title: Effectiveness of simple strategies in reducing multidrug resistant blood stream infections in Neonatal Intensive Care Unit of tertiary care hospital in Karachi, Pakistan.
abstract: OBJECTIVE
  To report reduction in transmission of multidrug resistant organisms from the neonatal intensive care unit after the implementation of simple risk-reduction strategies.
  
  
  METHODS
  Using a pre-and-post design, the study was carried out from June 2010 to December 2011 at the neonatal intensive care unit of Aga Khan University Hospital, Karachi, which is 12-bed, level III facility. The intervention comprised hand washing certification for all staff, use of chlorhexidine instead of povodine iodine for skin preparation, use of non-sterile gloves for diaper change, implementation of barrier nursing for clinically-suspected and culture-proven infections, provision of separate intubation and central line trolley for each room and limiting the use of umbilical catheters to 7 days. Data is reported for 3-month pre-intervention period, one-month implementation phase, and for 3-month post-intervention phase. Data for 12 months post-implementation is reported to show sustainability.
  
  
  RESULTS
  The average pre intervention rates of bloodstream infections due to extended spectrurm 3 lactamase, Acinetobacter, Pseudomonas and methicillin resistant staphylococcus aureus were 4.7, 3.3, 1.2 and zero respectively. The average number of admissions during the 3 phases was almost similar (49, 46 and 53 respectively). There was sustained reduction in rates for all organisms 12 months after the intervention period.
  
  
  CONCLUSIONS
  Nosocomial transmission of multi drug resistant organisms within the neonatal intensive care unit can be effectively reduced by adopting simple strategies.
authors.forename: Maqbool
authors.initials: M
authors.lastname: Qadir
authors.forename: Farah Naz
authors.initials: FN
authors.lastname: Qamar
authors.forename: Shahzadi
authors.initials: S
authors.lastname: Resham
authors.forename: Rehan
authors.initials: R
authors.lastname: Ali
authors.forename: Ahmad
authors.initials: A
authors.lastname: Khalil
authors.forename: Shakeel
authors.initials: S
authors.lastname: Ahmed
authors.forename: Hasina
authors.initials: H
authors.lastname: Amin
authors.forename: Sunaina
authors.initials: S
authors.lastname: Mossani
mesh_terms: D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control*; D002710:Chlorhexidine / Q000008:administration & dosage; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D018432:Drug Resistance, Multiple; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D017575:Gloves, Protective; D006235:Hand Disinfection; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods*; D007363:Intensive Care Units, Neonatal; D008297:Male; D010154:Pakistan; D063128:Tertiary Health Care
chemical_list: D002710:Chlorhexidine