Infection prevention and control practices in neonatal units participating in the NeoIPC project

Introduction

The EU Horizon 2020 funded project NeoIPC aims to identify and implement effective infection prevention and control (IPC) interventions for neonatal intensive care units (NICUs). 

Methods

A standardized questionnaire on IPC practices was answered by each NICU participating in the NeoIPC colonization assessment study. The study is still active and expected to be concluded in 2023. The IPC questions were mapped to the IPC Assessment Framework (IPCAF) corresponding to the core components 1 (IPC programmes), 2 (guidelines), 3 (training), 4 (surveillance) and 6 (audits). In addition, the questionnaire included neonatology-specific infection prevention aspects, such as feeding practices, which are not part of the IPCAF.

Results

By November 2022, 16 European sites in seven countries and one South African site had completed the standardized questionnaire on IPC practices. 

Most questions belonged to core components 2 (IPC guidelines) and 4 (surveillance of health-care-associated infections - HAIs). For the first of these, 11/17 sites reported having a neonatal department unit-specific IPC guidance and all of them made it available to NICU clinical staff. Regarding the prevention of central-line associated infections (CLABSI) 15/17 sites provided guidance for preparation of intravenous fluids, medications and parenteral nutrition. Guidance for peripheral and central lines were available in 13/17 and 14/17 sites respectively. In contrast, only 11/17 sites had SOPs for cleaning of incubators, non-invasive and invasive ventilators.

For core component 4, all sites were routinely collecting data on hand hygiene, HAIs and resistant bacterial colonization. All but one site had data for CLABSI rates, while data on bloodstream infections and clinically suspected sepsis rates were only reported in 13/17 and 10/17 respectively.  Screening of neonates for multidrug-resistant bacteria occurs in 65% to 76%, depending on the pathogen.  Surveillance data was shared with the unit staff in 14/17 sites. 

Conclusion

IPC practice implementation varied across NICUs and was lower for neonatology-specific practices, such as surveillance of culture negative sepsis. The results demonstrate the challenges to map, plan and implement IPC interventions in the setting of NICUs.