title: Late onset sepsis in newborn babies: epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit.
abstract: OBJECTIVE
  We assessed late onset sepsis (LOS) rates of neonates in a neonatal intensive care unit (NICU) before and after implementing an evidence-based bundle to prevent these infections in a country with poor resources.
  
  
  METHODS
  We evaluate trends of LOS between October 2010 and August 2012 in a large tertiary hospital in Brazil. We designed a protocol based of CDC guidelines for insertion of maintenance of central venous catheter targeted to reduction of bloodstream infections. During this period two major events occurred: a great increase of LOS rates in January months and relocation of the unit to a provisory place. Additionally we evaluated the risk factors and etiology of these infections.
  
  
  RESULTS
  A total of 112 (20.3%) cases defined as LOS were found. The overall incidence rate of LOS in the study was 16.1/1000 patient/days and 23.0/1000 CVC-days. Our monthly rates data of LOS/1000 patient-day reveal fluctuations over the studied period, with incidence rates of these infections in staff vacation period (January 2011 and 2012) significantly higher (59.6/1000 patients-days) than compared with the other months rates (16.6/1000 patients-days) (IRR=3.59; p<0.001). As opposite, the incidence rates of LOS during relocation period was lower (10.3/1000 patients-days) when compared with baseline period 26.7/1000 patients-days (IRR=2.59; p=0.007). After the intervention period, these rates decreased in the post intervention period, when compared with preintervention 14.7/1000 patients-days and 23.4/1000 patients-days, respectively (IRR=1.59; p=0.04).
  
  
  CONCLUSIONS
  Through simple infection control measures, LOS can be successfully controlled especially in NICUs of limited resources countries such as ours.
authors.affiliation: Microbiology Laboratory, Biomedical Science Institute, Uberlândia Federal University, Uberlândia, MG, Brazil. Electronic address: daianeresende_bio@hotmail.com.
authors.forename: Daiane Silva
authors.initials: DS
authors.lastname: Resende
authors.affiliation: Faculty of Medicine, Uberlândia University Hospital, Uberlândia Federal University, Uberlândia, MG, Brazil.
authors.forename: Anna Laura Gil
authors.initials: AL
authors.lastname: Peppe
authors.affiliation: Neonatology Department, Uberlândia University Hospital, Uberlândia Federal University, Uberlândia, MG, Brazil.
authors.forename: Heloisio
authors.initials: H
authors.lastname: dos Reis
authors.affiliation: Neonatology Department, Uberlândia University Hospital, Uberlândia Federal University, Uberlândia, MG, Brazil.
authors.forename: Vânia Olivetti Steffen
authors.initials: VO
authors.lastname: Abdallah
authors.affiliation: Microbiology Laboratory, Biomedical Science Institute, Uberlândia Federal University, Uberlândia, MG, Brazil.
authors.forename: Rosineide Marques
authors.initials: RM
authors.lastname: Ribas
authors.affiliation: Microbiology Laboratory, Biomedical Science Institute, Uberlândia Federal University, Uberlândia, MG, Brazil.
authors.forename: Paulo Pinto
authors.initials: PP
authors.lastname: Gontijo Filho
mesh_terms: D017668:Age of Onset; D001938:Brazil / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*
keywords: Bundle; Late onset sepsis; Neonates