Reducing infections from central lines in a neonatal intensive care unit, Egypt.

Problem: Central line-associated bloodstream infections in critically ill neonates are major challenge in neonatal intensive care units.

Approach: In April 2023, a multidisciplinary team, consisting of the infection prevention and control team, the unit head, a neonatal consultant doctor, a senior doctor and a head nurse, introduced the World Health Organization Multimodal Hand Hygiene Improvement Strategy in the neonatal intensive care unit of El-Shatby University Hospital, Egypt. The team introduced an antiseptic handwash and a disinfectant for surfaces and equipment, especially incubators. To highlight the incidence of infections in the unit and illustrate the effectiveness of the newly introduced products, the team offered training programmes for all health workers. Health workers' proper use of the introduced products was monitored and, if necessary, immediate corrective actions were taken. Monthly meetings were held to discuss hand hygiene compliance, infection rates and challenges in infection prevention and control.

Local setting: The neonatal intensive care unit has 70 incubators and 28 beds.

Relevant changes: The central line-associated bloodstream infection rate decreased from 13.85 infections per 1000 device days (95% confidence interval, CI: 10.44-18.03) before the intervention to 9.08 infections per 1000 device days (95% CI: 5.81-11.27). Hand hygiene compliance increased from 58% (70/120) to 71% (88/124) among nurses and from 64% (58/91) to 67% (67/100) among doctors.

Lessons learnt: Implementing a multimodal strategy through a multidisciplinary approach led to positive changes in infection prevention and control practices, and a reduction in central line bloodstream infections.