Training Materials - Best Care...Always!

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AGENDA

1. BCA at a glance

2. Lessons from Adult BCA

3. Why focus on the newborn

4. BCA for the newborn

3

BCA AT A GLANCE

1.Healthcare

Associated

Infections

3.BCA…for the newborn

2.Antimicrobial

Stewardship

10 LESSONS FROM ADULT BCA

5

1.

6

2.

7

3.

8

4.

9

5.

1

0

6.

1

1

7.

1

2

8.

1

3

9.

10.

EATING THE ELEPHANT ONE BITE AT A

TIME

Why focus on the newborn?

INFANT MORTALITY

IN RSA ( Stats SA, 2008)

Determinants of Infant Mortality

0thers

30%

Neonatal

31%

LRTI

17%

Diarrhoea

22%

16

NEONATAL DEATHS

IN RSA ( Stats SA, 2008)

Congential

Abnormalities

14%

Determinants of Neonatal Deaths

Prematurity

Sepsis

25%

Birth Asphyxia

25%

38%

17

DRIVERS OF MORBIDITY AND

MORTALITY

• Neonatal Sepsis

• Chronic Lung Disease

• Necrotising Enterocolitis

• Periventricular-Intraventricular

Haemorrhage

• Retinopathy of Prematurity

3 MAJOR COMPONENTS

1.Screening bundle

2.Drivers of

Mortality &

Morbidity

3. Sepsis bundle

SCREENING BUNDLE

1. Antenatal steroid compliance

2. HIV screening

3. HIV PMTCT compliance

4. Syphilis screening

5. Early NCPAP compliance

6. Cranial Ultrasound compliance

7. Retinal exam compliance

8. Caesarean section rate

CLD

PIH

NEC

DRIVERS OF

MORBIDITY &

MORTALITY

ROP

SEPSIS BUNDLE

• Early Bacterial Sepsis (EBS)

Vertical transmission

Within 72 hours of birth

• Late Onset Infections (LOI)

Healthcare Associated Infection

Bacteria, fungal or viral

After 72 hours of birth

SEQUENCING

Screening bundle

Data

Collection

M & M drivers

Bundles

EBS

Obstetric

Sepsis

Surveillance

LO

I

ICP &

CLABSI bundle

RETINOPATHY OF PREMATURITY

ROP

ROP BUNDLE

1.

2.

3.

4.

5.

Pulse oximetry on an infant receiving oxygen.

Saturation probe to be placed on the Right or Left hand.

Saturation aimed at 86-92%

Monitor alarm to be set at 85

(low) and 93 (high).

Fundoscopy screening done or booked before discharge.

ROP

CHRONIC LUNG DISEASE

CLD BUNDLE

1.

2.

3.

4.

5.

Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.

Neopuff use in neonatal resuscitation.

Gentle ventilation (NCPAP) vs

(HFO) vs (CV).

Permissive hypercapnia of more than 45mmHg.

Administration of systemic steroids to the infant to prevent or treat CLD.

CLD

NECROTISING ENTEROCOLITIS

NEC BUNDLE

1.

2.

3.

4.

Breastmilk or pasteurised EBM as a modality of feeding.

Trophic feeds within 24 hours of birth.

Adherence to “volume per day” protocol.

Adherence to “frequency of feeds” protocol.

NEC

PERIVENTRICULAR-INTRAVENTRICULAR

HAEMORRHAGE

PIH BUNDLE

1.

2.

3.

4.

5.

Administration of antenatal betamethasone where preterm delivery is inevitable in a pregnancy of 28-34 weeks gestation.

Delayed cord clamping for 45 seconds to a minute.

Neopuff use in neonatal resuscitation.

Maintain infant temperature to more than 36 degrees Celsius.

Developmental care: dim lights, low levels of noise and minimal handling.

PIH

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