Helder, O.K.

Prevention of nosocomial bloodstream infections in preterm infants (Doctoral Thesis)

2013-04-17T00:00:00Z

Protecting patients from harm is the overarching theme of the studies presented here. More precisely, this thesis places a focus on the prevention of nosocomial or hospitalacquired bloodstream infections in preterm infants, thus saving them from further harm. A nosocomial infection is an infection acquired during hospitalization 48-72 hours after admission or birth. These infections are a threat to patients’ health worldwide.

Transition from neonatal intensive care unit to special care nurseries: Experiences of parents and nurses (Article)

2012-05-01T00:00:00Z

OBJECTIVES: To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. DESIGN: Qualitative explorative study in two phases. SETTING: Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five community hospitals in the Netherlands. PARTICIPANTS: Twenty-one pairs of parents and 18 critical care nurses. METHODS AND MAIN RESULTS: Semistructured interviews were used. Thematic analysis and comparison of themes across participants were performed. Trust was a central theme for parents. Three subthemes, related to the chronological stages of transition, were identified: gaining trust; betrayal of trust; and rebuilding confidence. Trust was associated with five other themes: professional attitude; information management; coordination of transfer; different environments; and parent participation. Although nurses at an early stage repeatedly mentioned a possible transition to community hospitals, the actual announcement took many parents by surprise. Parents felt excluded during the actual transfer and most questioned its necessity. In the special care nursery, parents found it difficult to adjust to new routines and to gain trust in new caregivers, but eventually their worries dissolved. In contrast to neonatal intensive care unit nurses, special care nursery nurses quite understood the impact of transition on parents. CONCLUSIONS: Both parents and nurses considered present transitional arrangements to be inadequate. Nurses should provide more effective discharge planning and transitional care. A positive labeling of the transition as a first step to home discharge for the newborn seems appropriate. Parents need to be better-informed and should be involved in the planning process. Copyright

Computer screen saver hand hygiene information curbs a negative trend in hand hygiene behavior (Article)

2012-03-13T00:00:00Z

Background: Appropriate hand hygiene among health care workers is the most important infection prevention measure; however, compliance is generally low. Gain-framed messages (ie, messages that emphasize the benefits of hand hygiene rather than the risks of noncompliance) may be most effective, but have not been tested. Methods: The study was conducted in a 27-bed neonatal intensive care unit. We performed an inter- rupted time series analysis of objectively measured hand disinfection events. We used electronic devices in hand alcohol dispensers, which continuously documented the frequency of hand disinfection events. In addition, hand hygiene compliance before and after the intervention period were directly observed. Results: The negative trend in hand hygiene events per patient-day before the intervention (decrease by 2.3 [standard error, 0.5] per week) changed to a significant positive trend (increase of 1.5 [0.5] per week) after the intervention (P < .001). The direct observations confirmed these results, showing a significant improvement in hand hygiene compliance from 193 of 303 (63.6%) observed hand hygiene events at pretest to 201 of 281 (71.5%) at posttest. Conclusions: We conclude that gain-framed messages concerning hand hygiene presented on screen savers may improve hand hygiene compliance.

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison (Article)

2010-10-01T00:00:00Z

Background: Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction. Objectives: We studied the effectiveness of a hand hygiene education program on the incidence of nosocomial bloodstream infections. Design: Observational study with two pretests and two posttest measurements and interrupted time series analysis. Setting: A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands. Participants: Healthcare professionals who had physical contact with very low birth weight (VLBW) infants. Methods: The study was conducted during a period of 4 years. Medical and nursing staff followed a problem-based education program on hand hygiene. Hand hygiene practices before and after the education program were compared by guided observations. The incidence of nosocomial infections in VLBW infants was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth weight infants were analyzed by a segmented loglinear regression analysis. Results: During 1201 observations hand hygiene compliance before patient contact increased from 65% to 88% (p< 0.001). Median (interquartile range) drying time increased from 4. s (4-10) to 10. s (7-14) (p< 0.001).The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene intervention decreased from 44.5% to 36.1% (18.9%, p= 0.03) and from 17.3% to 13.5% (22.0%, p= 0.03), respectively.At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07% (95% CI -1.41 to +1.60) per month and decreased with -1.25% (95% CI -4.67 to +2.44) after the intervention (p= 0.51). The level of instant change was -14.8% (p= 0.48). Conclusions: The results are consistent with relevant improvement of hand hygiene practices among healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in nosocomial bloodstream infections.

Endotracheal suctioning: There's more to it than just technical care (Article)

2008-09-01T00:00:00Z

Computer-generated versus nurse-determined strategy for incubator humidity and time to regain birthweight (Article)

2008-05-01T00:00:00Z

Objective: To compare effects on premature infants' weight gain of a computer-generated and a nurse-determined incubator humidity strategy. An optimal humidity protocol is thought to reduce time to regain birthweight. Design: Prospective randomized controlled design. Setting: Level IIIC neonatal intensive care unit in the Netherlands. Participants: Infants of 24 to 30 weeks gestational age with a birthweight less than 1,500 g. Intervention: Two incubator humidity strategies were studied: computer-generated and nurse-determined humidity. Main outcome measure:Time needed to regain birthweight. Results: One hundred thirty six infants were enrolled: 65 were exposed to the computer-generated strategy and 71 to the nurse-determined strategy. Demographic characteristics were well balanced between groups, with birthweight 981 ± 245 versus 991 ± 213 g, mean gestational age 27.7 ± 1.7 versus 27.7 ± 1.6 weeks. Main outcome did not significantly differ between strategies: survival analysis showed an equal number of days needed to regain birthweight (median 9 days, with 95% CIs 8-10 and 7-11 for infants exposed to the computer-generated and nurse-determined humidity strategy, respectively). Conclusion: Computer-generated strategy does not reduce the time needed to regain birthweight.

Vibration therapy reduces CPAP need in a prospective randomised controlled trial (Article)

2008-01-01T00:00:00Z

Background: Increased mucus production is a common phenomena following ventilatory support, which might increase morbidity. In order to reduce airway obstruction we tested the effect of vibration therapy on the duration of ventilatory support. Methodology: We conducted a randomised control study in a level IIIC NICU (28 beds) of a university hospital. Compared were nonactive techniques to vibration therapy in preterm infants with a gestational age of 26 - 33 weeks. All infants were ventilated or receive respiratory support by nasal CPAP. Results: 104 infants were enrolled, 49 in the vibration group and 55 in the control group. Demographic characters were in the vibration group compared to control group mean birth weight 1274 (± 335) gram vs. 1240 (± 351) gram and mean gestational age 29.8 (± 1.3) weeks vs. 29.9 (± 1.4) weeks. Vibration therapy did not reduce ventilation time (100 vs. 80 hours, p = 0.88) however duration of CPAP decreases significant (57 vs 157 hours, p < 0.018). Conclusion: Vibration therapy reduced Mean Airway Pressure, oxygen requirements and CPAP need in preterm infants, but did not reduce the duration of mechanical ventilation.