title: Quality in practice: preventing and managing neonatal sepsis in Nicaragua.
abstract: OBJECTIVE
  Incorrect and excessive diagnosis of newborn infections in Nicaragua caused overcrowding in the neonatal intensive care units and unnecessary hospitalization.
  
  
  METHODS
  A baseline study in nine hospitals found that none correctly utilized disinfectants, sterilization or hand hygiene and that diagnosis of neonatal sepsis was based primarily on clinical manifestations.
  
  
  METHODS
  In 2007, the Ministry of Health (MINSA), with Unites States Agency for the International Development technical assistance, began developing guidelines and implementing quality improvement in infection prevention and control to reduce neonatal infections. In a second intervention phase, the MINSA introduced an algorithm for correct identification of maternal risk factors and standardized laboratory tests for neonatal sepsis.
  
  
  METHODS
  Interventions included developing national guidelines on correct use of disinfectants and hand hygiene; training medical staff on the guidelines; revising the basic medical supply list to support appropriate antisepsis; defining a package of diagnostic tests for neonatal sepsis and systematically measuring compliance with the new procedures.
  
  
  RESULTS
  The 18 hospitals achieved appropriate use of disinfectants in a 12-month period. In seven hospitals that introduced improvements in diagnosis and management of neonatal sepsis, application of the standardized laboratory package in suspected sepsis cases increased from 0% in April 2009 to 93% in July 2011, and the median incidence of neonatal sepsis was reduced by 67%.
  
  
  CONCLUSIONS
  The organizational changes implemented for the diagnosis and verification of neonatal sepsis led to a reduction in the newborn sepsis admissions and expenditures for antibiotics, allowing resources to be redirected to treating other critically ill newborns.
authors: University Research Co., LLC, 7200 Wisconsin Avenue, Suite 600, Bethesda, MD 20814, USA. sergio.lopez.nic@gmail.com.
authors: Sergio
authors: S
authors: López
authors: Yudy
authors: Y
authors: Wong
authors: Luis
authors: L
authors: Urbina
authors: Ivonne
authors: I
authors: Gómez
authors: Flavia
authors: F
authors: Escobar
authors: Bernarda
authors: B
authors: Tinoco
authors: Alba
authors: A
authors: Parrales
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D004202:Disinfectants / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D009527:Nicaragua / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000458:organization & administration*; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy
chemical_list: D004202:Disinfectants