Infection Prevention in the NICU: The Role of Care Bundles

Infection prevention in the neonatal intensive care unit (NICU) is an ongoing challenge for healthcare providers. Hospital born infections are an entirely preventable cause of morbidity and mortality among newborn infants.

Evidence-based practices for neonatal infusion therapy can lead to a measurable reduction in the occurrence of CLABSIs (central line associated blood stream infections). For example, studies have concluded that the use of a closed medication IV system is associated with a substantial decrease in the BSI rate. [1] 

Additionally, the use of ‘care bundles’ along with proper use of a closed IV set, can lead to a considerable improvement in the rate of nosocomial infections.

What is a Care Bundle?

“A care bundle is a set of interventions that, when used together, significantly improve patient outcomes.” [8] In terms of infusion therapy in neonates, it is described as the best practices that individually result in the prevention of blood stream infections.  When these practices are applied together, it results in a reduced rate of blood stream infections. Essentially with care bundles, the whole is greater than the sum of its parts.

Evidence-Based Data Supports Care Bundles

A cohort study of more than 3,000 critically ill patients measured ICU-acquired infections before and after an educational campaign for the insertion and maintenance of vascular access devices. [2] Blood stream infections were found to be significantly lower at 3.8 episodes per 1,000 patient-days after the strategies were implemented compared to 11.3 episodes before their application.

Recommended Bundle Activities for CLABSI Reduction

There are several commonsense measures that can have a major impact on infection prevention and CLABSI rates. Some of the components that can be considered as part of an IV-line care bundle include:

Proper hand hygiene as outlined by the World Health Organization [3] is a simple measure, that in combination with a central line care bundle, can reduce CLABSI rates dramatically by almost 90 percent [4].

Chlorhexidine skin antisepsis, per standard ICD recommendations, as part of a care bundle can lead to a significant reduction in blood stream infections in the NICU [5].

Optimal catheter selection with a minimal number of ports or lumens and aseptic lumen access is of high importance. Pairing the use of pre-attached flushing syringes, such as that offered by use of a closed medication IV system, can greatly reduce the risk of hospital acquired infection [6].

IV therapy devices are a critical component of modern medicine, but they can also become a pathway of healthcare-associated infections. This can be particularly concerning in the neonatal intensive care unit. Specific infection prevention strategies, such as using closed medication delivery IV systems, are known to decrease the occurrence of this complication [1].

The results of numerous studies demonstrate that an infusion care bundle has a substantially greater impact on the overall incidence of hospital-acquired infections in neonates compared to the components of the bundle individually. A combination of infection control measures can help achieve and sustain even better results in CLABSI prevention [7].

Find out more about infection prevention in the NICU with closed medication IV systems as a component of infusion care bundles.