Infection Prevention Using Closed Medication Systems: Does It Work?

08-01-19_NICU

Infection Prevention Using Closed Medication Systems: Does It Work?

Newborn babies, especially preterm neonates, who receive care in a neonatal intensive care unit (NICU) frequently have an underdeveloped immune system and poor skin integrity. In addition, these vulnerable infants are often subjected to multiple invasive tests and regular IV-line access to dispense medication. Because of this, these vulnerable neonate patients are routinely exposed during standard care in an environment that is conducive to bacterial colonization from the many healthcare workers who provide treatment to these patients daily. All of this makes these infants highly susceptible to bloodstream infections (BSIs), which are a serious treatment related complication that can result in extended NICU stays. “Although a 46{28f25cd67d050831d96b595822aa7832ec2efa90ff8f96cc7373c1377a36f705} decrease in CLABSIs has occurred in hospitals across the U.S. from 2008-2013, an estimated 30,100 central line-associated bloodstream infections (CLABSI) still occur intensive care units and wards of U.S. acute care facilities each year.”1

The incidence of bloodstream infections varies greatly in different NICUs across the nation. Why this variance was observed was examined in depth in a 2005 study, “Is Bloodstream Infection Preventable Among Premature Infants? A Tale of Two Cities”. 2

In this study, doctors from George Washington University Hospital experienced a significant rise in BSIs in their NICU. This led them to seek additional precautionary approaches at outside hospitals. While looking for answers, they found that no previous studies had attempted to correlate BSI rates with infection prevention practices across different NICUs. To investigate this, they compared more than a dozen NICUs. The idea was to identify the procedures, policies, and precautions that are associated with the lowest incidence of BSIs. Among the 16 NICUs reviewed, the lowest BSI rates were found at the Connecticut Children’s Medical Center (CMCC).

A team from George Washington University Hospital visited CMCC to observe their infection control practices. One deviation they identified was the management of intravenous lines for neonates and use of closed medication delivery IV systems. These closed medication systems were identified as a factor in reducing neonatal morbidity and mortality through bloodstream infection reduction. This system was then applied to the NICU at George Washington. The published study compared the incidence of bloodstream infections before and after the changes were made.

What infection metrics did the closed NICU infusion systems substantially affect among neonates admitted to the NICU at George Washington University Hospital? Should the use of these systems be a standard practice in NICUs across America and around the world?

Study Results for Closed Medication Systems

After observing the use of closed medication systems at CMCC and applying them to the NICU at their own hospital, a retrospective study was conducted by the physicians at George Washington University Hospital. The study looked at the incidence of bloodstream infections over a period of three years (January 1998 to December 2000) before the closed medication systems were in use. These numbers were compared to BSI infection rates for three years (January 2001 to December 2003) when infection control with closed medication systems was implemented. Variables such as gestational age, birth weight, race, gender, and length of hospital stay were considered.

A total of 536 low birth weight infants (< 2500 grams) were included in the study. Of these, 169 infants were admitted before the revised infection control policy was instituted (group 1) and 367 infants were admitted after implementation of the new infection prevention policy (group 2). Here are some of the findings:

  • Survival rates were comparable for group 1 and group 2 at 91.7{28f25cd67d050831d96b595822aa7832ec2efa90ff8f96cc7373c1377a36f705} and 94{28f25cd67d050831d96b595822aa7832ec2efa90ff8f96cc7373c1377a36f705} respectively
  • Incidence of BSIs decreased remarkably from 25.4{28f25cd67d050831d96b595822aa7832ec2efa90ff8f96cc7373c1377a36f705} in group 1 to 2.2{28f25cd67d050831d96b595822aa7832ec2efa90ff8f96cc7373c1377a36f705} in group 2
  • Culture-proven sepsis was reduced from 43 episodes in group 1 to 8 episodes in group 2
  • Culture-proven sepsis rate among very low birth weight infants (< 1500 grams) decreased from 46.7{28f25cd67d050831d96b595822aa7832ec2efa90ff8f96cc7373c1377a36f705} in group 1 to 5.6{28f25cd67d050831d96b595822aa7832ec2efa90ff8f96cc7373c1377a36f705} in group 2
  • Central line duration was 1.4 days longer for infants in group 1 compared to group 2
  • Incidence of central-line-related BSIs decreased from 15.17 per 1000-line days in group 1 to 2.1 BSIs per 1000 line days in group 2

The results of the study indicate a dramatic improvement in bloodstream infection rates among NICU patients when closed medication IV systems are used. The authors conclude that standard use of closed NICU infusion systems can significantly reduce morbidity and mortality among neonates from blood stream infection. These simple-to-use devices can be utilized, among other strategies, in on-going infection prevention efforts.


Bloodstream infections are a common complication among newborn babies admitted to the NICU. Learn how use of closed medication systems can lead to a substantial reduction in infection rates.

Citations:

  1. https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
  2. https://www.ncbi.nlm.nih.gov/pubmed/15930211

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