During implementation, 210 health care professionals attended one of 8 educational workshops. A web-based system was created that allows entering data regarding patients and BSI episodes, data monitoring, benchmarking and providing feedback to the units. At each NICU, one neonatologist was responsible for the implementation of the system and reporting the difficulties perceived throughout the process. RESULTS: Out of the 50 units that agreed to participate, 45 successfully started using the surveillance platform during the implementation phase, recording 1108 episodes of catheter-associated BSI (CABSI) in 3638 newborns, and finding an overall rate of CABSI of 18.4 (95% CI, 17.8-19.1) per 1000 catheter days. CONCLUSIONS: The NeoKissEs surveillance system constitutes a helpful source of information for the purpose of benchmarking the performance of neonatal units, assessing factors associated with BSI in VLBW infants and measuring the impact of future preventive interventions in NICUs.

Guía de procedimientos de esterilización a baja temperatura / No disponible

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Control of a Clonal Outbreak of Multidrug-Resistant Acinetobacter baumannii in a Hospital of the Basque Country after the Introduction of Environmental Cleaning Led by the Systematic Sampling from Environmental Objects.

Background. Between July 2009 and September 2010, an outbreak of multidrug-resistant (MDR) Acinetobacter baumannii was detected in one critical care unit of a tertiary hospital in the Basque Country, involving 49 infected and 16 colonized patients. The aim was to evaluate the impact of environmental cleaning and systematic sampling from environmental objects on the risk of infection by MDR A. baumannii. Methods. After systematic sampling from environmental objects and molecular typing of all new MDR A. baumannii strains from patients and environmental isolates, we analyzed the correlation (Pearson's r) between new infected cases and positive environmental samples. The risk ratio (RR) of infection was estimated with Poisson regression. Results. The risk increased significantly with the number of positive samples in common areas (RR = 1.40; 95%CI = 0.99-1.94) and positive samples in boxes (RR = 1.19; 95%CI = 1.01-1.40). The number of cases also positively correlated with positive samples in boxes (r = 0.50; P < 0.05) and common areas (r = 0.29; P = 0.18). Conclusion. Once conventional measures have failed, environmental cleaning, guided by systematic sampling from environmental objects, provided the objective risk reduction of new cases and enabled the full control of the outbreak.