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Area of Science:

  • Neonatal intensive care unit (NICU) infection control
  • Healthcare-associated infections (HAIs)
  • Patient safety and quality improvement

Background:

  • Neonatal intensive care units (NICUs) strive for zero central line-associated bloodstream infections (CLABSI).
  • A significant rise in CLABSI and other bloodstream infections (BSI) was observed in one NICU starting in 2019.
  • This increase coincided with modifications to the intravenous (IV) medication pump integration process.

Purpose of the Study:

  • To investigate the potential association between IV medication pump integration process changes and increased CLABSI and BSI rates.
  • To identify contributing factors to rising infection rates prior to implementing a quality improvement project.

Main Methods:

  • Observational pilot study utilizing a mixed-methods approach.
  • Statistical process control analysis to confirm increased CLABSI rates.
  • Human factors observations and environmental microbiome sampling of IV pump integration equipment.
  • Comparison of findings with CLABSI and BSI rates for temporal and geographic associations.

Main Results:

  • Statistically significant increases in CLABSI and BSI rates were observed following the 2019 IV pump integration changes.
  • The modified process involved more steps, increasing caregiver-environment interactions and medication administration time.
  • Environmental sampling revealed a 27% positivity rate, with a higher microbial burden on patient-specific mobile equipment used during IV administration.
  • Coagulase-negative Staphylococcus (CONS) was prevalent in both the NICU environment and patient blood cultures.

Conclusions:

  • Modified IV pump integration, while intended to enhance safety, may have unintended consequences, including increased infection risk.
  • The added complexity and duration of the process may lead to more caregiver-environment interactions, exposing vulnerable neonates.
  • Further research and quality improvement efforts are needed to simplify the IV administration process and reduce microbial load to decrease infection rates.