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    • A total of microorganism species

    2019-06-19

    A total of 46 microorganism species in the old NICU group and 35 in the new NICU group were isolated, respectively. Klebsiella pneumoniae was the most frequent pathogen in the old NICU group (Table 4), followed by E. coli, Methicillin-resistant Staphylococcus aureus (MRSA), Coagulase-negative Staphylococci (CoNS), C. parapsilosis, S. epidermidis, and E. cloacae. Methicillin-resistant Staphylococcus aureus was the most common pathogen in the new NICU group followed by CoNS, E. faecalis, A. baumannii, P. aeruginosa, E. faecium, E. coli, and K. pneumonia (Table 4). There was no statistically significant difference in the total number of microorganism species in both groups except K. pneumoniae. The infection rate of K. pneumoniae declined from 4.6% in FPH2 the old NICU to 0.7% in the new NICU (P = 0.01). The most frequent microorganism species isolated from the blood stream was K. pneumoniae (30%, 6/20) in the old NICU group, followed by E. coli (15%), C. koseri (10%), MRSA (10%), CoNS (10%).A. baumannii (20%, 2/10), P. aeruginosa (20%), were the two most common pathogens isolated from the blood stream in the new NICU group followed by CoNS (10%), MRSA (10%), E. faecalis (10%), and K. pneumoniae (10%).
    Discussion The influence of the inanimate NICU environment and facilities on nosocomial infection has been the focus of discussion in recent years. Many factors have been linked to nosocomial infection in NICU patients, including understaffing, overcrowding, and poor access to sinks or wash basins; however, controversy exists as to whether or not the inanimate environment of the NICU has an influence on nosocomial infection. Maki et al. reported that the inanimate hospital environment was thought to contribute only negligibly to endemic nosocomial infection. In a four-year study, Von Dolinger de Brito et al. stated that the rate of nosocomial infection rose significantly after patients were moved to a temporary unit, which had a lower FPH2 or wash basin to cot ratio and a higher monthly admission rate. The relocation of a NICU to a better-staffed facility with more space between beds, sinks or wash basins and isolation facilities was associated with a decrease in the infection rate. The new NICU of our hospital was designed according to the guidelines recommended by regulatory and professional bodies for nursery design in terms of adequate space for preterm infants, better facilities, and an adequate number of wash basins (Table 1). In this study, the average rate of nosocomial infection decreased from 6.26 cases per 1000 patient-days in the old NICU to 4.09 cases per 1000 patient-days in the new NICU (P = 0.03). The rate of infection episodes decreased from 19.0% (46/242) to 11.1% (30/270) (P = 0.01). Catheter-related infections are common nosocomial infections in an intensive care unit. Nosocomial infections of the bloodstream, lower respiratory tract, and urinary tract are closely associated with catheter insertion. In our study, bloodstream infection was the most common infection site in both NICUs, followed by lower respiratory tract and urinary tract infection, as shown in a previous study. A bundle is a small group of specific care practices each essential for providing effective and safe patient care to a defined group of patients. Significantly improved outcomes are expected to result from applying the combination of care practices and have been shown to reduce the rate of central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia in children. Catheter-related bundle care was implemented in our new NICU on January 1, 2011 due to the new policy of whole intensive care units in our hospital. We did not analyze the true catheter-associated infection rate, but the total numbers of bloodstream infections, lower respiratory tract infections, and urinary tract infections declined from 13.6% (33/242) in the old NICU down to 5.9% (16/270) in the new NICU with bundle care practices (P = 0.003) (Table 4). Of particular note was the decrease in bloodstream infections from 8.3% in the old NICU to 3.7% in the new NICU (P = 0.03). The cases of nosocomial infections from the lower respiratory tract and the urinary tract were also reduced to half of the reduced ratio as the blood stream infection (Table 4).The reason the infection rates in the lower respiratory tract and the urinary tract did not reflect the statistical decrease might be attributed to the few cases in both groups. The other sites of nosocomial infections included the gastrointestinal tract, eyes, and skin, and these non-catheter-associated infections showed no statistically significant difference between the two groups. We could not clarify the exact reason for the decrease in incidence and rate of nosocomial infection from follicle-stimulating hormone (FSH) study because of the replacement to a new facility and implementation of device bundles to the new NICU at the same time. The type of management implemented in the old and new facilities might play a role in the decrease of the incidence of nosocomial infection in this study.