Objectives: To assess the relationship between organisational and structural factors of UK neonatal intensive care units (NICUs) with risk adjusted probable nosocomial bacteraemia.
Design of study: A prospective observational study of infants concurrently admitted to 54 randomly selected UK NICUs between March 1998 and April 1999.
Results: Of the 13 334 infants admitted, 402 (2.97%) had probable nosocomial bacteraemia. The median unit level percentage of infants with probable nosocomial bacteraemia was 2.48% (minimum 0%, maximum 9%). The risk adjusted odds of probable nosocomial bacteraemia were increased by 1.13 (95% CI 1.07 to 1.20) for each additional level 1 cot per hand washbasin and decreased by 0.53 (95% CI 0.35 to 0.79) in infants admitted to units with an NICU infection control nurse compared with units without. There was no relation with an increase in the floor space of the unit per cot (odds ratio 0.99 (95% CI 0.98 to 1.00) per m2) or with the quality of hand washing signs (odds ratio 1.04 (95% CI 0.93 to 1.16) per increase in quality score).
Conclusions: There is widespread variation in rates of probable nosocomial bacteraemia in UK NICUs. Probable nosocomial bacteraemia is reduced in units with a dedicated infection control nurse and with the presence of more hand washbasins. Further research is required to identify methods to eliminate nosocomial bacteraemia.
- neonatal intensive care
- nosocomial infections
- patient safety
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↵* Members of the UK Neonatal Staffing Study Group are given at the end of the paper.
Gareth Parry planned and coordinated the writing of the paper, undertook the analysis, contributed to the study design and contributed to all sections of the paper. Janet Tucker contributed to the study design and contributed to all sections of the paper. William Tarnow-Mordi contributed to the study design and contributed to all sections of the paper.UK Neonatal Staffing Study Writing Committee: G J Parry, Health Services Research, ScHARR, University of Sheffield; J S Tucker, Dugald Baird Centre for Research on Women’s Health, Department of Obstetrics and Gynaecology, University of Aberdeen; W O Tarnow-Mordi, University of Sydney, Sydney, AustraliaUK Neonatal Staffing Study Steering Group: N Marlow (Chair), Department of Child Health, University of Nottingham; H Baumer, Department of Child Health, Derriford Hospital, Plymouth; M Boen, SCBU, Derby City Hospital; K Hamilton, Dumfries and Galloway Health Board; J Meran, Neonatal Unit, Good Hope Hospital, Stourbridge; D Milligan, Neonatal Unit, Royal Victoria Infirmary, Newcastle; C McCabe, ScHARR, University of Sheffield; J Nicholl, Medical Care Research Unit, University of Sheffield; P Nicolson, ScHARR, University of Sheffield; M Redshaw, Institute of Child Health, Royal Hospital for Sick Children, Bristol; K Rowan, ICNARC, Tavistock Square, London; J Scott, Neonatal Unit, Queen Mother’s Hospital, Glasgow; J Smith, SCBU, Princess Margaret Hospital, SwindonParticipating NICUs: Airedale General Hospital, Antrim Hospital, Arrowe Park Hospital, Birch Hill Hospital, Burnley General Hospital, City Hospital Birmingham, Derby City Hospital NHS Trust, Dewsbury District Hospital, Erne Hospital, Fairfield General Hospital, Farnborough Hospital, Gloucestershire Royal Hospital, Good Hope Hospital, Greenwich Healthcare Trust, Grimsby Maternity Hospital, Hereford County Hospital, Huddersfield Royal Infirmary, Jersey Maternity Hospital, Kent & Canterbury Hospital, Kettering General Hospital, King’s Mill Hospital, Norfolk & Norwich Hospital, North Devon District Hospital, Northampton General Hospital, Northern General Hospital Sheffield, Northwick Park Hospital, Nottingham University Hospital, Peterborough District Hospital, Prince Charles Hospital, Queen Elizabeth Hospital Gateshead, Rotherham District General Hospital, Royal Alexandra Hospital, Royal Devon & Exeter Hospital, Royal Hampshire County Hospital, Royal Oldham Hospital, Royal Preston Hospital, Royal Surrey County Hospital, Royal United Hospital, Salisbury NHS Trust, Scunthorpe General Hospital, South Cleveland Hospital, South End Hospital, Southern General Hospital, St George’s Hospital, St Mary’s Hospital, St Paul’s Hospital, St Peter’s Hospital, St Thomas’ Hospital, Stoke Mandeville Hospital, The Ipswich Hospital NHS Trust, William Harvey Hospital, Wordsley Hospital, Wycombe General Hospital, York District Hospital.
This study was funded by the NHS R&D Executive, Mother and Child Health Programme (grant number MCH:6-7) and endorsed by the British Association of Perinatal Medicine, the Neonatal Nurses Association (UK), and Scottish Neonatal Nurses Group. Gareth Parry was supported in writing this paper by The Commonwealth Fund, a national private foundation based in New York City that supports independent research on health and social issues. The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its director, officers, or staff.
The authors have no conflict of interest to declare.