Closed Medication Systems: Preventing Bloodstream Infections in Vulnerable Neonates

Bloodstream infections (BSIs) can lead to morbidity and mortality in newborn infants, especially in high risk premature babies. There are certain infection control practices and aseptic precautions among neonates that can reduce this. One of these practices involves the use of closed medication IV systems. These devices can lead to a significant reduction in BSI rates among vulnerable neonatal patient populations. How does a closed infusion system work? What are the benefits of using this method of medication administration in newborns?

Mode of Medication Delivery

Before closed IV delivery systems are deployed to a NICU, several practices may have been utilized. For example, the central line may have been accessed through a needleless valve that was attached to medication line tubing. That medication line would of first been cleaned and medication then infused. That medication syringe would then be disconnected, port re-cleaned, and then a flushing syringe would be attached to clear remaining medication from the line. In this scenario the IV system requires an open accessing of twice.

This approach can be easily altered with an optimal IV-line access set-up. A dramatic reduction in bloodstream infections was studied by George Washington University Hospital.  Investigators collected data on infection control practices from 16 NICUs. Based on the observations of these NICUs, a more refined method of medication infusion in higher risk neonates was developed to reduce IV line access to a single time for each infusion.


Below are two video detailing how this can be accomplished:

 


Benefits of Using a Closed Medication System

The use of closed IV medication systems can be an effective strategy to prevent central-line associated bloodstream infections (CLABSIs) in the NICU. These systems reduce touch contamination which, in turn, reduces the risk of IV-line infections and bacterial colonization by helping avoid flush techniques that require excessive connection/disconnection. Certain manufacturers can also further reduce a NICU’s exposure to excess connections by consolidating the sets needed to a single packaged unit. The disadvantage in standard infusion sets is these require a re-opening of the medication hub to flush the remaining meds through the line. The closed IV system requires a single opening of the medication hub for an infusion. Their effectiveness can be explained mathematically.

Assume:

X = number of medication infusions daily

P(x) = Probability of a BSI from a single access of IV line for infusion

Y = number of times hub is cleaned for each infusion for Closed IV flushing

**2Y = number of times the hub is cleaned for non-closed IV flushing (once to infuse meds, once more to flush)

Probability of BSI (standard flushing protocol) = P(Standard) = X*P(x)*2Y

Probability of BSI (closed IV system) = P(Closed IV) = X*P(x)*Y

If:  P(Closed IV) = X*P(x)*Y   &   P(Standard) = 2*X*P(x)*Y

Then:  P(Standard) = 2*P(Closed IV)   or   P(Closed IV) = 0.5* P(Standard)

Assuming all other infection prevention factors being equal (hub cleaning protocols, hand washing practices, number of daily infusions, etc.) the math concludes the use of closed IV system can reduce the incidence of blood stream infection by half! The simple function of reducing open line access by 50% allows this to be possible (2Y to Y). Over time, with many infusions (X), the effectiveness of this closed IV system can be measurable in CLABSI rates.

This is an easily reproducible protocol for NICU infusion that can provide measurable results. Serious consideration needs to be given to the use of these closed IV systems as a standard of practice.


Bloodstream infection is an entirely preventable complication encountered in the NICU. Learn more about our closed medication systems and how they can help reduce infection rates in your patients.

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  • Sep 27 2019
  • Category: NICU
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