National surveillance of nosocomial infections in neonatal intensive care units in Belgium (Neo-KISS)

<p>The national college of "Mother and Newborn" has the objective to improve the quality of care, by development of quality indicators, reporting and benchmarking. A significant heterogenity in morbidity and mortality between NICUs was found during the national intensive care benchmarking 2004-2008 report (NICAUDIT), which might have been due to differences in nosocomial infection rates. Indeed, nosocomial infections are more frequent in preterm infants than in pediatric patients, especially in very low birth weight infants (<1500 gram). Studies in Germany have shown that surveillance of infections, and benchmarking can result in a significant decrease in the incidence of infections. Another aim of the surveillance is to find risk factors for nosocomial infections which can be used to prevent nosocomial infections. Primary bloodstream infections especially those related to vascular lines and nosocomial pneumonia related to the use of respiratory devices are the primary focus of this surveillance. For this surveillance the German national surveillance protocol Neo-KISS (Krankenhaus-Infektions-Surveillance-System) is used. Both incidence densities (per patient days as numerator) and device associated infection rates (per catheter or ventilator days as numerator) are calculated. Also the device utilization and antibiotic utilization (per 100 patient days) were calculated. To standardize the infectious risk for each NICU, potential confounding factors and additional risk factors were measured and the (adjusted) standardized infection rates (SIR) are calculated for each unit. A SIR of 1 means that the infection rate is in accordance to the expected rate for the case-mix of the unit. The analysis was supported by WIV-ISP (K. Mertens) and BICS (M. Gérard).After a pilot phase in 2010, 7 out of 19 NICUs participated in the surveillance period 2011voluntary via web-based data collection forms. During this study period, 441 patients responsible for 14990 patient days were entered in the study. The mean gestational age was 28.8 weeks and mean birth weight was 1095 g with a mean surveillance duration of 33.6 days. Surveillance was ended because of patient transfer (26.5%), bodyweight of 1800 g reached (62.1%) or mortality (11.3%). The ventilation utilization (CPAP and/or intubation) and central line utilization were 62.7 days and 51.9 days per 100 patient days. Antibiotic utilization was 25.8 days per 100 patient days on average.</p>