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A STUDY ON THE INCIDENCE OF INFECTION IN PREMATUREBABIES IN NICU, 2014

A study based ! "e#$a%e H s&'ta#

(Me!t' ! t &'$ t't#e '! b #d #ette%s)

SYNOPSIS FOR DISSERTATION TO BE SUBMITTED BY SPRIN* 2014

TO

SI++IM MANIPA UNI-ERSITY, INDIA

I! &a%t'a# .u#.'##/e!t . t e %e u'%e/e!ts . % t e a a%d . t e De3%ee . MBA'!

T M (S&e$'a#'5at' !)

SUBMITTED BY6

Ma!7u T /as (Na/e)

1804001942 (R ## N )

U!de% t e *u'da!$e .

:D%; Sa%a

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SUBMITTED TO

P% 7e$t C %d'!at %

"'sd / Bus'!ess S$ #

RA+IA F%ee = !e

INTRODUCTION

INFECTION IN PREMATURE BABIES

Sepsis is the presence of bacteria or other harmfu or!anisms in the b oo"stream# causin! an inf ammator$ state throu!hout the bo"$% Peop e of a a!es an"states of hea th can become septic# but premature babies in the NICU are at a much!reater ris& for s$stemic infections% Preemies ha'e immature immune s$stems# an"can(t fi!ht off infections 'er$ )e % Man$ preemies a so ha'e in'asi'e proce"ures)hi e the$ are in NICU% Centra I* ines i&e umbi ica catheters or PICC ines#mechanica 'enti ation an" sur!eries can a intro"uce infection into the bo"$%

Sepsis in NICU !enera $ fa s into one of t)o cate!ories# bacteria sepsisor fun!a sepsis% Bacteria sepsis can ha'e either an ear $ onset or a ate onset%Ear $ onset sepsis occurs )hen the bab$ is e+pose" to bacteria from the mom#

either "urin! pre!nanc$ or birth% In ate onset sepsis# the bacteria enters the bo"$after birth# usua $ from an in'asi'e proce"ure% There are man$ "ifferent bacteriathat can cause sepsis# inc u"in! ,BS# E co i#S Epi"ermi"is , an" -isteria%

NICU care an" prematurit$ a so increase the ris& for fun!a infections%Antibiotics# use" to pre'ent an" treat bacteria sepsis# can increase fun!a !ro)thin the bo"$% In'asi'e proce"ures a o) fun!us to enter the b oo" stream an" cancause sepsis% Can"i"a# )hich causes .east infections# is the most common cause of fun!a sepsis in preemies%

Because sepsis can be 'er$ "ifficu t to treat# pre'entin! sepsis is an important partof NICU care%

COMPAN. PROFI-E

Me"ic inic /e care hospita )hich operates in Me"ic inic Mi"" e East is part of Me"ic inic Internationa # one of the top 01 iste" pri'ate hea thcare !roups in the)or " )ith 23 hospita s in Southern Africa# 04 in S)it5er an" un"er the name

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6irs an"en an" 3 hospita s an" 7 c inics in the UAE% Me"ic inic Internationa 8shea"9uarters are in Ste enbosch# South Africa%

Pre'ious $ E6- Mana!ement Ser'ices# the compan$ became Me"ic inic Mi"" eEast )hen its ma:orit$ shareho "er# Me"ic inic Internationa # ac9uire" aremainin! shares from its partners *ar&e$ ,roup an" ,enera E ectric in October3103%

Me"ic inic Mi"" e East o)ns an" operates some of the most respecte" hea thcarefaci ities in the re!ion% These inc u"e Me"ic inic /e care 6ospita # Me"ic inic Cit$6ospita # Me"ic inic Dubai Ma # Me"ic inic Ibn Battuta# Me"ic inic Mea"o)s#

Me"ic inic Arabian Ranches# Me"ic inic Mi"riff# Me"ic inic A ;usais# Me"ic inicA Sufouh# Me"ic inic Beach Roa" an" Me"ic inic Corniche%

Me"ic inic Mi"" e East operates accor"in! to the same bran" 'a ues as Me"ic inicInternationa # name $ the

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Hea#t $a%e '!dust%y

The ea#t $a%e '!dust%y # or /ed'$a# '!dust%y # is an a!!re!ation of sectors )ithinthe economic s$stem that pro'i"es !oo"s an" ser'ices to treat patients )ithcurati'e # pre'enti'e #rehabi itati'e # an" pa iati'e care% The mo"ern hea th carein"ustr$ is "i'i"e" into man$ sectors an" "epen"s on inter"iscip inar$ teams oftraine" professiona s an" paraprofessiona s to meet hea th nee"s of in"i'i"ua s an"

popu ations%

The hea th care in"ustr$ is one of the )or "8s ar!est an" fastest>!ro)in!in"ustries% Consumin! o'er 01 percent of !ross "omestic pro"uct @,DP of most"e'e ope" nations# hea th care can form an enormous part of a countr$8s econom$%

For purpose of finance an" mana!ement# the hea th care in"ustr$ is t$pica $"i'i"e" into se'era areas% As a basic frame)or& for "efinin! the sector# the Unite"

Nations Internationa Stan"ar" In"ustria C assification @ISIC cate!ori5es thehea th care in"ustr$ as !enera $ consistin! of?

1. 6ospita acti'ities

2. Me"ica an" "enta practice acti'ities

3. Other human hea th acti'ities %

This thir" c ass in'o 'es acti'ities of# or un"er the super'ision of# nurses#mi")i'es# ph$siotherapists# scientific or "ia!nostic aboratories# patho o!$ c inics#resi"entia hea th faci ities# or other a ie" hea th professions # e%!% in the fie " ofoptometr$# h$"rotherap$# me"ica massa!e# $o!a therap$# music therap$#occupationa therap$# speech therap$# chiropo"$# homeopath$# chiropractics#acupuncture# etc%

The , oba In"ustr$ C assification Stan"ar" an" the In"ustr$ C assificationBenchmar& further "istin!uish the in"ustr$ as t)o main !roups?

1. 6ea th care e9uipment an" ser'ices an"

2. Pharmaceutica s # biotechno o!$ an" re ate" ife sciences .

The hea th care e9uipment an" ser'ices !roup consists of companies an" entitiesthat pro'i"e me"ica e9uipment# me"ica supp ies# an" hea th care ser'ices# such ashospita s# home hea th care pro'i"ers# an" nursin! homes % The atter iste" in"ustr$!roup inc u"es companies that pro"uce biotechno o!$# pharmaceutica s# an"misce aneous scientific ser'ices%

http://en.wikipedia.org/wiki/Economic_systemhttp://en.wikipedia.org/wiki/Curative_carehttp://en.wikipedia.org/wiki/Preventive_medicinehttp://en.wikipedia.org/wiki/Physical_therapyhttp://en.wikipedia.org/wiki/Interdisciplinary_teamhttp://en.wikipedia.org/wiki/Paraprofessionalhttp://en.wikipedia.org/wiki/International_Standard_Industrial_Classificationhttp://en.wikipedia.org/wiki/Dentistryhttp://en.wikipedia.org/wiki/Healthhttp://en.wikipedia.org/wiki/Allied_health_professionhttp://en.wikipedia.org/wiki/Global_Industry_Classification_Standardhttp://en.wikipedia.org/wiki/Industry_Classification_Benchmarkhttp://en.wikipedia.org/wiki/Industry_Classification_Benchmarkhttp://en.wikipedia.org/wiki/Pharmaceuticalshttp://en.wikipedia.org/wiki/Biotechnologyhttp://en.wikipedia.org/wiki/Life_scienceshttp://en.wikipedia.org/wiki/Nursing_homehttp://en.wikipedia.org/wiki/Curative_carehttp://en.wikipedia.org/wiki/Preventive_medicinehttp://en.wikipedia.org/wiki/Physical_therapyhttp://en.wikipedia.org/wiki/Interdisciplinary_teamhttp://en.wikipedia.org/wiki/Paraprofessionalhttp://en.wikipedia.org/wiki/International_Standard_Industrial_Classificationhttp://en.wikipedia.org/wiki/Dentistryhttp://en.wikipedia.org/wiki/Healthhttp://en.wikipedia.org/wiki/Allied_health_professionhttp://en.wikipedia.org/wiki/Global_Industry_Classification_Standardhttp://en.wikipedia.org/wiki/Industry_Classification_Benchmarkhttp://en.wikipedia.org/wiki/Industry_Classification_Benchmarkhttp://en.wikipedia.org/wiki/Pharmaceuticalshttp://en.wikipedia.org/wiki/Biotechnologyhttp://en.wikipedia.org/wiki/Life_scienceshttp://en.wikipedia.org/wiki/Nursing_homehttp://en.wikipedia.org/wiki/Economic_system

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Other approaches to "efinin! the scope of the hea th care in"ustr$ ten" to a"opt a broa"er "efinition# a so inc u"in! other &e$ actions re ate" to hea th# such ase"ucation an" trainin! of hea th professiona s# re!u ation an" mana!ement ofhea th ser'ices "e i'er$# pro'ision of tra"itiona an" comp ementar$ me"icines#

an" a"ministration of hea th insurance %PROB-EM IDENTIFICATION AND DE*E-OPMENT

Nosocomia infection or 6AI is a serious prob em for neonates# )ho area"mitte" for intensi'e care% As it is associate" )ith increases in morta it$#morbi"it$# an" pro on!e" en!th of hospita sta$# both the human an" fisca cost ofthese infections are hi!h% A thou!h the rate of nosocomia sepsis increases )ith the"e!ree of both prematurit$ an" o) birth )ei!ht , no specific ab test has beensho)n to be 'er$ usefu in impro'in! our abi it$ to pre"ict )ho has a rea b oo"

stream infection an" therefore )ho nee"s to be treate" )ith a fu course ofantibiotics% As a resu t antibiotic use is "oub e the rate of

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To maintain the 9ua it$ of care pro'i"e" b$ the hea th care professiona s b$a"optin! proper infection contro measures%

SCOPE OF T6E STUD.

Most 6AI in the NICU resu t from the instrumentation an" proce"ures re9uire"to preser'e an infant(s ife% Thus it is not possib e to o)er the rate of 6AI mere $ b$ imitin! the use of proce"ures% Furthermore# it is no on!er acceptab e toconsi"er 6AI as a conse9uence of neonata intensi'e care%

6AI are thou!ht to !enerate substantia economic bur"ens% Morbi"it$ an"morta it$ are increase"# hospita sta$ is pro on!e" an" a""itiona cash cost arise for consumab e use" to treat the infection% The ris& of ac9uirin! another infection isa so be ie'e" to increase )ith en!th of hospita sta$% It a so causes e!a ties an"financia bur"en on the hospita %

A recent re'ie) su!!este" that 01>G1H of 6AI are pre'entab e )ith appropriateinfection contro .

6.POT6ESIS FORMU-ATION

To compare the infection rate of 310 )ith the infection rate of pre'ious t)o$ears @3103 an" 310 an" a so to compare )ith Internationa stan"ar"s @CDC # thestu"$ formu ate" the fo o)in! h$pothesis as Nu h$pothesis 6o an" A ternati'eh$pothesis 6a%

6o>The inci"ence of infection in preterm babies a"mitte" in /e care hospita NICU is ess in 310 compare to pre'ious 3 $ears%

6a>The inci"ence of infection in preterm babies a"mitte" in /e care hospita NICU is not ess in 310 compare to pre'ious 3 $ears%

SAMP-IN, MET6OD

Samp in! in'o 'es the stu"$ of a sma number of in"i'i"ua s chosen from a ar!e!roup% In this research stu"$# the tota popu ation comprises of G7 premature babies

)ho are bet)een 3 )ee&s to 3 )ee&s , a"mitte" in /e care hospita NICU from3103 to 310 %

In the samp in! metho"# )e se ect an a"e9uate number of e ements from the popu ation% Samp e si5e refers to the number of representati'es to be ta&en assamp es% Samp e unit refers to the sin! e member of the samp e%

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For this pro:ect# the samp in! metho" a"opte" is ;uota samp in!# the samp einc u"e a minimum number from each specifie" sub!roup in the popu ation% Thetota popu ation un"er stu"$ is sub !roupe" into # preterm babies born in3103#310 an" 310 %These are a!ain sub !roupe" into3# preterm babies bet)een

3 )ee&s to 3 )ee&s# an" bet)een 37)ee&s to 3 )ee&s% The samp e si5e is 1%An" 01 are a ocate" for each $ear# 2 for 3 )ee&s to 3 )ee&s an" 2 for 37 )ee&sto 3 )ee&s%

DATA CO--ECTION

Co ection of "ata is the first an" most important sta!e in an$ statistica sur'e$%The metho" for co ection of "ata "epen"s upon 'arious factors such as ob:ecti'e#scope an" nature of in'esti!ation an" a'ai abi it$ of resources%

Sources of Data

The "ata sources cou " be either prob em specific an" primar$ or historica an"secon"ar$ in nature%

Primar$

Primar$ "ata is the one )hich is co ecte" b$ the in'esti!ator for the purpose ofa specific in9uir$ or stu"$% Such "ata is ori!ina in character an" is !enerate" b$ asur'e$ con"ucte" b$ in"i'i"ua s or research institution or an$or!anisation%Inter'ie)# 9uestionnaire# an" te ephoneJmai are a e+amp es of

primar$ "ata% In this retrospecti'e stu"$# I inten" to co ect "ata from se ecte" patient fi es b$ samp in! metho"%

Secon"ar$

Secon"ar$ "ata is an$ information that is use" for the current in'esti!ation# butis obtaine" from some "ata# )hich has been co ecte" an" use" b$ some othera!enc$ or person in a separate in'esti!ation or sur'e$ is &no)n as secon"ar$ "ata%The$ are a'ai ab e in a pub ishe" or unpub ishe" form% The "ata )hich I inten" toco ect is pub ishe" "ata b$ Centres of Disease Pre'ention an" Contro # USA an"

unpub ishe" "ata )hich )as co ecte" b$ Infection Contro Department# /e care6ospita %

DATA ANA-.SIS

Ana $sis of "ata is a process of inspectin!# transformin! an" mo"e in! "ata )iththe !oa of "isco'erin! usefu information# su!!estin! conc usions an" supportin!"ecision ma&in!% The purpose of ana $5in! "ata is to obtain usab e an" usefu

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information% The ana $sis# irrespecti'e of )hether the "ata is 9ua itati'e or9uantitati'e ma$ "escribe an" summari5e the "ata# i"entif$ re ationships bet)eenthe 'ariab es# compare 'ariab es# i"entif$ the "ifference bet)een 'ariab es# an"forecast outcomes% /hen usin! a 9uantitati'e metho"o o!$ )e are norma $ testin!

theor$ throu!h the testin! of a h$pothesis% In this stu"$ I )i procee" )ith the fo o)in! s$stematic )a$s to ana $5e the"ata that I ha'e co ecte" throu!h primar$ an" secon"ar$ sources%

The "ata ana $sis is "one as per the fo o)in! proce"ure?

a C assification an" tabu ation of "ata

Numerica "ata can be c assifie" into c ass inter'a s% This is to assist the9uantitati'e ana $sis of "ata% The "ata obtaine" from the samp e is re"uce" to

homo!enous !roupe" "ata% The$ are?i%Preterm babies born in 3103

ii% Preterm babies born in 310

iii% Preterm babies born in 310

Each of the abo'e !roup )i ha'e c ass imits>an upper an" o)er imit%

Once )e c assifie" the "ata# arran!e the "ata accor"in! to some o!ica pattern%This is referre" to as tabu ation of "ata% This in'o 'es an or"er $ arran!ement of"ata into an arra$ that is suitab e for a statistica ana $sis# usua $ this is an or"er $arran!ement of ro)s an" co umns%

b Ana $sis of Data

At the ana $sis sta!e# the first step is to "escribe the samp e )hich is fo o)e" b$inferentia ana $sis% In the "escripti'e ana $sis# )e "escribe the samp e# )hereasthe inferentia ana $sis "ea s )ith !enera i5in! the resu ts as obtaine" from thesamp e%

Descripti'e ana $sis "ea s )ith summar$ measures re atin! to samp e "ata% Thecommon )a$s to summari5e the "ata are b$ ca cu atin! a'era!e# ran!e# stan"ar""e'iation# fre9uenc$ an" percenta!e "istribution%

After "escripti'e ana $sis has been carrie" out# the too s of inferentia statisticsare app ie"% Un"er inferentia statistics# inferences are "ra)n on popu ation

parameters base" on samp e resu ts .

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CONC-USION

The premature babies in NICU are at a much !reater ris& for infections% Thisstu"$ he ps to fin" the inci"ence of infection in premature babies in NICU in310 #to compare the inci"ence of infection )ith pre'ious 3 $ears # to e'a uate theeffecti'eness of Infection Pre'ention an" Contro Pro!ramme in NICU#/e care6ospita # an" to ma&e recommen"ations in Infection Pre'ention an" Contro ifnee"e"%