A STUDY ON THE INCIDENCE OF INFECTION IN PREMATURE

BABIES IN NICU, 2014

A study based on Welcare Hospital
(Mention topic title in bold letters)

SYNOPSIS FOR DISSERTATION TO BE SUBMITTED BY SPRING 2014

TO
SIKKIM MANIPAL UNIVERSITY, INDIA

In partial fulfillment of the requirements for the award of the Degree of MBA
in
TQM (Specialization)

SUBMITTED BY:
Manju Thomas (Name)
1304001842 (Roll No)

Under the Guidance of

Dr. Saravana Kumar (Name of Guide)
MD Pediatrics (Specialization)
Address..
United Arab Emirates

SUBMITTED TO
Project Coordinator
Wisdom Business School
RAKIA Free Zone

INTRODUCTION
INFECTION IN PREMATURE BABIES
Sepsis is the presence of bacteria or other harmful organisms in the blood
stream, causing an inflammatory state throughout the body. People of all ages and
states of health can become septic, but premature babies in the NICU are at a much
greater risk for systemic infections. Preemies have immature immune systems, and
cant fight off infections very well. Many preemies also have invasive procedures
while they are in NICU. Central IV lines like umbilical catheters or PICC lines,
mechanical ventilation and surgeries can all introduce infection into the body.
Sepsis in NICU generally falls into one of two categories, bacterial sepsis
or fungal sepsis. Bacterial sepsis can have either an early onset or a late onset.
Early onset sepsis occurs when the baby is exposed to bacteria from the mom,
either during pregnancy or birth. In late onset sepsis, the bacteria enters the body
after birth, usually from an invasive procedure. There are many different bacteria
that can cause sepsis, including GBS, E coli,S Epidermidis, and Listeria.
NICU care and prematurity also increase the risk for fungal infections.
Antibiotics, used to prevent and treat bacterial sepsis, can increase fungal growth
in the body. Invasive procedures allow fungus to enter the blood stream and can
cause sepsis. Candida, which causes Yeast infections, is the most common cause of
fungal sepsis in preemies.
Because sepsis can be very difficult to treat, preventing sepsis is an important part
of NICU care.
COMPANY PROFILE
Mediclinic Welcare hospital which operates in Mediclinic Middle East is part of
Mediclinic International, one of the top 10 listed private healthcare groups in the
world with 52 hospitals in Southern Africa, 16 in Switzerland under the name

Hirslanden and 2 hospitals and 9 clinics in the UAE. Mediclinic International's

headquarters are in Stellenbosch, South Africa.
Previously EHL Management Services, the company became Mediclinic Middle
East when its majority shareholder, Mediclinic International, acquired all
remaining shares from its partners Varkey Group and General Electric in October
2012.
Mediclinic Middle East owns and operates some of the most respected healthcare
facilities in the region. These include Mediclinic Welcare Hospital, Mediclinic City
Hospital, Mediclinic Dubai Mall, Mediclinic Ibn Battuta, Mediclinic Meadows,
Mediclinic Arabian Ranches, Mediclinic Midriff, Mediclinic Al Qusais, Mediclinic
Al Sufouh, Mediclinic Beach Road and Mediclinic Corniche.
Mediclinic Middle East operates according to the same brand values as Mediclinic
International, namely the Science of Care. At Mediclinic Middle East, we are
driven by the question, how can the application of science improve the lives of our
patients? Our requirements are exacting and our application is definitive. We
insist on practical proof at all times, and our healthcare professionals lead patients
through a controlled and customized treatment process, orchestrated to deliver the
best possible outcome. Our hallmark is a rigorous, specialist-dominated approach,
delivered in a respectful and human manner.
Our five brand drivers are:
Practical
Exacting
Deliberate
Orchestrated
Human
INDUSTRY PROFILE

Health care industry

The health care industry, or medical industry, is an aggregation of sectors within
the economic system that provides goods and services to treat patients with
curative, preventive, rehabilitative, and palliative care. The modern health care
industry is divided into many sectors and depends on interdisciplinary teams of
trained professionals and paraprofessionals to meet health needs of individuals and
populations.
The health care industry is one of the world's largest and fastest-growing
industries. Consuming over 10 percent of gross domestic product (GDP) of most
developed nations, health care can form an enormous part of a country's economy.
For purpose of finance and management, the health care industry is typically
divided into several areas. As a basic framework for defining the sector, the United
Nations International Standard Industrial Classification (ISIC) categorizes the
health care industry as generally consisting of:
1. Hospital activities;
2. Medical and dental practice activities;
3. "Other human health activities".

This third class involves activities of, or under the supervision of, nurses,
midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics,
residential health facilities, or other allied health professions, e.g. in the field of
optometry, hydrotherapy, medical massage, yoga therapy, music therapy,
occupational therapy, speech therapy, chiropody, homeopathy, chiropractics,
acupuncture, etc.
The Global Industry Classification Standard and the Industry Classification
Benchmark further distinguish the industry as two main groups:
1. Health care equipment and services; and
2. Pharmaceuticals, biotechnology and related life sciences.

The health care equipment and services group consists of companies and entities
that provide medical equipment, medical supplies, and health care services, such as
hospitals, home health care providers, and nursing homes. The latter listed industry
group includes companies that produce biotechnology, pharmaceuticals, and
miscellaneous scientific services.

Other approaches to defining the scope of the health care industry tend to adopt a
broader definition, also including other key actions related to health, such as
education and training of health professionals, regulation and management of
health services delivery, provision of traditional and complementary medicines,
and administration of health insurance.
PROBLEM IDENTIFICATION AND DEVELOPMENT
Nosocomial infection or HAI is a serious problem for neonates, who are
admitted for intensive care. As it is associated with increases in mortality,
morbidity, and prolonged length of hospital stay, both the human and fiscal cost of
these infections are high. Although the rate of nosocomial sepsis increases with the
degree of both prematurity and low birth weight, no specific lab test has been
shown to be very useful in improving our ability to predict who has a real blood
stream infection and therefore who needs to be treated with a full course of
antibiotics. As a result antibiotic use is double the rate of proven sepsis and we
are facilitating the growth of resistant organisms in the NICU.
Welcare hospital NICU is a level III NICU which admits, extreme preterm
babies, low birth weight babies and very sick term neonates. The data which is
collected by the Infection control department of Welcare hospital shows that, the
incidence of infection in 2014 is much lesser than previous 2 years. The statistical
data which is published by the CDC, USA helps to compare the infection rate of
2014, the first 3 quarters shows that the infection rate of Welcare hospital NICU is
not higher than the International standards.
OBJECTIVE AND SCOPE OF STUDY
OBJECTIVE

To determine the incidence of health care associated infection (HAI) in

premature babies in 2014.

To compare the NICU, Welcare Hospital infection rate with Centers of

Disease Control and Prevention (CDC).

To compare the NICU, Welcare Hospital, 2014 infection rate with previous
years of infection rates (2012 and 2013).

To make recommendations on infection prevention and control in NICU.

To maintain the quality of care provided by the health care professionals by

adopting proper infection control measures.

SCOPE OF THE STUDY

Most HAI in the NICU result from the instrumentation and procedures required
to preserve an infants life. Thus it is not possible to lower the rate of HAI merely
by limiting the use of procedures. Furthermore, it is no longer acceptable to
consider HAI as a consequence of neonatal intensive care.
HAI are thought to generate substantial economic burdens. Morbidity and
mortality are increased, hospital stay is prolonged and additional cash cost arise for
consumable used to treat the infection. The risk of acquiring another infection is
also believed to increase with length of hospital stay. It also causes legal ties and
financial burden on the hospital.
A recent review suggested that 10-70% of HAI are preventable with appropriate
infection control.
HYPOTHESIS FORMULATION
To compare the infection rate of 2014 with the infection rate of previous two
years (2012 and 2013) and also to compare with International standards (CDC), the
study formulated the following hypothesis as Null hypothesis Ho and Alternative
hypothesis Ha.
Ho-The incidence of infection in preterm babies admitted in Welcare hospital
NICU is less in 2014 compare to previous 2 years.
Ha-The incidence of infection in preterm babies admitted in Welcare hospital
NICU is not less in 2014 compare to previous 2 years.
SAMPLING METHOD
Sampling involves the study of a small number of individuals chosen from a large
group. In this research study, the total population comprises of 79 premature babies
who are between 23weeks to 32 weeks, admitted in Welcare hospital NICU from
2012 to 2014.
In the sampling method, we select an adequate number of elements from the
population. Sample size refers to the number of representatives to be taken as
samples. Sample unit refers to the single member of the sample.

For this project, the sampling method adopted is Quota sampling, the sample
include a minimum number from each specified subgroup in the population. The
total population under study is sub grouped into3, preterm babies born in
2012,2013 and 2014.These are again sub grouped into2, preterm babies between
23weeks to 28 weeks, and between 29weeks to 32 weeks. The sample size is 30.
And 10 are allocated for each year, 5 for 23weeks to 28 weeks and 5 for 29 weeks
to 32 weeks.
DATA COLLECTION
Collection of data is the first and most important stage in any statistical survey.
The method for collection of data depends upon various factors such as objective,
scope and nature of investigation and availability of resources.
Sources of Data
The data sources could be either problem specific and primary or historical and
secondary in nature.
Primary
Primary data is the one which is collected by the investigator for the purpose of
a specific inquiry or study. Such data is original in character and is generated by a
survey conducted by individuals or research institution or any
organisation.Interview, questionnaire, and telephone/mail are all examples of
primary data. In this retrospective study, I intend to collect data from selected
patient files by sampling method.
Secondary
Secondary data is any information that is used for the current investigation, but
is obtained from some data, which has been collected and used by some other
agency or person in a separate investigation or survey is known as secondary data.
They are available in a published or unpublished form. The data which I intend to
collect is published data by Centres of Disease Prevention and Control, USA and
unpublished data which was collected by Infection Control Department, Welcare
Hospital.
DATA ANALYSIS
Analysis of data is a process of inspecting, transforming and modeling data with
the goal of discovering useful information, suggesting conclusions and supporting
decision making. The purpose of analyzing data is to obtain usable and useful

information. The analysis, irrespective of whether the data is qualitative or

quantitative may describe and summarize the data, identify relationships between
the variables, compare variables, identify the difference between variables, and
forecast outcomes. When using a quantitative methodology we are normally testing
theory through the testing of a hypothesis.
In this study I will proceed with the following systematic ways to analyze the
data that I have collected through primary and secondary sources.
The data analysis is done as per the following procedure:
a)Classification and tabulation of data
Numerical data can be classified into class intervals. This is to assist the
quantitative analysis of data. The data obtained from the sample is reduced to
homogenous grouped data. They are:
i.Preterm babies born in 2012
ii. Preterm babies born in 2013
iii. Preterm babies born in 2014
Each of the above group will have class limits-an upper and lower limit.
Once we classified the data, arrange the data according to some logical pattern.
This is referred to as tabulation of data. This involves an orderly arrangement of
data into an array that is suitable for a statistical analysis, usually this is an orderly
arrangement of rows and columns.
b)Analysis of Data
At the analysis stage, the first step is to describe the sample which is followed by
inferential analysis. In the descriptive analysis, we describe the sample, whereas
the inferential analysis deals with generalizing the results as obtained from the
sample.
Descriptive analysis deals with summary measures relating to sample data. The
common ways to summarize the data are by calculating average, range, standard
deviation, frequency and percentage distribution.
After descriptive analysis has been carried out, the tools of inferential statistics
are applied. Under inferential statistics, inferences are drawn on population
parameters based on sample results.

CONCLUSION
The premature babies in NICU are at a much greater risk for infections. This
study helps to find the incidence of infection in premature babies in NICU in
2014,to compare the incidence of infection with previous 2 years , to evaluate the
effectiveness of Infection Prevention and Control Programme in NICU,Welcare
Hospital, and to make recommendations in Infection Prevention and Control if
needed.