New method for neonatal ICUs reduces infection and lung distress in premature infants

A new method for improving quality of care can reduce hospital-acquired infections and chronic respiratory distress with oxygen dependency in premature infants in neonatal ICUs, according to a new study in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/press/cmaj081727.pdf.

The researchers developed the Evidence-based Practice for Improving Quality method and applied it to 12 Canadian Neonatal Network hospitals over a 3-year period. Working in multidisciplinary groups, each hospital developed a list of hospital-specific practice changes and priorities to implement in the neonatal ICU.

The study included 6519 infants divided into 3 groups — infection, pulmonary and a control group. After adopting practice-change strategies, the incidence of hospital-acquired (nosocomial) infection decreased 32% and 45% in the first two groups. Respiratory distress (bronchopulmonary dysplasia) in the pulmonary group decreased 15% and there was a 12% decrease in death from this condition.

Based on pooled hospital data, the authors showed previously that 40% of infections in neonatal ICUs were associated with central lines and central catheters inserted into organs. They looked at individual hospital data which revealed different patterns of infection associated with catheter insertions.

“Our method enables hospitals to select practice changes pertinent to them for targeted intervention,” writes principal investigator Dr. Shoo Lee of Mount Sinai Hospital and the University of Toronto and coauthors. “This is potentially more efficient and cost-effective.”

The study involved researchers from pediatric departments at University of Toronto (U of T); Memorial University; University of Calgary; University of Manitoba; University of Western Ontario; University of British Columbia (UBC); University of Saskatchewan; University of Ottawa; Dalhousie University; Department of Health Care and Epidemiology and Department of Obstetrics and Gynecology, UBC; the Department of Nursing, U of T.

“We found that interventions aimed at one outcome may affect other outcomes,” wrote the authors. “We speculate that the decrease in the incidence of nosocomial infections in the pulmonary group was related to improved lung status and a reduced need for assisted respiration, invasive interventions, improved feeding and growth, and better overall health.”

The method used in the study may be applicable in other areas of health care and may increase efficiency and reduce the costs.

In a related commentary http://www.cmaj.ca/press/cmaj091243.pdf, Dr. William McGuire of the Hull York Medical School in York, UK, and coauthor write that variations in practice contribute to uneven outcomes for premature infants. “Benchmarking and audit studies in neonatal networks have revealed marked variation in practice even when good evidence exists for specific interventions.” They conclude that this study “adds to the accumulating evidence that multifaceted interventions may change practice and outcomes in neonatal intensive care settings,” although more analysis is needed to ensure the best use of resources to help infants and their families.

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