Kandasamy, Y. (2009) Infection control during administration of parenteral nutrition in preterm babies. Archives of Disease in Childhood: fetal and neonatal, 94 (1). F78-F78.

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Abstract

Total parenteral nutrition (TPN) is standard practice for preterm babies in modern neonatal intensive care units. Although more difficult to site, peripherally inserted percutaneous central venous catheters need to be replaced less frequently than peripheral cannulae and therefore have been shown to reduce interruptions in nutrition. The guidelines of the Centers for Disease Control and Prevention on prevention of infection related to peripherally inserted percutaneous central venous catheters recommends the use of "maximal sterile barrier precautions" (use of cap, mask, sterile gown, sterile gloves and large sterile drape) for the insertion of the line, but it acknowledges that the efficacy of these recommendations has not been studied. Furthermore, the guidelines do not stipulate if sterile barrier precautions should also be applied during subsequent changing of bags of parenteral nutrition. We observed an increase in the incidence of bacteraemia in premature babies from January to April 2006 in our neonatal intensive care unit in North Queensland, Australia. An infection control guideline was introduced on May 2006 in which TPN bags were changed every 48 h, with the use of maximal sterile barrier precautions. This practice was, however, expensive and time consuming. Retrospectively, we investigated the effect of the new infection control technique in reducing the bacteraemia rate. The study period was divided into two 12-month epochs, before and after implementation of the changes. Any premature baby admitted during the study period who received TPN via a peripheral long line was included in the study. Blood culture results at birth and before the insertion of the long line were excluded from analysis. Analysis revealed that the percentage of babies receiving TPN who subsequently developed bacteraemia was higher in the pre-intervention group than in the post-intervention group (odds ratio (OR) 2.13; 95% CI 0.93 to 4.90). Mortality was 9.4% in the pre-intervention group compared with 2.6% in the post-intervention group (OR 3.67; 95% CI 0.93 to 20.9). Multivariate logistic regression showed that bacteraemia was associated with gestation (OR 0.65; 95% CI 0.44 to 0.97) and TPN use (OR 4.17; 95% CI 1.37 to 12.7) in the pre-intervention group. We concluded that the new regimen reduced bacteraemia and mortality, although the study was not a randomised and controlled trial and could not account for unmeasured or unknown confounders

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