The relationship between nosocomial bacteraemia and organizational factors in a random sample of 54 neonatal intensive care units.

Objectives: To assess the relationship between organisational and structural factors of UK neonatal intensive care units (NICUs) with risk adjusted probable nosocomial bacteraemia.

Design of study: A prospective observational study of infants concurrently admitted to 54 randomly selected UK NICUs between March 1998 and April 1999.

Results: Of the 13 334 infants admitted, 402 (2.97%) had probable nosocomial bacteraemia. The median unit level percentage of infants with probable nosocomial bacteraemia was 2.48% ( minimum 0%, maximum 9%). The risk adjusted odds of probable nosocomial bacteraemia were increased by 1.13 (95% CI 1.07 to 1.20) for each additional level 1 cot per hand washbasin and decreased by 0.53 (95% CI 0.35 to 0.79) in infants admitted to units with an NICU infection control nurse compared with units without. There was no relation with an increase in the floor space of the unit per cot ( odds ratio 0.99 (95% CI 0.98 to 1.00) per m(2)) or with the quality of hand washing signs ( odds ratio 1.04 (95% CI 0.93 to 1.16) per increase in quality score).

Conclusions: There is widespread variation in rates of probable nosocomial bacteraemia in UK NICUs. Probable nosocomial bacteraemia is reduced in units with a dedicated infection control nurse and with the presence of more hand washbasins. Further research is required to identify methods to eliminate nosocomial bacteraemia.