Neonatal Central Line Associated Laboratory Confirmed Bloodstream Infections

Background: Study was carried out from June to September 2009 on the group of 815 newborns, hospitalized at a highly specialized hospital. In this period of time neonatologists noted a three-times increase in central line-associated bloodstream infections (7,9/1000 pds) for infants 590-3440g.

Objective: Coagulase-negative staphylococci (CNS), especially methicillin-resistant S. haemolyticus and S. epidermidis were recognized as predominant invasive species.

Methods: Into the detail analysis we chose to include 18 newborns with CNS Central/Peripheral Line Associated Laboratory-Confirmed Bloodstream Infection (LCBSI-CVC/PVC), in which the first infection symptoms appeared in their fourth day of life or later, and CVC or PVC was used during at least 24 hours. The study tried to find out the transmission route of pathogens. We analysed in detail the phenotype and genotype characteristics of blood and cerebrospinal fluid isolates from neonates as well as isolates from environment and medical staff. The resistance phenotypes were determined by the disk diffusion method and E-test according to CLSI guidelines. Presence of species specific genes and resistance genes was confirmed using multiplex PCR amplification. Isolates were genotyped by pulsed field gel electrophoresis (PFGE) after macrorestriction with SmaI enzymes. The PFGE banding patterns were analyzed with the Jaccard coefficient and UPGMA by using Molecular Analyst (Applied Maths) software.

Results: The genetic profile analyses indicated clone occurrence between investigated strains of CNS, and thereby it confirmed the transmission of isolates between newborns. The result of molecular studies indicate high epidemic level of resistance genes among microorganisms isolated from patients and the environment as well as horizontal spread of selected clones.

Conclusions: To analyze and change this situation an independent audit was performed by the Chair of Microbiology, Jagiellonian University Medical College, Cracow. Meetings were held with the nursing staff, neonatologists, nurse practitioners, pharmacy and infection control teams to review the literature and establish a plan for decreasing the rate of infections in this high-risk group. The Three Step Plan was developed to address infection rates. The following procedures were standardized: hand hygiene, skin preparation, frequency and hygiene of line changes, blood culture collections and dressing changes. Review of the plan was done with all the staff and teaching was provided by one of the neonatologists on proper dressing technique and handling of central lines. The quarterly system to collect data and to monitor the changes were devised. The changes created a positive outcome for both the low birth weight infants and for the nursing and medical staff.