Hand hygiene compliance of health care workers in a neonatal intensive care unit: a prospective observation study

Background: We aimed to determine hand hygiene (HH) compliance of the healthcare workers (HCW’s) and evaluate if there is an epidemiological relation between the microorganisms isolated from the hands of HCWs and patients clinical materials in the neonatal intensive care unit (NICU).Methods: HH compliance was observed in two unannounced phases in March and in August within the scope of 5 indications determined by WHO. Between two phases personnel was trained to improve HH by educational sessions and introduction of Semmelweis system hand in scan (HIS, Sysmex) in the unit.  A total of 22 nurses, 11 physicians and 5 staff was working in the NICU. Hand samples taken from HCW by glove juice method were inoculated quantitatively in culture plates and colonies were identified by MALDI-TOF MS. Epidemiological relation between clinical isolates and hand samples was investigated with arbitrary primed PCR.Results: Although overall compliance remained only 50%, a significant increase in compliance was detected in August prior to aseptic procedures and after contact with patients and body fluids. Alcohol scrub was preferred as 60.4% in March and 75.2% in August. HH efficacy reached to 72% by implementing HIS. During this period, 10.7% of 607 patient’s samples revealed clinically significant growth. Potential pathogens were isolated in 5.2% of 144 hand samples, but any epidemiological correlation with patient isolates was detected.Conclusions: HH compliance observations should be done at regular intervals and current technology could be utilized in trainings to overcome hospital related infections

Maternal Thyroid Dysfunction and Neonatal Thyroid Problems

Aim. To investigate obstetric features of pregnant women with thyroid disorders and thyroid function tests of their newborn infants. Methods. Women with hypothyroidism and having anti-thyroglobulin (ATG) and anti-thyroid peroxidase (anti-TPO) antibodies were assigned as group I, women with hypothyroidism who did not have autoantibodies were assigned as group II, and women without thyroid problems were assigned as group III. Results. Pregnant women with autoimmune hypothyroidism (group I) had more preterm delivery and their babies needed more frequent neonatal intensive care unit (NICU) admission. In group I, one infant was diagnosed with compensated hypothyroidism and one infant had transient hyperthyrotropinemia. Five infants (23.8%) in group II had thyroid-stimulating hormone (TSH) levels >20 mIU/mL. Only two of them had TSH level >7 mIU/L at the 3rd postnatal week, and all had normal free T4 (FT4). Median maternal TSH level of these five infants with TSH >20 mIU/mL was 6.6 mIU/mL. In group III, six infants (6.5%) had TSH levels above >20 mIU/mL at the 1st postnatal week. Conclusion. Infants of mothers with thyroid problems are more likely to have elevated TSH and higher recall rate on neonatal thyroid screening. Women with thyroid disorders and their newborn infants should be followed closely for both obstetrical problems and for thyroid dysfunction

Prevalence of Newborn Intensive Care Unit-Acquired, Healthcare-Associated Blood-Stream Infections in Neonatal Intensive Care Unit Patients: Results From The First National Point-Prevalence Survey

Purpose: Patients admitted to neonatal intensive care units (NICUs) are at high risk of Healthcare-Associated Blood-stream Infection (HABSI). We conducted a national multicenter assessment of HABSI in NICUs to determine the prevalence of infections and describe associated risk factors. Material and Methods: We conducted a point prevalence survey of HABSI in 38 NICUs. Patients present on the survey date were included. Data on demographics, underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes were collected for all NICU patients. Results: A total of 933 patients in 38 NICUs participated in the study, 142 of whom had HABSI, corresponding to a prevalence of 15.2%. The reported HABSI were clinical sepsis (n=88, 61.9%), laboratory-confirmed bloodstream infection (n=50, 35.2%) and catheter related infection (n = 4, 2.9%). Causative microorganisms were isolated in 54 (38%) patients with HABSI. The most common causative pathogens were coagulase negative Staphylococcus (n=34, 25.7%) and Candida spp. (n=10, 7%). The risk factors for HABSI were total parenteral nutrition, nasogastric feeding tube, central venous catheter, absence of High Efficiency Particulate Air (HEPA), gastrointestinal system disease, carrying out the preventive application bundle for catheter related infections, absence of next to each incubator disinfectant, duration of hospitalization more than 3 days and post-natal age more than 30 days. At 4-week follow up, 33 (3.5%) patients had died, 13 (39.3%) of whom died from healthcare-associated infections. HABSI were not found to be risk factors for death (p>0.05). Conclusion: This national multicenter study documented the high prevalence of NICU-acquired infections. Preventing these infections should be national priority. [Cukurova Med J 2015; 40(1.000): 119-128

Hindmilk for procedural pain in term neonates

WOS: 000287629200010PubMed ID: 21428195Altun-Koroglu O, Ozek E, Bilgen H, Cebeci D. Hindmilk for procedural pain in term neonates. Turk J Pediatr 2010; 52: 623-629. The aim of this study was to investigate whether repeated doses of hindmilk were effective for pain relief during routine heel stick in term neonates. Infants enrolled in this double-blind placebo-controlled study were randomly assigned to hindmilk, 12.5% sucrose and distilled water groups. Infants were given 1 ml of the test solution 1 minute prior to, immediately before and 1 minute after the heel stick. Pain responses were assessed by physiologic and behavioral parameters and also according to the Neonatal Facial Coding System (NFCS). There were significant reductions in crying time, duration of the first cry and tachycardia, time needed for return to baseline heart rate, and the average and 1- and 5-minute NFCS scores in the hindmilk group when compared with the distilled water group. When the hindmilk group was compared to the sucrose group, only the NFCS scores at 1 and 2 minutes reached statistical significance in favor of the sucrose group. Repeated dose hindmilk administration is an effective analgesic intervention in term newborns during heel stick. Although the analgesic effect of 12.5% sucrose is slightly superior, hindmilk may be considered as a physiologically suitable alternative to sucrose