[A quality improvement project on reducing antibiotic use duration in very low birth weight preterm infants in the neonatal intensive care unit]
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Mei-Ying Quan1, Shu-Ju Feng1, Yu Zhang1
1Department of Pediatrics, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
Insights
Quality improvement methods significantly reduced antibiotic duration in very low birth weight (VLBW) preterm infants. This initiative lowered antibiotic exposure, enhancing care for vulnerable newborns.
Area of Science:
- Neonatal Intensive Care Unit (NICU) quality improvement
- Antibiotic stewardship in pediatrics
- Preterm infant healthcare outcomes
Context:
- Antibiotic resistance is a growing concern, particularly in vulnerable populations like preterm infants.
- Prolonged antibiotic use in neonatal intensive care units (NICUs) contributes to resistance and adverse effects.
- Effective strategies are needed to optimize antibiotic duration in very low birth weight (VLBW) infants.
Purpose:
- To implement and evaluate quality improvement (QI) measures aimed at reducing antibiotic use duration in hospitalized VLBW preterm infants.
- To identify key factors contributing to prolonged antibiotic exposure in this population.
- To establish evidence-based interventions for rational antibiotic prescribing in the NICU.
Summary:
- A QI project in a NICU utilized Pareto analysis to identify drivers of prolonged antibiotic use in VLBW infants, including non-standard prescribing and delayed discontinuation.
- Interventions focused on standardizing sepsis protocols, staff education, and optimizing care practices like central venous catheter duration and enteral nutrition.
- Implementation of these QI strategies led to a significant reduction in antibiotic use duration from 49% to 32%.
Impact:
- Demonstrates the successful application of QI tools and process control to reduce unnecessary antibiotic exposure in a high-risk infant population.
- Provides a scalable model for other NICUs seeking to improve antibiotic stewardship and combat antimicrobial resistance.
- Contributes to improved patient safety and potentially better long-term outcomes for VLBW preterm infants by minimizing antibiotic-related risks.
Objectives:
To develop effective measures to reduce antibiotic use duration in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit through quality improvement methods.
Methods:
The study population consisted of hospitalized VLBW preterm infants, with the percentage of hospitalization time during which antibiotics were used from November 2020 to June 2021 serving as the baseline. The specific quality improvement goal was to reduce the duration of antibiotic use. Factors affecting antibiotic use duration in preterm infants were analyzed using Pareto charts. Key drivers were identified, and specific interventions were formulated based on the stages of antibiotic use. Changes in the percentage of antibiotic use duration were monitored with run charts until the quality improvement target was achieved.
Results:
From November 2020 to June 2021, the baseline antibiotic use duration percentage was 49%, with a quality improvement target to reduce this by 10% within 12 months. The Pareto analysis indicated that major factors influencing antibiotic duration included non-standard antibiotic use; delayed cessation of antibiotics when no infection evidence was present; prolonged central venous catheter placement; insufficient application of kangaroo care; and delayed progress in enteral nutrition. The interventions implemented included: (1) establishing sepsis evaluation and management standards; (2) educating medical staff on the rational use of antibiotics for preterm infants; (3) supervising the enforcement of antibiotic use standards during ward rounds; (4) for those without clear signs of infection and with negative blood cultures, discontinued the use of antibiotics 36 hours after initiation; (5) reducing the duration of central venous catheterization and parenteral nutrition to lower the risk of infection in preterm infants. The control chart showed that with continuous implementation of interventions, the percentage of antibiotic use duration was reduced from 49% to 32%, a statistically significant decrease.
Conclusions:
The application of quality improvement tools based on statistical principles and process control may significantly reduce the antibiotic use duration in VLBW preterm infants. Citation:Chinese Journal of Contemporary Pediatrics, 2024, 26(7): 736-742.
