Implementation of optimized kangaroo care for infection prevention and control in neonatal intensive care units...

Hospital-acquired neonatal severe infections and resistant bacterial colonization in neonatal care are a world-wide challenge. Preventing the spread of resistant bacteria in neonatal intensive care units (NICUs) is specifically challenging, for example, due to multi-patient rooms, spaces being crowded with equipment, and high antibiotic use in these settings. Kangaroo care (KC), a practice that involves skin-to-skin contact between newborn infants and caregivers, is a promising, low-cost intervention that has been associated with reduced morbidity and mortality in low-birthweight infants. Despite these and other health benefits, KC has not been implemented systematically or consistently in NICUs following current WHO guidelines. The NeoIPC project aims to optimize KC practices in NICUs and to determine the effect on severe neonatal infections and resistant bacterial colonization among high-risk infants.

Within the NeoIPC project, NeoDeco is a multi-center, parallel-group, cluster-randomized type 2 hybrid effectiveness-implementation study with 24 NICUs from five European countries representing clusters. NeoImplement, comprising the implementation elements of NeoDeco, focuses on (1) providing implementation support to sites in the intervention arm of the study and (2) evaluating the implementation of optimized KC in intervention sites. Implementation support consists of core implementation strategies that are offered to all intervention sites as well as the co-design of tailored implementation strategies for each individual site. Innovative methods supporting this co-design process are presented in this protocol. The implementation evaluation comprises a mixed-methods longitudinal study evaluating barriers and facilitators and various implementation outcomes, including a comprehensive economic evaluation.

NeoImplement focuses on implementing optimized KC in participating NICUs by offering and co-developing strategies that can be sustained beyond the duration of the study. The accompanying implementation evaluation will provide insights into the effectiveness, feasibility, acceptability, sustainability, and cost-effectiveness of strategies targeting the implementation of optimized KC in European NICUs. A long-term goal of the study is to develop strategies for implementing KC that can be applied by NICUs beyond this study and to present an approach for how KC champions in NICUs themselves can develop context-sensitive implementation strategies.

NCT05993442, December 27, 2024 https://classic.

gov/ct2/history/NCT05993442 .