A. van den Hoogen

Incidence of infections of ventricular reservoirs in the treatment of post-haemorrhagic ventricular dilatation: a retrospective study (1992-2003).

Background: Since 1992, infants with progressive posthaemorrhagic ventricular dilatation (PHVD) have been treated in the Neonatal Intensive Care Unit, Wilhelmina Children’s Hospital, Utrecht, The Netherlands, with a ventricular reservoir. Objective: To retrospectively study the incidence of infection using this invasive procedure. Methods: Between January 1992 and December 2003, 76 preterm infants were treated with a ventricular reservoir. Infants admitted during two subsequent periods were analysed: group 1 included infants admitted during 1992–7 (n = 26) and group 2 those admitted during 1998–2003 (n = 50). Clinical characteristics and number of reservoir punctures were evaluated. The incidence of complications over time was assessed, with a focus on the occurrence of infection of the reservoir. Results: The number of punctures did not change during both periods. Infection was significantly less common during the second period (4% (2/50) v 19.2% (5/26), p = 0.029). Conclusion: The use of a ventricular reservoir is a safe treatment to ensure adequate removal of cerebrospinal fluid in preterm infants with PHVD. In experienced hands, the incidence of infection of the ventricular reservoir or major complications remains within acceptable limits.

Clarifying the benefits of the positive reappraisal coping intervention for women waiting for the outcome of IVF

STUDY QUESTION Does the use of a positive reappraisal coping intervention (PRCI) alone following IVF embryo transfer influence anxiety, the depression and treatment outcome when compared with its use combined with monitoring emotions, monitoring emotions alone or no intervention? SUMMARY ANSWER Woman using the PRCI alone had significantly lower anxiety levels at Day 10 of the waiting period and 6 weeks after the start of the waiting period but also a significantly higher clinical pregnancy rate compared with the other three groups. WHAT IS KNOWN ALREADY The waiting period, which follows embryo transfer after IVF/ICSI is very stressful. The use of the PRCI together with a daily monitoring form increases positive emotions but appears not to reduce anxiety. The impact of using the PRCI without daily recording of emotions may be more beneficial. STUDY DESIGN, SIZE, DURATION Following completion of recruitment to a recently published 3-arm randomized controlled trial (RCT) of the use of the PRCI in the post-embryo transfer waiting period, a further 110 participants were recruited to study the impact of the PRCI in clinical practice without concurrent emotional monitoring. Data collection took place between May 2012 and December 2012. Outcomes were compared with those generated by a RCT of the PRCI with daily emotional monitoring, daily emotional monitoring only or routine care. PARTICIPANT, MATERIALS, SETTING, METHODS To capture the impact of the PRCI on this further group, questionnaires were completed at three time points: just before the waiting period (Time 1: preintervention), on Day 10 of the 14-day waiting period (Time 2: waiting period intervention) and 6 weeks after the start of the waiting period (Time 3: post-intervention). Data generated were compared with the data from the RCT. To compare the impact over time on anxiety and depression, a repeated multilevel linear model design was used. MAIN RESULTS AND THE ROLE OF CHANCE Nighty-eight of the 110 women who were recruited received the PRCI intervention without daily monitoring (PRCI-comparison group). After correcting for known confounding factors, compared with women in all three groups of the original RCT, women in the PRCI-comparison group had a significantly lower anxiety at Time 2 (n = 83) and Time 3 (n = 70) but not significantly lower depression levels. Women in the PRCI-comparison group had a significantly higher clinical pregnancy rate (39.8%, P = 0.033) but there were no significant differences in clinical pregnancies with fetal heartbeat (P = 0.10). LIMITATIONS, REASONS FOR CAUTION A limitation of this study is that the additional study group was not randomized to the intervention, and may therefore be subject to selection bias. The study was also done subsequent to the other three groups. WIDER IMPLICATIONS OF THE FINDINGS This simple low cost self-help coping intervention can be offered to women during the waiting period in an IVF/ICSI treatment. A further RCT comparing PRCI only to a non-intervention group is necessary to confirm these findings. STUDY FUNDING/COMPETENT INTERESTS The Women and Baby Division of the University Medical Centre Utrecht funded the study. The authors have no conflicting interest(s).

Systematic review found that there was moderate evidence that vaccinating healthcare workers prevented pertussis in infants

This systematic review investigated the effectiveness of vaccinating healthcare workers against pertussis on the occurrence of nosocomial pertussis outbreaks or infections among unprotected infants. We focused on eight studies, with five different study designs, that involved 39,129 healthy adolescents and adults, 115 healthcare workers, 2000 simulated healthcare workers and a simulated population of 200,000 people.

74 Training and Checklists; How to Safely Evacuate a Nicu

Introduction Evacuation is an uncommon and hard to practice event in a Neonatal Intensive Care Unit (NICU). Insecurity of untrained personnel can lead to disastrous incidents. To improve training and to recognize problems, a large multidisciplinary evacuation training was organized. Methods The evacuation procedure was filmed by a professional film crew and edited into a 10-minute instructional movie. The film was shown to the full nursing staff. With lessons learned from this evacuation the current evacuation protocol was evaluated and several inconsistencies were identified. Results During the training the current evacuation area proved unsuitable because of absence of the appropriate connections. Furthermore the staff trained was uncertain of their tasks during the training. Lastly essential equipment was hard to find. To increase awareness and regulate the procedure a checklist was developed. The coordinating nurse was made responsible for a weekly run through of the checklist. The instructional video will be shown to all new colleagues. Currently, a simulation computer program is being developed to routinely practice an evacuation in a safe environment. Conclusion The local evacuation procedure should be well known among NICU staff. Multidisciplinary training is an important tool to identify the positive and negative aspects of the current procedure. A checklist can help to increase awareness and to the early identification of possible problems. Acknowledgements Multidisciplinary working group evacuation, the fire department UMC Utrecht and fire department Utrecht.

470 Patient Safety in the Nicu

Background: Patient safety is a spearhead of the University Medical Centre of Utrecht (UMCU), the Netherlands. It recognizes that human error is inevitable. Wherever possible, the system should be (re)designed in such a way that human error is discovered or intercepted before it leads to patient harm. Reporting incidents is part of the patient safety program running in our hospital. The Neonatal Intensive Care Unit (NICU) of the UMCU wanted to have more insight in the incident reports on their unit. By analysing the reports with NICU professionals, the chance of effective improvement on the department would be increased. Aim: Increase of patient safety by incident analyses. Method: Our NICU started a multi disciplinary local report committee. Procedures for analysing reports were made. In the analyses we looked at organisational factors, human errors and technical failures. Moreover we used ‘why questions’ and the ‘barrier analysis’. Implications for practice: Local reporting needs support by management. It is necessary that all disciplines are represented in the committee and that members are approachable and are ambassadors for incident reporting. Regular feedback and presenting results to management and medical and nursing staff, stimulates reporting. Work instructions after exchanging mother milk, a new feeding application form and ongoing attention for the administration of extra oxygen are examples which resulted in fewer incidents. Conclusion: After three years incident reporting became more regular. The reports increased from 37 in 2006 to 138 in 2009. Meanwhile a number of procedures has been adapted and improved, as a result of which patient safety increased.

1394 Clinical Outcome of Neonatal Conssepsis with a Vancomycin-Sparing Regimen: Favourable Results with Cefazolin as First Choice Agent

Background and aims: The typical empiric antimicrobial treatment protocol for neonatal coagulase-negative staphylococci (CONS) sepsis includes vancomycin. However, the protocol in our NICU prescribes cefazolin to cover CONS. The susceptibility of CONS blood isolates to cefazolin and clinical outcome of infants with CONS sepsis was studied during 2000-2006. Methods: Clinical characteristics, symptoms of sepsis and antibiotic use were studied retrospectively. Susceptibility of CONS blood isolates to cefazolin was determined by E-test. Results: 163/185 infants with proven CONS sepsis were treated with cefazolin. Median MIC value of cefazolin was 0.75-2 (range 0.01-256) µg/ml and 77-96% of all isolates was susceptible to cefazolin (MIC ≤8 µg/ml) during 2000-2006. In 121/140 (86%) infants with cefazolin-susceptible and 21/23 cases (91%) with cefazolin-resistant CONS isolate cefazolin was clinically efficacious. 12/17 second blood cultures in 19 non-responders yielded CONS with unchanged MIC. In 78% of good responders and 22% of non-responders a central venous catheter was removed at onset of sepsis. Nonresponders were switched to vancomycin. Conclusions: Majority of CONS isolates remained susceptible to cefazolin over a period of 7 years. Cefazolin is clinically efficacious in >85% of cases and can be recommended as first choice agent for therapy of CONS sepsis. Removal of a central venous catheter may be the most important therapeutic measure.

NO CEREBRAL WHITE MATTER DAMAGE DUE TO CONS SEPSIS IN PRETERM INFANTS DETERMINED BY APPARANT DIFUSSION COEFFICIENT (ADC) ON MRI

Background and aims: Neonatal sepsis may cause cerebral white matter (WM) damage in preterm infants, compromising outcome. Coagulase-negative staphylococcal (CONS) sepsis is a frequent cause of morbidity in preterm infants, however generally not developing into a fulminant disease. To determine the impact of CONS sepsis on cerebral WM, the ADC of 3 WM regions was measured using diffusion-weighted MRI (DW-MRI) performed at term-equivalent age. Methods: Cerebral DW-MRI was performed routinely in 81 preterm infants (GA< 31 weeks). Four infants with cerebral white matter damage due to venous infarction or hydrocephalus, before CONS sepsis occurred in 1, were excluded. The ADC of frontal, parietal and occipital WM was calculated in 31 infants with CONS sepsis and 50 infants without sepsis. Results: ADC values in parietal WM were significantly lower as compared to frontal or occipital WM in both groups (p< 0.001), indicating developmental differences (table 1). No differences were found in ADC values of infants with or without CONS sepsis in all 3 regions of cerebral WM. Conclusions: CONS sepsis in preterm infants is not associated with cerebral white matter damage as determined by ADCs in cerebral MRI at termequivalent age.