Related Experiment Video
Updated: Mar 27, 2026
Assessment of Intestinal Transcytosis of Neonatal Escherichia coli Bacteremia Isolates
Published on: February 17, 2023
Assessment of the severity of visible blood in the stool using a cluster of neonatal cases -a quality improvement
S Gupta1, G S Suresh2, B Paes1
1Division of Neonatology, Department of Pediatrics, McMaster University and Children's Hospital, ON, Canada.
Insights
A new Visible Blood in the Stool -Assessment Tool (VBS-AT) standardizes reporting and monitoring of VBS severity. This improves clinical evaluation and facilitates timely infant discharge without additional cost.
Area of Science:
- Neonatal care
- Clinical assessment tools
- Infectious disease control
Background:
- Lack of a validated tool to monitor visible blood in stool (VBS) hinders decisions on contact precautions and discharge.
- Visible blood in stool (VBS) requires careful assessment in neonatal units.
Purpose of the Study:
- To evaluate the impact of a VBS investigation, parent appraisal template, and Visible Blood in the Stool -Assessment Tool (VBS-AT) on standardized reporting.
- To assess the effectiveness of the VBS-AT in evaluating clinical improvement and guiding patient management.
Main Methods:
- A prospective quality improvement cohort study in a tertiary neonatal unit.
- Implementation of the VBS-AT and a parent appraisal template at the bedside for infants with isolated VBS.
- Defined criteria for contact precaution discontinuation and discharge readiness.
Main Results:
- The VBS-AT graded 78% of 98 VBS episodes in eight infants.
- Consistent VBS grading and progress evaluation effectively contained a VBS cluster.
- Infants with VBS grade ≤2 for four consecutive days showed no deterioration or complications.
Conclusions:
- Implementing a standardized tool for VBS investigation and monitoring is feasible.
- The VBS-AT improves the effectiveness of care for infants with VBS at no extra cost.
- Objective monitoring facilitates timely discharge of stable infants.
Background:
Non-availability of an established validated tool to assess and monitor the severity of visible blood in a stool (VBS) specimen over time, prevents effective decision making about discontinuation of contact precautions and hospital discharge.
Objective:
To determine the impact of implementing a VBS investigation, parent apprisal template and Visible Blood in the Stool -Assessment Tool (VBS-AT) on standardized reporting and the evaluation of clinical improvement.
Methods:
A prospective quality improvement cohort study was conducted in a tertiary, neonatal unit. All infants with isolated VBS without clinical signs, radiological pneumatosis and abnormal laboratory results were included. The template and VBS-AT instrument were implemented at the bedside. Criteria for discontinuation of contact precautions and readiness for discharge home were defined apriori.
Results:
Eight infants developed VBS during the cluster lasting ten days. Seventy-four (78%) of the 98 episodes were graded by the VBS-AT. Five of the six infants had a maximum VBS grade of 3. The duration of VBS and contact precautions ranged from 4-38 days. All six infants with a VBS grade ≤2 for 4 consecutive days did not deteriorate beyond grade ≥3 or develop gastrointestinal complications during the ten week period following the end of the cluster. Consistent objective reporting of the severity of VBS and consistent evaluation of infants' progress over time contained the cluster effectively and facilitated discharge of stable infants.
Conclusions:
Implementation of a tool to standardize, investigate and objectively monitor the severity of VBS is feasible and improves effectiveness of care at no extra cost.
Related Concept Videos
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:30Serum Laboratory Studies, Stool Test, Breath Test